Urological complications after live donor kidney transplantation: Intravesical or extravesical ureterovesical anastomosis?

Urological complications after renal transplantation cause significant patient morbidity and may result in transplant failure. The majority of urological complications is related to the ureterovesical anastomosis and occurs within 3 months after transplantation.

Successful formation of the ureterovesical anastomosis is important in preventing complications and securing a functional transplant. Several techniques for ureterovesical anastomosis are described, with variable outcome. The surgical protocol for transplant ureteroneocystostomy has oscillated between intravesical and extravesical procedures. No technique has been convincingly proven to be superior to the other, although some studies suggest the superiority of the extravesical technique. In our center the standard technique is the intravesical technique. In case an urological complication (e.g. ureteral stenosis) occurs after transplantation, we might decide to place a percutaneous nephrostomy catheter (PCN). PCN can therefore been seen as a measure for the urological complications.

The aim of this study is to assess the rate of percutaneous nephrostomy (PCN) placement for urological complications in patients with an intra and extravesical ureterovesical anastomosis in live kidney transplantation, in order to determine which anastomosis technique has the least urological complications.

Our hypothesis is that the extravesical technique reduces the incidence of PCN placement, and urological complications.

Follow-up will be 1 year.

1. Intervention: Extravesical ureterovesical anastomosis technique;

2. Control: Intravesical ureterovesical anastomosis technique.