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Urinary Reconstruction after Kidney Transplantation:
Pyeloureterostomy or Ureteroneocystostomy

*Reza F. Saidi1, *Nahel Elias2, Martin Hertl2, *Tatsou Kawai2, Dicken S.c. Ko2, A. B. Cosimi2
1University of Massachusetts Medical School, Worcester, MA;2Massachusetts General Hospital, Boston, MA

Objective: Ureteroneocystostomy (UCN) is the most widely utilized urinary reconstruction technique during kidney transplantation. Disadvantage of this technique include a high incidence of hematuria and reflux, plus the potential for obstruction secondary to distal ureteral fibrosis. Pyeloureterostomy (PU) avoids these complications but increases technical complexity.
Design: Between January 1990 to December 2005 in 1066 kidney transplantations, 768 (72.1%) patients underwent reconstruction by PU and 298 (27.9%) underwent UNC.
Setting: Tertiary referral center
Patients: kidney transplant recipients
Intervention: urinary reconstruction (PU vs USN)
Main Outcome Measures: urinary complications, urinary revisions, survival
Results: Patients in PU Group underwent simultaneous ipsilateral native nephrectomy.
The operative time was longer in PU Group compared to UNC Group; 210+_36 minutes vs 182+-24 (p<0.001). Overall surgical complications in PU Group were comparable to UNC Group (9.5% vs. 12.3%). Urinary complication rate was also comparable in both groups; 3.2% (25/768) in PU Group and 5% (15/298) in UNC Group. However, urinary obstruction consisted 60% of urinary complication in UNC Group compared to 32% in PU Group (p<0.01).
Majority of urinary complications were treated non-operatively. However, 24 %( 6/25) of patients in PU Group compared to 46.6% (7/15) in UNC Group needed operative intervention/revision for ureteral reconstruction (p<0.01)
Conclusions: PU is a safe and effective method of urinary tract reconstruction in renal transplantation. Pyeloureterostomy should be part of every transplant surgeons' armamentarium.

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