PP 123. Pyeloureterostomy Versus Ureteroneocystostomy Following Renal Transplant Surgery

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J. Norris, S. Ravi-Shankar

16:42 - 16:48h at Lanchid Room

Categories: Organ and Cell Transplantation, Poster Session

Session: Poster II (P4) - Varia

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Background
A best evidence topic in transplant surgery was written according to a structured protocol. The question addressed was: In patients undergoing renal transplant surgery requiring urinary reconstruction, does pyeloureterostomy, as compared to  ureteroneocystostomy, improve clinical outcomes?

Material and Methods
A total of 116 papers were identified using the search protocol described, of which four represented the best evidence available to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated.

Result
Three of the four studies compared clinical outcomes between pyeloureterostomy(ureteropyelostomy) and ureteroneocystostomy; the fourth paper additionally addressed  ureteroureterostomy. Whilst ureteroneocystostomy remains the most common method of reconstruction, two studies actually demonstrated considerable advantages of pyeloureterostomy with regards to lower rates of postoperative sepsis, urinary obstruction and lower requirements for secondary operative intervention for ureteral reconstruction. One paper described no clear advantage of pyeloureterostomy, and the authors of another trial suggested that ureteroneocystostomy should be favoured over pyeloureterostomy as this produced lower rates of major urologic complications.

Conclusion
The clinical bottom line is that pyeloureterostomy should form an essential component in every transplant surgeon's toolbox, particularly for difficult patients with multiple anticipated complications, or when there is fear of ureteral blood compromise, such as with cadaveric kidneys. Nonetheless, a secondary conclusion from our study is that a further, larger scale trial would be
immensely useful in this prescient field, to aid clarification to the discrepancies that we have highlighted.