Bootcongres

Introduction: Urological complications are the most frequent cause of surgical morbidity following kidney transplantation with a mean prevalence between 3% and 5%. The risk of complications may be associated with the surgical technique used for the ureterovesical anastomosis. Several techniques have been described however no consensus exists about which technique to use. The aim of this systematic review was to compare the existing techniques in relation to the risk of urological complications. Methods: Two independent researchers performed a systematic search of the literature. All studies that compared ureterovesical anastomotic techniques in kidney-only transplantation were included. Study endpoints were urinary leakage, ureteral stricture, vesicoureteral reflux and hematuria. Subanalyses of stented and non-stented techniques were performed. Results: Two randomized clinical trials and twenty-four observational studies were included. Meta-analyses were performed on the Lich-Gregoir (LG) versus Politano-Leadbetter (PL) techniques and LG versus U-stitch (U) techniques. Compared with the PL technique, the LG technique had a significantly lower prevalence of urinary leakage (risk ratio (RR) 0.47, 95% confidence interval (CI) 0.30 to 0.75) and a significantly lower prevalence of hematuria when compared with both PL and U techniques (RR 0.28, 95% CI 0.16 to 0.49 and RR 0.23, 95% CI 0.11 to 0.50 respectively), regardless of ureteral stenting. There was no difference in the prevalence of ureteral strictures between the LG, PL and U techniques, when corrected for ureteral stenting. The prevalence of vesicoureteral reflux was not significantly different between the LG and PL technique.

Conclusions: Of the three ureterovesical anastomotic techniques most frequently used during renal transplantation, the LG technique results in fewer urological complications than the PL and U techniques.