Ureteroneocystostomy with delayed endovesical antireflux defense - the new method of prophylaxis of transplant vesicoureteral reflux: randomized clinical study
Abstract
Objective of the study. The high prevalence of vesico-ureteral reflux (VUR) in kidney graft is one of the weaknesses in the kidney transplantation. This condition is associated with the risk of urinary tract infections and renal allograft dysfunction. The objective of this study was the development of new method of VUR medical prophylaxis and evaluation of it clinical efficacy. Methods. We conducted retrospective study to find the risks factors of VUR in kidney transplant. 68 patients were included to the study. Based on the found risks factors, we proposed a new method of medical prophylaxis of VUR. To evaluate its efficacy we run the randomized prospective controlled clinical study to compare with Lich-Gregoir method in 36 patients. Results. We found that the main risk factor of VUR is the low residual volume of urine output. We created the new method of ureteroneocystostomy with delayed antireflux defence by endovesical injection of periureteral bulking substances. We conducted randomized prospective clinical study of the efficacy of new method compared with routine Lich-Gregour technique. We found that it helps to reduce the frequency of VUR in the risk patients from 72% to 28% (p=0.0184). Besides, we found that our method was associated with reduces risks of UTI, shortness of surgery time and provides the reasonable degree of safety.
About the Authors
A. V. Kalachyk
9th city clinical hospital
Russian Federation
Russian Federation
A. V. Narbin
9th city clinical hospital
Russian Federation
Russian Federation
A. O. Shkutov
9th city clinical hospital
Russian Federation
Russian Federation
M. V. Kozlova
9th city clinical hospital
Russian Federation
Russian Federation
References
1. Калачик О.В., Нарбин А.В., Вершинин П.Ю., и др. Распространённость и факторы риска инфекций мочевых путей у реципиентов почечного трансплантата. Сборник научных трудов «Современные проблемы инфекционной патологии человека», выпуск 7: 166-171.
2. Bennett LN, Voegeli DR, Crummy AB, et al. Urologic complications following renal transplantation: role of interventional radiologic procedures. Radiology 1986. 160: 531-6.
3. Eggli DF, Tulchinsky M. Scintigraphic evalution of paediatric urinary tract infections. Seminars in nuclear Medicine.1993. 23(3): 199-218.
4. El-Mekresh M, Osman Y, Ali-El-Dein B, et al. Urological complications after living-donor renal transplantation. Br J Urol Int. 2001. 87: 295-306.
5. Figueiredo AJ, Parada BA, Cunha MF, et al. Ureteral complications: Analysis of risk factors in 1000 renal transplants. Transplant Proc. 2003. 35: 1087-1088.
6. Filly, R., Friedland, G. W., Govan, D. E. et al.: Development and progression of clubbing and scarring in children with recurrent urinary tract infections. Radiology. 1974. 113: 145.
7. Giessing M. Urinary tract infection in renal transplantation. Arab Journal of Urology. 2012. 10: 162-168.
8. Greenbaum L., O. Mesrobian H.-G. Vesicoureteral reflux. Petiatr Clin N Am. 2006. 53: 413-27.
9. Hulley Stephen B., Cummings Stephen R. et al. Designing Clinical Research. Fourth edition. 2013, Philadelphia, USA,Supplement Table 6В.1.
10. Jacobson, S.H., Eklof, O., Eriksson, C.G. et al.: Development of hypertension and uraemia after pyelonephritis in childhood: 27 year follow up. BMJ. 1989. 299: 703.
11. Jacobson, S.H., Eklof, O., Lins, L.E. et al. Long-term prognosis of post-infectious renal scarring in relation to radiological findings in childhood-a 27-year follow-up. Pediatr Nephrol. 1992. 6: 19.
12. Lahdes-Vasama, T., Niskanen, K., Ronnholm, K. Outcome of kidneys in patients treated for vesicoureteral reflux (VUR) during childhood. Nephrol Dial Transplant. 2006. 21: 2491.
13. Marx WL, Halasz NA, McLaughlin AP, Gittes RF. Urological complications in renal transplantation. J Urol. 1974. 112: 561.
14. McDonald JC, Rohr MS, Frentz GD. External ureterocystostomy and ureteroureterostomy in renal transplantation. Ann Surg. 1979. 190: 663.
15. Meier-Kriesche HU, Schold JD, Srinivas TR, Kaplan B. Lack of improvement in renal allograft survival despite a marked decrease in acute rejection rates over the most recent era. Am J Transplant. 2004. 4: 378-83.
16. Morris Peter, Knechtle Stuart J. Kidney Transplantation. Principles and Practice. 6 edition. Saunders Elsevier, 2008: 163-165.
17. Mundy AR, Podesta ML, Bewick M, et al. The urologic complications of 1000 renal transplants. Br J Urol. 1981. 53: 397-402.
18. Mundy AR, Podesta ML, Bewick M, et al. The urological complications of 1000 renal transplants. Br J Urol. 1981. 53: 397.
19. Ojo A.O., Hanson J.A., Wolfe R.A., et al. Long-term survival in renal transplant recipients with graft function. Kidney Int. 2000. 57: 307-313.
20. Saemann M, Horl WH. Urinary tract infection in renal transplant recipients. Eur J Clin Invest [Review]. 2008. 38(Suppl 2): 58-65.
21. Secin FP, Rovegno AR, Marrugat RE, et al. Comparing Taguchi and Lich-Gregoir ureterovesical reimplantation techniques for kidney transplants. J Urol. 2002. 168: 926.
22. Smellie, J. M., Prescod, N. P., Shaw, P. J. et al. Childhood reflux and urinary infection: a follow-up of 10-41 years in 226 adults. Pediatr Nephrol. 1998. 12: 727.
23. Starzl T.E., R.Shapiro, A.Tzakis and T.R. Hakala. A New Technique of Extravesical Ureteroneocystostomy for Renal Transplantation. Transplantation Proceedings. Oct. 1989. 21(5): 3856-3858.
24. Starzl TE, Groth CG, Putnam CW, et al. Urological complications in 216 human recipients of renal transplants. Ann Surg. 1970. 172: 1.
25. Thrasher JB, Temple DR, Spees EK. Extravesical versus Leadbetter-Politano ureteroneocystostomy: A comparison of urological complications in 320 renal transplants. J Urol. 1990. 144: 1105-1109.
26. Treves ST, Conolly LP, O’ Tuama LA et al. Paediatric. In Wagner H.N., Szabo Z, Buchanan J.W. Principles of Nuclear Medicine, 2 edn, Philadelphia: W.B. Saunder Company, 1995: 1147-52.
27. USRDS 2004 Annual Data Report. Am J Kidney Dis. 2005. 45: 8-280.
28. van Roijen JH, Kirkels WJ, Zietse R, et al. Long-term graft survival after urological complications of 695 kidney transplantations. J Urol. 2001. 165(6 Pt 1): 1884-1887.
29. Veale JL, Yew J, Gjertson DW, et al. Long-term comparative outcomes between 2 common ureteroneocystostomy techniques for renal transplantation. J Urol. 2007. 177: 632-636.
30. Waltke EA, Adams MB, Kauffman HM, Jr., et al. Prospective randomized comparison of urologic complications in end-to-side versus Politano-Leadbetter ureteroneocystostomy in 131 human cadaver renal transplants. J Urol. 1982. 128: 1170-1172.
31. Woodruff M, Robson JS, Nolan B, et al. Renal transplantation in man. Lancet. 1969. 1: 6.
Review
For citations:
Kalachyk A.V., Narbin A.V., Shkutov A.O., Kozlova M.V. Ureteroneocystostomy with delayed endovesical antireflux defense - the new method of prophylaxis of transplant vesicoureteral reflux: randomized clinical study. Nephrology and Dialysis. 2015;17(4):452-458. (In Russ.)
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