A 4-Year Review of Balloon Dilation of Ureteral Strictures in Renal Allografts

Bromwich, E.; Coles, Simon; Atchley, J.; Fairley, I; Brown, J. L.; Keoghane, S.R.

doi:10.1089/end.2006.20.1060

Cited by 29 publications

(21 citation statements)

References 2 publications

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“…In 2 cases, endoscopic dilation was applied. This technique is seldom used because it has a low success rate and a high recurrence rate compared with open technique, especially if the obstructive lesion is relatively long [7][8][9] . All urological complications after revision of the ureterovesical anastomosis occurred in patients who had undergone neoureterocystostomy.…”

Section: Discussionmentioning

confidence: 99%

Ureteral Reconstruction after Renal Transplantation: Clinical Outcome and Risk Factors

Alberts¹,

Minnee²,

Bemelman³

et al. 2012

Urol Int

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Introduction: The incidence of urological complications after renal transplantation ranges from 2.5 to 30%. Often surgical revision is necessary. The risk factors for surgical revision and which surgical techniques to apply are not elucidated. This study investigates the outcome and risk factors for surgical revision of the ureterocystostomy. Materials and Methods: Between January 1995 and March 2009, 1,157 consecutive kidney transplantations were performed. All patient charts and surgical reports were reviewed. Results: Urological complications occurred in 142 (12.3%) patients. In 60 patients (5.2%) surgical revision was necessary. Of these 60 patients, 43 (71.7%) received neoureterocystostomy, 10 (16.7%) ureteropyelostomy reconstruction and 7 (11.7%) other techniques. Independent risk factors for surgical revision were donor ureteral reconstruction (odds ratio (OR) 48.66, 95% confidence interval (CI) 5.01–472.97), recipient age <18 years (OR 4.85, 95% CI 1.50–15.72) and delayed graft function (OR 2.70, 95% CI 1.36–5.36). Ureteral stenting was a protective factor for surgical revision (OR 0.30, 95% CI 0.12–0.81). The urological complication rates after neoureterocystostomy, ureteropyelostomy reconstruction and other techniques were 16, 0 and 0%, respectively. The overall surgical success rate was 92%. Conclusions: Ureteral stenting, recipient age, delayed graft function and perioperative ureteral reconstruction are significant factors associated with surgical revision of the ureterocystostomy. Surgical revision of the ureterocystostomy is a successful therapy with a low recurrence rate.

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Section: Discussionmentioning

confidence: 99%

Ureteral Reconstruction after Renal Transplantation: Clinical Outcome and Risk Factors

Alberts¹,

Minnee²,

Bemelman³

et al. 2012

Urol Int

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“…[9] reported that 13 patients underwent dilatation with (nine patients) or with no (four) diathermic incision, only the four patients treated with dilatation had recurrent obstruction, while the nine treated with dilatation and incision had no obstruction recurrence (mean follow-up 58 months, range there was no recurrence of obstruction in six of eight patients. The outcomes of published reports (with more than five patients) on endoscopic management for ureteric obstruction in transplanted kidneys are summarized in Table 2 [6,7,[9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24]. The total long-term success rate was 68%.…”

Section: Discussionmentioning

confidence: 99%

“…Recently Bromwich et al . [23] reported that the success rate of repeated multiple balloon dilatations for ureteric strictures in renal allografts was only 25%, they also recommended that definitive surgical management should be considered if a first dilatation fails.…”

Section: Discussionmentioning

confidence: 99%

“…Traditionally this complication has been managed with open surgery, with considerable morbidity and mortality [3,4]. Currently, minimally invasive endourological techniques, such as percutaneous antegrade or transurethral retrograde endoluminal balloon dilatation and ureterotomy, are being used more frequently for treatment with high success rates and lower complication rates, and thus may offer an appropriate alternative to open surgery [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23]. Endoscopic management for obstructive uropathy has been used in our institution for the last 12 years.…”

Section: Introductionmentioning

confidence: 99%

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Endoscopic incision for obstruction of vesico‐ureteric anastomosis in transplanted kidneys

He¹,

Li²,

Chen³

et al. 2008

BJU International

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OBJECTIVE To report our experience of endoscopic incision for obstruction of vesico‐ureteric anastomosis (VUA) in transplanted kidneys. PATIENTS AND METHODS Between February 2001 and March 2006, six men and two women (mean age 38 years, range 27–57) with VUA obstruction in their transplanted kidneys were treated by percutaneous nephrostomy and endoscopic incision. After the anastomosis was completely cut, two JJ stents were placed in the ureter for 4–6 weeks. During the follow‐up, serum urea, creatinine and uric acid levels were measured, and urine culture, ultrasound examination and washout renal scintigraphy were performed every month for the first 6 months, then every 3 months. RESULTS In all, 12 procedures of endoureterotomy were performed and all procedures resulted in successful incision of the obstruction. There were no complications during or after the procedures. The retrograde and antegrade endoureterotomies were performed with four procedures in two patients and eight procedures in six patients, respectively. At a mean (range) follow‐up of 16 (4–45) months, five of the eight patients had ureteric patency and stable renal function. In three patients there was a recurrence of obstructive uropathy, immediately after JJ stent removal, which finally required open surgical correction. CONCLUSIONS Percutaneous nephrostomy and endoscopic incision is safe and effective for obstruction of VUA in transplanted kidney, and it can be the initial therapy for ureteric obstruction in transplanted kidneys; however, open surgical reconstruction should be considered if the initial endoscopic incision procedure fails.

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“…The reported success rate after initial ureteroplasty with a plain balloon is low in the literature, between 45% and 58% 3,8 . The success rate is even lower following subsequent ureteroplasty for persistent stricture 9 …”

Section: Introductionmentioning

confidence: 96%

Comparison of tandem ureteral stents, cryoplasty, and cutting balloon ureteroplasty in treatment of refractory transplant ureteral strictures

Jalaeian

Talaie

Hunter

et al. 2020

Clinical Transplantation

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The objective of study was to compare clinical outcome of cryoplasty, tandem stents, and cutting balloon ureteroplasty as “bailout procedures” to prevent surgical intervention or stent dependency in renal transplant patients with refractory ureteral stricture. All patients who underwent a bailout procedure from June 11, 2003, to August 8, 2015, at a single institution were reviewed retrospectively. Refractory ureteral stricture was defined as ureteral stenosis not responding to at least two prior percutaneous plain balloon ureteroplasties. Primary patency was defined as stable allograft function following the procedure with unobstructed urine outflow, not requiring indwelling ureteral stent, repeat ureteroplasty, or surgical revision. Sixty‐one procedures were performed on 51 patients. Patients were followed up for a median of 286 days. Overall primary patency rate was 26.1%. Primary patency rate by method was 38.1%, 23.1%, and 14.3% after cryoplasty, tandem stent placement, and cutting balloon dilatation, respectively (P = .260). Primary patency rate was higher in early (<3 months post‐transplant) ureteral strictures (35.7% vs 13.3%; P = .047). More complications identified in patients who had tandem ureteral stents (P = .00754). As some renal transplant patients may not be good operative candidates for ureteral revision, it would be reasonable to attempt one of these “bailout” interventions as long as the clinical team and patient are aware of overall low potential for achieving primary patency.

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A 4-Year Review of Balloon Dilation of Ureteral Strictures in Renal Allografts

Abstract: Definitive surgical management should be considered if obstruction persists after one attempt at ureteral dilation, as multiple dilations have a low success rate (25%).

Cited by 29 publications

References 2 publications

Ureteral Reconstruction after Renal Transplantation: Clinical Outcome and Risk Factors

Ureteral Reconstruction after Renal Transplantation: Clinical Outcome and Risk Factors

Endoscopic incision for obstruction of vesico‐ureteric anastomosis in transplanted kidneys

Comparison of tandem ureteral stents, cryoplasty, and cutting balloon ureteroplasty in treatment of refractory transplant ureteral strictures

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