Vesicoureteral Reflux After Kidney Transplantation?

Ron Shapiro, MD

Disclosures

November 11, 2003

Question

What is the current recommendation for the procedure for vesicoureteral reflux after kidney transplantation?

Response from Ron Shapiro, MD

The evolution of the ureteroneocystostomy in kidney transplantation gradually shifted from more invasive to less invasive techniques. The original technique, ascribed to Politano and Ledbetter, involved a relatively large cystotomy, creation of a submucosal tunnel, and anastomosing the ureter to the bladder from within. Although the incidence of reflux associated with this procedure was low, the incidence of stenosis was a problem. The extravesical technique used more commonly now, ascribed to Lich, involves exposure of about 3 cm of the mucosal layer after incising the muscle layer, anastomosis of the ureter to the mucosa, and closing the muscle layer partially, to effect a submucosal tunnel. Reflux is more common with this technique, but stenosis is less of a problem.

Most of the time, reflux does not cause problems. Occasionally, patients are asked to double void to ensure that the bladder has been emptied. In cases of transplant pyelonephritis refractory to long-term antibiotic suppression, either ureteroureterostomy to the native ureter or reimplantation using an antireflux procedure can be effective therapy, although this is indicated in only a small percentage of cases.

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