Uretero-ureteral anastomosis was performed in 135 patients (40 women and 95 men) during
kidney transplantation using either cadaver (120 cases) or living donor (15 cases) organs. The ureter of the retained kidney was linked proximal to the
transplantation, whether or not there had been previous contemporary
nephrectomy. Results were highly interesting: no mortality, no need to remove graft for urinary complications and no ureteral anastomotic
stenosis. Urological complications were absent in 108 cases (80%) while 17 cases (12.6%) developed a
urinary fistula, only 5 of which required surgical intervention
Hematoma related to the
nephrostomy occurred in 6 cases (4.4%) but operation was necessary in only 2 of these cases. Overall need for repeat surgery involved only 7 patients (5.2%) during the month following
transplantation. One of 2 cases of
hematoma operated upon required partial excision of the
transplantation kidney due to the presence of an intraparenchymatous
arteriovenous fistula. A curious finding was that of the 17 cases developing fistulae most of them had received live donor kidneys (5/15) whereas only 12 occurred in the 120 cadaver kidney transplants. Prevention of fistulae appears to be assisted by spatulation of the ureter rather than by its bevelled section, and the maintenance of a long ureteral loop to avoid
traction. It is suggested that certain postoperative urine losses may be the result of a hyper-diuresis, without actual dehiscence of the anastomosis. In 4 patients with a urine output of more than 1.5 litres at the time of
transplantation, the kidney proximal to the ureteral
ligature became infected, and a second
nephrectomy was necessary in 4 cases.