EDITORIAL COMMENT

Ureter-related urological complications, such as urinary leakage and ureter strictures may lead to increased morbidity and prolonged hospital stay in kidney transplant recipients. In this retrospective study, the authors have evaluated the role of ureteral length on urological complications in 198 living donor kidney recipients followed for a median of 26 months. After shortening every ureter before an intravesical or extravesical ureteroneocystostomy over an ureteral stent, ureteral lengths have been measured in all recipients and used to divide recipients into three categories as short (≤8.5 cm), medium (8.6-10.9 cm) and long (≥11 cm) ureters. Percutaneous nephrostomy tube (PCN) placement had been considered as the primary outcome for urological complications. Eightten percent of the recipients in the short ureter, 20% of the medium ureter and 21% of the long ureter category had experienced PCN placement (p=0.886). Even after excluding the PCN placements for simple hydronephrosis cases, no significant difference were observed between three ureter categories. Although the number of PCN placements was higher than in the literature, the authors claim that they use a lower threshold for PCN placement even in low-grade hydronephrosis. Risk factor analysis for gender, arterial multiplicity and type of ureteroneocystostomy showed no differences in PCN placements between the three ureteral length categories. The authors have concluded that ureteral length alone did not seem to influence the number of urological complications in living donor kidney transplantation. However, further research should be planned on microvascular blood flow of the ureter to enlighten the risk factors for the development of urological complications.