A randomized controlled trial comparing intravesical to extravesical ureteroneocystostomy in living donor kidney transplantation recipients.
Slagt IK, Dor FJ, et al.Kidney International 2014; 85(2): 471-477.
Aims
To investigate the superiority of either intravesical or extravesical ureteroneocystostomy in living donor renal transplant recipients.
Interventions
Patients were randomised to receive either an intravesical (Politano-Leadbetter) or an extravesical (Lich-Gregoir) ureteroneocystostomy during establishment of the urinary tract, following kidney transplantation extraperitoneally in the iliac fossa.
Participants
200 living-donor kidney transplant recipients.
Outcomes
The primary outcomes included the incidence of percutaneous nephrostomy placement within three months of transplantation, serum creatinine level combined with hydronephrosis or fluid collection, monitoring of the percutaneous nephrostomy position and leakage of the utereoneocystostomy. Secondary outcomes included operation time of the kidney transplantation, graft urethral length at time of urethral transplantation, type of ureteroneocystostomy and procedure details, complications within six months including; urinary tract infections, stent-related complications, tacrolimus toxicity, rejection
Follow-up
3 months.
CET Conclusions
This was a careful good quality randomised controlled trial comparing intravesical with extravesical implantation of the ureter into the bladder of the recipients of a living donor kidney. The primary outcome was the need for a percutaneous nephrostomy and this was similar in both groups. The reasons for the nephrostomy were leakage and hydronephrosis. The incidence was the same in both groups and 5 patients in each group required a surgical reintervention following the percutaneous nephrostomy. A urinary catheter was left in place for 7 days in both groups and a ureteric stent was removed at 10 days. For reasons that are not clear there are significantly fewer urinary tract infections in the extravesical ureteroneocystostomy group. The operative time for the extravesical technique was obviously considerably shorter and certainly it is a much simpler technique. One of the potential advantages of the intravesical technique is to prevent reflux, but this is not considered in this report. Thus this study does provide quite good evidence that the extravesical approach is certainly the equivalent of the intravesical approach for implantation of the transplanted ureter into the recipient bladder and bearing in mind that it is a much simpler technique for the average surgeon it is to be recommended.
Data analysis
Available case analysis
Trial registration
Netherlands Trial Register NTR2320