The modified Barry technique to prevent vesicoureteric reflux in paediatric renal transplant recipients: initial...

We present the initial clinical results of the 'modified Barry technique' for the prevention of VUR in paediatric renal transplant grafts. Ours is the only centre in the UK using this technique, as confirmed in a questionnaire developed in our department.

We retrospectively analysed data of 15 paediatric renal transplant patients (operated June 2006-November 2009) who had their vesicoureteric anastomosis performed using the modified Barry technique with a 2-cm submucosal anti-reflux tunnel. The original Barry technique involved the creation of a 4-cm tunnel; this was modified by us to reduce the risk of ureteric stenosis.

At a median follow up of 23.7 months (6.3-39.4), the incidence of VUR was 7% (1/15). There was no evidence of postoperative urological complications, such as urinary leak, primary ureteric obstruction including anastomotic stricture/stenosis, transplant graft renal calculi and chronic rejection. At current follow up, graft and patient survival are 100%.

With the introduction of the modified Barry technique, the incidence of VUR in our series fell 10-fold to 7%, compared with our earlier study (P<0.0001), without any urological complications. Although the initial results are encouraging, larger patient numbers and longer follow up are required to validate this technique further.