“Pantaloon” Ureteroneocystostomy for Double Ureter Kidney Grafts: A Matched Single-Center Study of Perioperative and Long-Term Outcomes over 14 Years

Background/Objectives: Double ureter kidney grafts raise concerns about increased urologic complications. Limited data exist on optimal surgical management due to small sample sizes in previous reports. This study evaluated outcomes using pantaloon ureteroneocystostomy in the largest reported cohort worldwide. Research Questions: Does pantaloon ureteroneocystostomy achieve comparable outcomes to single ureter transplants? Are long-term graft survival and function equivalent? Should this technique be adopted as standard practice? Methods: This retrospective matched cohort study involves 2210 kidney transplantations (2010–2024). Twenty-six double ureter grafts underwent pantaloon ureteroneocystostomy with dual stenting. Controls matched 1:1 for donor type, era, and recipient characteristics. The primary outcome was urologic complications. Statistical analysis included Kaplan–Meier survival curves and Mann–Whitney U tests. Results: Groups were well matched (median age: 51 vs. 52 years, 50% living donors each). Urologic complications occurred in 3.8% double ureter versus 7.7% control grafts (p = 1.000), markedly lower than 15.4% reported in recent literature. The single complication was early urinary leak, surgically repaired. No late strictures developed. The 5-year graft survival was 96.0% vs. 92.3% (p = 1.000). The final creatinine was comparable (1.25 vs. 1.28 mg/dL, p = 0.891). Conclusions: The pantaloon technique achieves superior outcomes in the largest reported double ureter cohort, with complication rates lower than previously published series. These findings support adopting this standardized approach globally to expand donor criteria while maintaining excellent outcomes.