{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T15:42:11Z","timestamp":1786722131566,"version":"build-2736575974"},"reference-count":47,"publisher":"Public Library of Science (PLoS)","issue":"1","license":[{"start":{"date-parts":[[2021,1,11]],"date-time":"2021-01-11T00:00:00Z","timestamp":1610323200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:p>Urologic complications can still occur following kidney transplantation, sometimes requiring multiple radiological and\/or surgical procedures to fully correct the problem. Previously proposed extravesical ureteral reimplantation techniques still carry non-negligible risks of the patient developing urologic complications. About 10 years ago, a new set of modifications to the Lich-Gregoir technique was developed at our center, with the goal of further minimizing the occurrence of urologic complications, and without the need for initial ureteral stent placement. It was believed that an improvement in the surgical technique to minimize the risk of developing urologic complications was possible without the need for stent placement at the time of transplant. In this report, we describe the advantages of this technique (i.e., mobilized bladder, longer spatulation of the ureter, inclusion of bladder mucosa with detrusor muscle layer in the ureteral anastomosis, and use of a right angle clamp in the ureteral orifice to ensure that it does not become stenosed). We also retrospectively report our experience in using this technique among 500 consecutive (prospectively followed) kidney transplant recipients transplanted at our center since 2014. During the first 12mo post-transplant, only 1.4%(7\/500) of patients developed a urologic complication; additionally, only 1.0%(5\/500) required surgical repair of their original ureteroneocystostomy. Five patients(1.0%) developed a urinary leak, with 3\/5 having distal ureteral necrosis, and 1\/5 subsequently developing a ureteral stricture. Two other patients developed ureteral stenosis, one due to stricture and one due to ureteral stones. These overall results are excellent when compared with other reports in the literature, especially those in which routine stenting was performed. In summary, we believe that the advantages in using this modified extravesical ureteroneocystostomy technique clearly help in lowering the early post-transplant risk of developing urologic complications. Importantly, these results were achieved without the need for ureteral stent placement at the time of transplant.<\/jats:p>","DOI":"10.1371\/journal.pone.0244248","type":"journal-article","created":{"date-parts":[[2021,1,11]],"date-time":"2021-01-11T21:14:37Z","timestamp":1610399677000},"page":"e0244248","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":30,"title":["Results of a previously unreported extravesical ureteroneocystostomy technique without ureteral stenting in 500 consecutive kidney transplant recipients"],"prefix":"10.1371","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0269-4152","authenticated-orcid":true,"given":"Gaetano","family":"Ciancio","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed","family":"Farag","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Javier","family":"Gonzalez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5446-2556","authenticated-orcid":true,"given":"Paolo","family":"Vincenzi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9607-7509","authenticated-orcid":true,"given":"Jeffrey J.","family":"Gaynor","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2021,1,11]]},"reference":[{"key":"pone.0244248.ref001","doi-asserted-by":"crossref","first-page":"1889","DOI":"10.1111\/j.1600-6143.2004.00595.x","article-title":"Stented versus nonstented extravesical ureteroneocystostomy in renal transplantation: a metaanalysis","volume":"4","author":"RS Magnus","year":"2004","journal-title":"Am J Transplant"},{"key":"pone.0244248.ref002","doi-asserted-by":"crossref","first-page":"627","DOI":"10.1046\/j.1464-410X.2002.03004.x","article-title":"The urological complications of renal transplantation: A series of 1535 patients","volume":"90","author":"EH Streeter","year":"2002","journal-title":"BJU Int"},{"key":"pone.0244248.ref003","doi-asserted-by":"crossref","first-page":"932","DOI":"10.1016\/S0022-5347(17)66369-9","article-title":"An operative technique for the correction of vesicoureteral reflux","volume":"79","author":"VA Politano","year":"1958","journal-title":"J Urol"},{"key":"pone.0244248.ref004","doi-asserted-by":"crossref","first-page":"554","DOI":"10.1016\/S0022-5347(17)65219-4","article-title":"Recurrent urosepsis in children","volume":"86","author":"R Lich","year":"1961","journal-title":"J Urol"},{"key":"pone.0244248.ref005","first-page":"286","article-title":"Congenital vesico-ureteral reflux","volume":"30","author":"W. Gregoir","year":"1962","journal-title":"Acta Urol Belg"},{"key":"pone.0244248.ref006","doi-asserted-by":"crossref","first-page":"593","DOI":"10.1111\/tri.12301","article-title":"Ureterovesical anastomotic techniques for kidney transplantation: A systematic review and meta-analysis","volume":"27","author":"VP Alberts","year":"2014","journal-title":"Transpl Int"},{"key":"pone.0244248.ref007","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1016\/S0022-5347(17)47113-8","article-title":"Parallel incision, unstented extravesical ureteroneocystostomy: Followup of 203 kidney transplants","volume":"134","author":"JM Barry","year":"1985","journal-title":"J Urol"},{"key":"pone.0244248.ref008","first-page":"637","article-title":"New experimental methods for implantation of the ureter in bladder and conduit","volume":"4","author":"I. Shanfield","year":"1972","journal-title":"Transplant Proc"},{"key":"pone.0244248.ref009","doi-asserted-by":"crossref","first-page":"194","DOI":"10.1016\/S0022-5347(17)61491-5","article-title":"Implantation of transplant ureters: A technique","volume":"105","author":"Y Taguchi","year":"1971","journal-title":"J Urol"},{"key":"pone.0244248.ref010","doi-asserted-by":"crossref","first-page":"1005","DOI":"10.1007\/s11255-007-9204-z","article-title":"Modified extravesical ureteral reimplantation technique for kidney transplants","volume":"39","author":"A Abou-Elela","year":"2007","journal-title":"Int Urol Nephrol"},{"key":"pone.0244248.ref011","doi-asserted-by":"crossref","first-page":"414","DOI":"10.1016\/0090-4295(73)90370-1","article-title":"Ureteroneocystostomy in renal transplantation","volume":"1","author":"MW Woodruff","year":"1973","journal-title":"Urology"},{"key":"pone.0244248.ref012","first-page":"3856","article-title":"A new technique of extravesical ureteroneocystostomy for renal transplantation","volume":"21","author":"TE Starzl","year":"1989","journal-title":"Transplant Proc"},{"key":"pone.0244248.ref013","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1016\/S0022-5347(17)59467-7","article-title":"Extravesical ureteroneocystostomy in 170 renal transplant patients","volume":"113","author":"JW Konnak","year":"1975","journal-title":"J Urol"},{"key":"pone.0244248.ref014","doi-asserted-by":"crossref","first-page":"663","DOI":"10.1097\/00000658-197911000-00018","article-title":"External ureteroneocystostomy and ureterourterostomy in renal transplantation","volume":"190","author":"JC McDonald","year":"1979","journal-title":"Ann Surg"},{"key":"pone.0244248.ref015","doi-asserted-by":"crossref","first-page":"1662","DOI":"10.1097\/00005392-199805000-00085","article-title":"Modified Lich-Gregoir ureteral reimplantation: Experience of a Canadian Center","volume":"159","author":"SP Lapointe","year":"1998","journal-title":"J Urol"},{"key":"pone.0244248.ref016","doi-asserted-by":"crossref","first-page":"1413","DOI":"10.1016\/j.transproceed.2010.04.016","article-title":"Kidney transplant ureteroneocystostomy techniques and complications: Review of the literature","volume":"42","author":"L Kayler","year":"2010","journal-title":"Transplant Proc"},{"key":"pone.0244248.ref017","doi-asserted-by":"crossref","first-page":"142","DOI":"10.5500\/wjt.v8.i5.142","article-title":"Early urological complications after kidney transplantation: An overview","volume":"8","author":"J Buttugieg","year":"2018","journal-title":"World J Transplant"},{"key":"pone.0244248.ref018","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1148\/radiology.159.2.2938210","article-title":"Extraperitoneal paravesical spaces: CT delineation with US correlation","volume":"159","author":"YH Auh","year":"1986","journal-title":"Radiology"},{"key":"pone.0244248.ref019","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1007\/s00423-011-0780-0","article-title":"Mesh biocompatibility: Effects of cellular inflammation and tissue remodeling","volume":"397","author":"K Junge","year":"2012","journal-title":"Langenbecks Arch Surg"},{"key":"pone.0244248.ref020","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1016\/j.smim.2007.11.004","article-title":"Foreign body reaction to biomaterials","volume":"8","author":"JM Anderson","year":"2008","journal-title":"Semin Immunol"},{"key":"pone.0244248.ref021","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1016\/j.trim.2016.11.004","article-title":"Randomized trial of rATg\/daclizumab vs. rATg\/alemtuzumab as dual induction therapy in renal transplantation: Results at 8 years of follow-up.","volume":"40","author":"G Ciancio","year":"2017","journal-title":"Transplant Immunol"},{"key":"pone.0244248.ref022","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1111\/ajt.14107","article-title":"The Banff 2015 Meeting Report: Current challenges in rejection classification and prospects for adopting molecular pathology","volume":"17","author":"A Loupy","year":"2017","journal-title":"Am J Transplant"},{"key":"pone.0244248.ref023","doi-asserted-by":"crossref","first-page":"604","DOI":"10.7326\/0003-4819-150-9-200905050-00006","article-title":"A new equation to estimate glomerular filtration rate","volume":"150","author":"for the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI)","year":"2009","journal-title":"Ann Intern Med"},{"key":"pone.0244248.ref024","article-title":"Routine intraoperative ureteric stenting for kidney transplant recipients","volume":"6","author":"CH Wilson","year":"2013","journal-title":"Cochrane Database Sys Rev"},{"key":"pone.0244248.ref025","doi-asserted-by":"crossref","first-page":"1190","DOI":"10.1111\/tri.13638","article-title":"Stenting the ureteroneocystostomy reduces urological complications in kidney transplantation: A noninferiority randomized controlled trial, SPLINT trial","volume":"33","author":"LSS Ooms","year":"2020","journal-title":"Transplant Int"},{"key":"pone.0244248.ref026","doi-asserted-by":"crossref","first-page":"867","DOI":"10.1016\/j.urology.2004.11.050","article-title":"Routine insertion of ureteral stent in live-donor renal transplantation: Is it worthwhile?","volume":"65","author":"Y Osman","year":"2005","journal-title":"J Urol"},{"key":"pone.0244248.ref027","doi-asserted-by":"crossref","first-page":"926","DOI":"10.1016\/S0022-5347(05)64544-2","article-title":"Comparing Tachuchi and Lich-Gregoir ureterovesical reimplantation techniques for kidney transplantation","volume":"168","author":"FP Secin","year":"2002","journal-title":"J Urol"},{"key":"pone.0244248.ref028","doi-asserted-by":"crossref","first-page":"3077","DOI":"10.1016\/j.transproceed.2005.08.006","article-title":"Comparing Taguchi and anterior Lich-Gregoir ureterovesical reimplantation techniques for kidney transplantation","volume":"37","author":"MA Zargar","year":"2005","journal-title":"Transplant Proc"},{"key":"pone.0244248.ref029","doi-asserted-by":"crossref","first-page":"632","DOI":"10.1016\/j.juro.2006.09.042","article-title":"Long-term comparative outcomes between 2 common ureteroneocystostomy techniques for renal transplantation","volume":"177","author":"JL Veale","year":"2007","journal-title":"J Urol"},{"key":"pone.0244248.ref030","doi-asserted-by":"crossref","first-page":"61","DOI":"10.3109\/2000-1967-095","article-title":"The Taguchi technique of the trasnpalnted kidney ureter implantation\u2013Singgle centre experience","volume":"112","author":"J Pacovsky","year":"2007","journal-title":"Upsala J Med Sci"},{"key":"pone.0244248.ref031","doi-asserted-by":"crossref","first-page":"1461","DOI":"10.1016\/j.transproceed.2006.11.017","article-title":"Ureteral complications in renal transplantation: A comparison of the Lich-Gregoir versus the Taguchi technique","volume":"39","author":"RS Lee","year":"2007","journal-title":"Transplant Proc"},{"key":"pone.0244248.ref032","doi-asserted-by":"crossref","first-page":"893","DOI":"10.1016\/j.urology.2007.06.1100","article-title":"Routine stenting reduces urologic complications as compared with stenting \u201con demand\u201d in adult kidney transplantation","volume":"70","author":"P Georgiev","year":"2007","journal-title":"Urology"},{"key":"pone.0244248.ref033","doi-asserted-by":"crossref","first-page":"3317","DOI":"10.1016\/j.transproceed.2009.08.046","article-title":"Endoscopic management of urologic complications following renal transplantation: Impact of ureteral anastomosis","volume":"41","author":"X Tillou","year":"2009","journal-title":"Transplant Proc"},{"key":"pone.0244248.ref034","doi-asserted-by":"crossref","first-page":"82","DOI":"10.12659\/AOT.881999","article-title":"Complications of ureterovesical anastomosis in adult renal transplantation: Comparison of the Lich-Gregoire and the Taguchi techniques","volume":"16","author":"A Ameer","year":"2011","journal-title":"Ann Transplant"},{"key":"pone.0244248.ref035","doi-asserted-by":"crossref","first-page":"E372","DOI":"10.1111\/j.1399-0012.2012.01655.x","article-title":"Kidney transplant ureteroneocystostomy: Comparison of full-thicknes vs. Lich-Gregoir techniques","volume":"26","author":"L Kayler","year":"2012","journal-title":"Clin Transplant"},{"key":"pone.0244248.ref036","doi-asserted-by":"crossref","first-page":"186","DOI":"10.1016\/j.transproceed.2019.10.008","article-title":"Urologic complications in 4000 kidney transplants performed at the Saint Barnabas Health Care System","volume":"52","author":"M Whang","year":"2020","journal-title":"Transplant Proc"},{"key":"pone.0244248.ref037","doi-asserted-by":"crossref","first-page":"1375","DOI":"10.1016\/S0041-1345(03)00519-0","article-title":"Urologic complications in over 1000 kidney transplants performed at the Saint Barnabas HealthCare System","volume":"35","author":"M Whang","year":"2003","journal-title":"Transplant Proc"},{"key":"pone.0244248.ref038","doi-asserted-by":"crossref","first-page":"1619","DOI":"10.1016\/j.transproceed.2011.02.014","article-title":"Urologic complications in more than 2500 kidney transplantations performed at the Saint Barnabas HealthCare System","volume":"43","author":"M Whang","year":"2011","journal-title":"Transplant Proc"},{"key":"pone.0244248.ref039","doi-asserted-by":"crossref","first-page":"579","DOI":"10.1007\/s11908-011-0210-z","article-title":"Recurrent urinary tract infections in kidney transplant recipients","volume":"13","author":"S Mitra","year":"2011","journal-title":"Curr Infect Dis Rep"},{"key":"pone.0244248.ref040","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1053\/j.ajkd.2004.04.040","article-title":"Late urinary tract infection after renal transplantation in the United States","volume":"44","author":"KC Abbott","year":"2004","journal-title":"Am J Kidney Dis"},{"key":"pone.0244248.ref041","doi-asserted-by":"crossref","first-page":"732","DOI":"10.1097\/TP.0b013e3182a04997","article-title":"Independent risk factors for urinary tract infection and subsequent bacteremia or acute cellular rejection: A single-center report of 1166 kidney allograft recipients","volume":"96","author":"JR Lee","year":"2013","journal-title":"Transplantation"},{"key":"pone.0244248.ref042","doi-asserted-by":"crossref","first-page":"196","DOI":"10.1177\/1526924817699965","article-title":"Vesicoureteral reflux in kidney transplantation","volume":"27","author":"NM Molenaar","year":"2017","journal-title":"Prog Transplant"},{"key":"pone.0244248.ref043","doi-asserted-by":"crossref","first-page":"1400","DOI":"10.1016\/S0022-5347(01)64999-1","article-title":"Pyelonephritis and vesicoureteral reflux after renal transplantation in young children","volume":"157","author":"TJ Neuhas","year":"1997","journal-title":"J Urol"},{"key":"pone.0244248.ref044","doi-asserted-by":"crossref","first-page":"1760","DOI":"10.1097\/TP.0b013e318172802d","article-title":"Complex vascular anatomy in live kidney donation: imaging and consequences for clinical outcome","volume":"85","author":"NF Kok","year":"2008","journal-title":"Transplantation"},{"key":"pone.0244248.ref045","doi-asserted-by":"crossref","first-page":"2769","DOI":"10.1016\/S0041-1345(00)01874-1","article-title":"Urinary complications after kidney transplantation can be reduced","volume":"32","author":"P Blanchet","year":"2000","journal-title":"Transplant Proc"},{"key":"pone.0244248.ref046","doi-asserted-by":"crossref","first-page":"949","DOI":"10.1111\/j.1464-410X.2007.07207.x","article-title":"Surgical anatomy of the ureter","volume":"100","author":"R. Fr\u00f6ber","year":"2007","journal-title":"BJU Int"},{"key":"pone.0244248.ref047","doi-asserted-by":"crossref","first-page":"469","DOI":"10.12659\/AOT.898748","article-title":"Multiple renal arteries in kidney transplantation: a systemic review and meta-analysis","volume":"21","author":"M Zorgdrager","year":"2016","journal-title":"Ann Transplant"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0244248","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,1,11]],"date-time":"2021-01-11T21:15:02Z","timestamp":1610399702000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0244248"}},"subtitle":[],"editor":[{"given":"Justyna","family":"Go\u0142\u0119biewska","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2021,1,11]]},"references-count":47,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2021,1,11]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0244248","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,1,11]]}}}