[Comparative evaluation of two methods for the uretero-cystic anastomosis]

Comparative analysis of two types of ureterocystic anastomosis in kidney transplantation showed the advantages and shortcomings of the method developed at the Moscow Regional Scientific Research Clinical Institute. The new anastomosis fundamentally differs from the traditional Mebel-Shumakov method in the absence of sutures between the ureter and the bladder mucosa. This feature makes it possible to avoid injury to the bladder mucosa which is often changed in prolonged anuria and reduce the edema and ischemia of the terminal part of the ureteral graft. This facilitates adaptation of the anastomosis to polyuria which often occurs in the early postoperative period. The relatively simple techniques shortens the time needed for the operation. These advantages of the new method of ureterocystotomy are manifested by decrease of the total number of urological complications and the relative incidence of serious early urological complications like fistula of the ureterocystic anastomosis and necrosis of the ureter which most often lead to loss of the transplant and sometimes to death of the patient. The use of the anastomosis developed at the Clinical Institute, however, is attended by a relatively high incidence of ureteral stricture in the late-term postoperative period, evidently due to prolonged contact of urine with the bladder muscular coat and the ureteral adventitia. Thus, the more favorable results of ureterocystic anastomosis formed by the method developed at the Clinical Institute allow it to be recommended for further use in kidney transplantation.