Vesicoureteral Reflux in Renal Transplant Recipients?
Vesicoureteral Reflux in Renal Transplant Recipients?
What is the cause and incidence of vesicoureteral reflux in renal transplant recipients?
Jesus Alberto Maestral, MD
That is a big question! There are probably many causes of reflux after transplantation. Surgeons talk about technical issues and "antireflux" ureteroneocystostomies. The most commonly performed antireflux procedure, the original Politano-Leadbetter reimplantation, involves a large bladder opening and a long submucosal tunnel. This procedure is associated with considerable morbidity, including a high incidence of stenosis.
The extravesical technique attributed to Lich involves recreating a submucosal tunnel at the dome of the bladder by partial closure of the muscle layer over the ureterneocystostomy. Starzl introduced a technique whereby the bladder wall musculature was not formally closed, but was allowed to reapproximate itself over the ureter, to minimize the risk of stenosis. When we compared this procedure with the Lich technique, the incidence of reflux was similar. Reflux probably occurs more than we think, but is clinically silent in the absence of infectious problems. The reported incidence ranges from 5% to 25%, depending on the series, but it is not clear what the real incidence is, as it would be necessary to study every transplanted patient, and there is no need to do that.
What is the cause and incidence of vesicoureteral reflux in renal transplant recipients?
Jesus Alberto Maestral, MD
That is a big question! There are probably many causes of reflux after transplantation. Surgeons talk about technical issues and "antireflux" ureteroneocystostomies. The most commonly performed antireflux procedure, the original Politano-Leadbetter reimplantation, involves a large bladder opening and a long submucosal tunnel. This procedure is associated with considerable morbidity, including a high incidence of stenosis.
The extravesical technique attributed to Lich involves recreating a submucosal tunnel at the dome of the bladder by partial closure of the muscle layer over the ureterneocystostomy. Starzl introduced a technique whereby the bladder wall musculature was not formally closed, but was allowed to reapproximate itself over the ureter, to minimize the risk of stenosis. When we compared this procedure with the Lich technique, the incidence of reflux was similar. Reflux probably occurs more than we think, but is clinically silent in the absence of infectious problems. The reported incidence ranges from 5% to 25%, depending on the series, but it is not clear what the real incidence is, as it would be necessary to study every transplanted patient, and there is no need to do that.
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