Objectives: Ureteral obstruction, vesicoureteral reflux (VUR), and urine leak constitute the most common urological complications following pediatric kidney transplantation (KT). Redo ureteroneocystostomy (UNC) is one of the methods used in the treatment of these complications. This study aims to systematically review the available evidence regarding the success and complications associated with redo UNC in pediatric KT recipients.
Methods: This systematic review (SR) focused on studies examining the success and complications of redo UNC in pediatric KT recipients, limited to English-language publications. The SR was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines with the searches encompassing databases of Web of Science, PubMed, and Scopus.
Results: After screening 253 abstracts, nine studies with a total of 78 patients were included. The most common indication for redo UNC was VUR (50/78, 64.1%), followed by obstruction (19/78, 24.4%), urine leak (5/78, 6.4%), urinary fistula (3/78, 3.8%), and ureteral necrosis (1/78, 1.3%). The extravesical method was used in 15 patients, with the modified Lich-Gregoir technique being the most frequent. The intravesical approach, most commonly the Cohen technique, was used in 14 patients. The average success rate for redo UNC was 91.4%. Postoperative complications included urinary tract infections and urinary obstruction.
Conclusion: Based on currently limited available data, redo UNC is an effective and safe option for pediatric KT recipients with ureteral complications.
Trial registration: PROSPERO: CRD42024592989.
Keywords: kidney transplantation; pediatrics; reimplantation; ureteral obstruction; vesicoureteral reflux.
© 2025 The Japanese Urological Association.