Urinary Tract Morbidity in Renal Transplantation

Current progress in the field of renal allotransplantation may make this experimental modality a commonplace therapeutic procedure in medical centers throughout the country. The problems of allograft rejection far outweigh technical difficulties with the vascular anastomoses. This is not true, however, with ureteral reconstitution. As the ability to counteract the early rejection crisis improves, the morbidity and complications resulting from ureteral surgery become manifest. Ureterocutaneous fistulae are common complications and their incidence has prompted the development of several new techniques, some hitherto untried in clinical surgery. Starzl¹ has advocated a seromuscular ureteroureteral anastomosis with fine silk which in his hands and others has given excellent results.² Leadbetter has reported a pyeloureteric anastomosis with equal success.³ The Politano-Leadbetter procedure⁴ has been employed in many centers with satisfactory results. The variety of surgical operations utilized attests to the frequency of problems encountered. Since it is often difficult to