Comparison of urological complications with primary ureteroureterostomy versus conventional ureteroneocystostomy

Urological complications after kidney transplantation may be serious and carry a high risk of graft loss. The purpose of this study was to compare urological complications with primary ureteroureterostomy versus conventional ureteroneocystostomy retrospectively. Between December 1993 and April 2008, 1287 kidney transplants were performed at our institution. Urological complications such as urine leakage, ureteral obstruction and vesicoureteral reflux (VUR) were summarized according to the different ways of urinary tract reconstruction, ureteroureterostomy (U-U) and ureteroneocystostomy (U-C). Overall, urological complications were encountered in 94 (7.3%) cases, including urine leakage (n = 44, 3.4%), ureteral obstruction (n = 36, 2.8%), VUR (n = 14, 1.1%). Seventy-six cases (7.8%) were in the U-C group and 18 cases (5.8%) were in the U-U group. Ninety-three recipients were successfully treated, and one lost the graft because of pelvis and ureteral necrosis. There was no recipient loss secondary to these complications. In conclusion, U-U does not change the overall incidence of urological complications comparing to U-C, but it can decrease the incidence of urine leakage. It is a good first option with a greater possibility of resolving a ureteral stenosis with endourology and no risk of reflux.