Sachin Patil1, Sturt Geffner1,2, Harry Sun1,2 and Matthew Whang2*
1Department of Surgery, Saint Barnabas Medical Center, USA
2Division of Urology, Saint Barnabas Medical Center, USA
Introduction: Renal transplant patients are at a higher risk for urinary tract infections and vesicoureteral reflux is a well-known risk factor for recurrent urinary tract infections. The exact incidence of vesicoureteral reflux is difficult to determine in renal transplant patients because routine VCUG (voiding cystourethrogram) is not performed. Majority of patients with VUR (Vesicoureteral reflux) are asymptomatic, however those patients with recurrent symptomatic UTI tend to have higher grade of VUR. We have experienced a 3% symptomatic reflux rate in our transplant patients and have performed reconstructive surgery on a majority of them. Because there is a paucity of published data regarding success rate of such reconstructive surgery, we have reviewed our data. This study represents the largest dataset looking into outcomes following corrective surgery for VUR in renal transplant patients with recurrent symptomatic UTI.Patient and
Methods: Demographic and Clinical data on all the renal transplant patients with recurrent symptomatic UTI who had undergone corrective surgery for VUR was abstracted (July 1993 to December 2014). The benefit of the surgical correction of VUR was assessed by follow-up urine culture and sensitivity. Standard statistical methods were used for data analysis.Results: A total of 123 patients who had under gone corrective surgery for VUR associated symptomatic UTI formed the study group. The mean age of the patients was 44.6±14.4 years with Male: Female ratio of 1: 2.5. Majority of the patients (71.5%) underwent a uretero-ureterostomy using the ipsilateral native ureter with an end to end anastomosis, 15.4% of patients underwent a uretero-ureterostomy using the ipsilateral native ureter with an end to side anastomosis, 8.9% of patients underwent a uretero-neocystostomy using the Politano-Leadbetter technique due to an absence of a suitable ipsilateral native ureter, 3.3% of patients underwent a uretero-neocystostomy using the Lich-Gregoir technique and 0.8% of patients underwent a uretero-pyelostomy using the ipsilateral native ureter. Overall cure from symptomatic UTI was observed in 95.1% of patients. There were no procedure related complications, however there was graft loss noted in 4.9% (N=6) of patients due to allograft rejection. There was one mortality due to an unrelated cause.Conclusion: Corrective surgery for VUR associated with recurrent symptomatic UTI in renal transplant patients is a highly effective option. The surgeon should investigate the availability of the ipsilateral ureter as it is critical for success of the operation.
VUR; Recurrent UTI; Renal transplant recipients
Patil S, Geffner S, Sun H, Whang M. Surgical Treatment of Vesicoureteral Reflux in Kidney Transplant Patients with Symptomatic Urinary Tract Infection: A Single Institution Review of 123 Patients. Clin Surg. 2016; 1: 1160.