Low Rate of Urological Complications in Pediatric Kidney Transplantation Using a Stentless Ureteral Anastomosis

Pediatric kidney transplant recipients are susceptible to a range of complications that may compromise allograft function and are associated with significant morbidity. Urologic complications represent an important subset that may necessitate multiple radiological and/or surgical interventions.

Our previously reported modified extravesical ureteroneocystostomy technique was designed to avoid routine stent placement at the time of transplant as well as to reduce postoperative urologic complications. Here, we reviewed 107 consecutive pediatric kidney transplant recipients transplanted at our center since 2014 who received no stent placement at the time of transplant.

The observed percentage who developed a urologic complication during the first 12 months post-transplant was 3.7% (4/107), and only 2.8% (3/107) required surgical intervention. Ureteral obstruction/stricture was observed in 2.8% (3/107), with two being due to UPJ obstruction, and one being due to the occurrence of multiple kidney stones that occluded the distal ureter/ureterovesical junction (UVJ). No urinary leaks, 0.0% (0/107), were observed during the first 12 months post-transplant. Additionally, poor bladder compliance along with Grade 4 vesicoureteral reflux occurred in one patient. One patient (who developed a UPJ obstruction) was successfully managed with interventional radiology alone. The other three patients required surgical intervention: ureteral reimplantation for the patient having UVJ obstruction due to multiple kidney stones, pyeloureterostomy in one patient with a UPJ obstruction, and bladder augmentation along with (ureter, ileum, and ileal) Monti Mitrofanoff in the patient having poor bladder compliance.

In pediatric kidney transplantation, our extravesical ureteroneocystostomy technique without routine ureteral stent placement was associated with a low incidence of post-transplant urological complications.