External ureteroneocystostomy and ureteroureterostomy in renal transplantation

"External" ureteroneocystostomy is a method of reconstructing the urinary tract for renal transplantation. As performed by us, it is a modification of the technique of Witzel, Sampson, and Lich. It has the advantages of requiring a very short length of ureter, avoiding a separate and large cystotomy, and retaining the antireflux mechanism. This technique is described in detail. Ureteroureterostomy has been used as the preferred procedure when the bladder wall is very thin or when the vascular attachments are such that a ureteral length of greater than 6-7 cm would be required for bladder implantation. Since using these techniques we have reduced the early complication rate of ureteral implantation from 11.9% in a consecutive series of 126 transplants to 0% in the last 88 consecutive transplants. A review of the literature which led to the adoption of these techniques is also presented.