New technique for allograft ureteroneocystomy for better transvesical endoscopic handling of allograft urological complications.
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We studied a new ureteroneocystostomy technique for the anastomosis of the transplanted ureter and the native bladder that involves the change of the position of the neoureteral orifice during renal graft transplantation to the posterio-lateral aspect of the bladder's dome. We applied the technique on 30 consecutive renal transplant recipients (25 males and five females with ages between 15-50 years). Mucosa to mucosa anastomosis was performed, and all of the patients had double J (DJ) stents inserted in the ureters. The patients were followed for one year. At the time of removing the DJ stents, we evaluated the ureters by inserting ureteral catheters and by performing ureteroscopy transvesically and the results were compared with another group of 30 patients who underwent the conventional anterio-lateral ureteroneocystostomy. The retrograde stenting of the ureters was much more easily performed in the study group than the controls. During the follow-up of the study patients, renal ultrasound and renal function tests did not disclose any urological complications. We conclude that the new technique is effective and safe and enabled better retrograde handling of the allograft ureter than the conventional ureteroneo-cystostomy. Advantages of the new technique included the need for a shorter ureter, the normally appearing orifice of the allograft ureter in the bladder, and the unproblematic retrograde vesical approach for the posterolateral ureter.