Endoscopic antireflux surgery leading to obstruction in pediatric renal transplant patients

Abstract

To describe a multicenter experience with management of ureteral obstruction after injection of Dx/HA for VUR in pediatric renal transplant patients. The records of all pediatric renal transplant patients who underwent Dx/HA injection for VUR and had subsequent obstruction were identified, and the management and outcomes were reviewed. Follow-up ranged from 1 to 10 years. There were four patients identified, all of whom had a history of rising creatinine, recurrent UTI, and increasing hydronephrosis which led to the diagnosis of high-grade VUR. Obstruction was diagnosed within 24-72 hours after injection in three patients. One patient was asymptomatic, and rising creatinine and hydronephrosis were noted 1 month after injection. One patient was managed expectantly, while three patients underwent ureteral stent placement. After the stent was removed, one patient went on to open reimplant due to delayed obstruction, the second patient with voiding dysfunction is currently managed with an indwelling ureteral stent and may require further definitive surgery, the third patient recovered, and the fourth is being observed. Our cases illustrate that despite initial successful management of the obstruction in some, delayed obstruction is possible and may necessitate open reimplant. It is imperative that these patients have close follow-up after Dx/HA.

When does vesicoureteral reflux in pediatric kidney transplant patients need treatment?

“…The possibility that the resolution of VUR in two patients was due to spontaneous resolution rather than due to Dx/HA cannot be excluded. The rate of obstruction after Dx/HA in native ureters is low (<1%), and while there are reports of obstruction after Dx/HA injection into pediatric transplant ureters, the severity of this complication is worrisome . We report an alarming complication of Dx/HA injection into transplant ureters, which is delayed obstruction occurring 2 years after injection.…”