Intravesical Versus Extravesical Ureteroneocystostomy in Kidney Transplantation: A Systematic Review and Meta-Analysis

Background: Urologic complications are still a major problem postoperatively with a reported incidence of up to 30%, associated with significant morbidity, mortality, prolonged hospital stay, and high medical costs. To date, there is no evidence favoring either an extravesical or an intravesical approach. The purpose of this systematic review and meta-analysis is to determine if an intravesical or an extravesical anastomosis in kidney transplantation is to be preferred. Methods: Comprehensive searches were conducted in PubMed, Embase, and the Cochrane Library. Reference lists were searched manually. The methodology was in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis statement. Two randomized controlled trials and 17 cohort studies were identified. Results: Based on the meta-analysis, outcome was in favor of the extravesical anastomosis. A relative risk of 0.67 (95% confidence interval [95% CI], 0.48-0.93; P=0.02) for stenosis, 0.55 (95% CI, 0.39-0.80; P=0.001) for leakage, 0.56 (95% CI, 0.41-0.76; P<0.001) for the total number of urologic complications, and 0.41 (95% CI, 0.22-0.76; P=0.005) for hematuria was demonstrated. Conclusion: Based on our results, we conclude that there is evidence in favor of the extravesical ureteroneocystostomy for having a smaller amount of urologic complications in kidney transplantation. (C) 2012 Lippincott Williams & Wilkins, Inc.

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Página original: http://pdfs.journals.lww.com/transplantjournal/9000/00000/Intravesical_Versus_Extravesical.98851.pdf

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