The urinary complications of renal transplantation still menace the graft and often the patient’s life, occurring in almost 11% of cases. Since virtually all authors must often resort to uretero-vesical implantation, we have analyzed our complications in 100 instances of termino-terminal ureteroureteral anastomosis among the 120 transplantations we have done over the last 5 years.19 fistulas, 5 stenoses and 1 lithiasis have led to one or more reoperations. These complications had as their origin death by vascular ulceration and two nephrectomies of perfectly functioning transplants. In all three, one was dealing with fistulas, in which immunologic factors did not play a preponderant role etiologically. Apart from the fact that they were more frequent with kidneys from unrelated donors, one noted that the fistula in 2 cases appeared at a time of crisis of the transplant, that lesions with edematous and ischemic features at the end of the transplant’s ureter could have been recognized by endoscopy at the time of crisis, and that they totally disappeared with healing. Perforative ureteral and even pyelic lesions were identified at a distance from the anastomotic site and, without knowing the aspects of soft tissue rejection, certain ureteral features could bring it about. On the other hand, the sequelae of ureteroureteral reanastomosis, whether carried out for fistula or for stenosis, at a time when rejection becomes less frequent, are generally extremely simple. In fact, if this anastomosis, the most physiological, seems a bit more exposed to the danger of complications than the others, the complications seem less grave and repair easier. This is why we think termino-terminal ureteroureteral anastomosis should keep its place of choice, while more startling indications should perhaps be reserved for cadaver transplants, in any case, for non-related transplants.

Keywords:
Renal allotransplantation technique complications statistics, Ureter Anastomosis
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© 1973 S. Karger AG, Basel
1973
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