A simplified technique for ureteroneocystostomy in renal transplantation

From October 1988 to December 1993, 148 kidney transplants were carried out at our institution. An extravesical ureteral reimplantation technique resulting in a submucosal tunnel in the bladder wall was performed on 101 of the patients. For this technique, two small incisions are made at the outer part of the bladder wall until the mucosa is seen, then a submucosal tunnel is dissected between them and the graft's ureter is introduced and advanced in it (Alférez-Barry). Afterward the bladder mucosa is opened at the distal incision and the ureter is introduced into the bladder and fixed by a single direct anchorage stich (Taguchi). The minimal patients' follow-up is 18 months. Complications deriving from ureter reimplantation with this technique were present in 12.8% of the patients and included 4 cases of stenosis (3.9%), 4 cases of urinary fistula (3.9%), and 5 cases of hematuria (4.9%). We conclude that submucosal tunnelled ureteroneocystostomy with direct anchorage is a technique that simplifies kidney transplant surgery with good results. Ureteral direct anchorage can be used in any kind of ureteral anastomosis.