Endourological Management is Better in Early-Onset Ureteral Stenosis in Kidney Transplantation

Juaneda, B.; Alcaraz, Antonio; Bujons, Anna; Guirado, Luís; Díaz, J.M.; Martí, J.L. Palmero; Torre, P. de la; Sabaté, Sergi; Villavicencio, H.

doi:10.1016/j.transproceed.2005.09.199

Cited by 53 publications

(32 citation statements)

References 6 publications

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“…Several contemporary series of primary balloon dilation have been published including a total of 94 patients [8–11]. At a mean follow-up of 37.3 months (range 17 to 78 months), the reported success rate was 51% (range 44% to 62%).…”

Section: Resultsmentioning

confidence: 99%

The Current Role of Endourologic Management of Renal Transplantation Complications

Duty

Conlin

Fuchs

et al. 2013

Advances in Urology

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Introduction. Complications following renal transplantation include ureteral obstruction, urinary leak and fistula, urinary retention, urolithiasis, and vesicoureteral reflux. These complications have traditionally been managed with open surgical correction, but minimally invasive techniques are being utilized frequently. Materials and Methods. A literature review was performed on the use of endourologic techniques for the management of urologic transplant complications. Results. Ureterovesical anastomotic stricture is the most common long-term urologic complication following renal transplantation. Direct vision endoureterotomy is successful in up to 79% of cases. Urinary leak is the most frequent renal transplant complication early in the postoperative period. Up to 62% of patients have been successfully treated with maximal decompression (nephrostomy tube, ureteral stent, and Foley catheter). Excellent outcomes have been reported following transurethral resection of the prostate shortly after transplantation for patients with urinary retention. Vesicoureteral reflux after renal transplant is common. Deflux injection has been shown to resolve reflux in up to 90% of patients with low-grade disease in the absence of high pressure voiding. Donor-gifted and de novo transplant calculi may be managed with shock wave, ureteroscopic, or percutaneous lithotripsy. Conclusions. Recent advances in equipment and technique have allowed many transplant patients with complications to be effectively managed endoscopically.

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Section: Resultsmentioning

confidence: 99%

The Current Role of Endourologic Management of Renal Transplantation Complications

Duty

Conlin

Fuchs

et al. 2013

Advances in Urology

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“…Minimally invasive endoscopic or percutaneous management is often the first option for patients with ureteral strictures after renal transplant surgery. Percutaneous balloon dilation success rates in patients have been reported as 50%[5,6]. Prognostic factors for successful dilatation include early diagnosis after transplant, length of stricture and a previous episode of rejection [6].…”

Section: Discussionmentioning

confidence: 99%

“…Percutaneous balloon dilation success rates in patients have been reported as 50%[5,6]. Prognostic factors for successful dilatation include early diagnosis after transplant, length of stricture and a previous episode of rejection [6]. However, in many patients, acute renal failure/oliguria/hydronephrosis representing stricture disease does not present early after renal transplantation, and endoscopic management is less likely to be a viable option.…”

Section: Discussionmentioning

confidence: 99%

“…In one study of 56 patients with ureteral stenosis after kidney transplant, initial treatment with percutaenous nephrostomy followed by balloon dilatation and stenting resulted in a 45% success rate [6]. Considering patients in the same series who presented more than 5 months after initial transplant surgery, the success rate of endourologic treatment was only 11% ( P = 0.6) [6]. In our series of late‐onset ureteral strictures, none of seven patients were succesfully treated with balloon dilatation and stenting.…”

Section: Discussionmentioning

confidence: 99%

“…Those patients found to have ureteral strictures as the cause of obstruction may be initially treated by endoscopic or percutaneous management, including JJ stent insertion or percutaneous balloon dilatation. However, although these techniques are minimally invasive, they are often limited by their success rates, which are in the range 45–62%[5,6]. When these endoscopic options fail or are not feasible, more definitive surgical corrections are required to prevent subsequent renal failure and/or allograft loss.…”

Section: Introductionmentioning

confidence: 99%

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Reconstruction of late‐onset transplant ureteral stricture disease

et al. 2010

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Study Type – Therapy (case series) Level of Evidence 4 What’s known on the subject? and What does the study add? Most of the published literature reporting on ureteral obstruction after renal transplantation details the outcomes of management when performed within a few months post‐transplantation. The present study attempts to document the management and outcomes of patients who develop delayed ureteral strictures after renal transplant. OBJECTIVE • To describe our experience with surgical management of transplant ureteral strictures over a 6‐year period. PATIENTS AND METHODS • The present study identified patients who underwent open reconstruction for transplant ureteral strictures between March 2002 and May 2008 after kidney or kidney–pancreas transplantation. • Baseline clinical characteristics were documented, including age at transplantation and reconstruction, serum creatinine levels, immunosuppressive drug regimen, and comorbidities. • Postoperative complications were noted, including urinary tract infections, stricture recurrence and graft failure. • Successful reconstructions were defined as stable allograft function with unobstructed outflow not requiring repeat dilation, ureterotomy or stent placement. RESULTS • Median age at the time of reconstruction was 51 years and the mean time from transplantation was 62 months. • Seven of the 13 patients had failed previous balloon dilation. • The patients were followed for a median of 41 months and a successful repair was achieved in 10 of 13 patients. • Ureteral strictures recurred in two patients who received ureteroneocystostomies, which were subsequently managed with chronic stent exchanges. • Another recurrence involved a 1.5‐cm anastomotic stricture 6 months postoperatively, which was balloon‐dilated and has remained recurrence‐free for 16 months. CONCLUSIONS • Patients who present >6 months after renal transplantation with ureteral strictures that are recalcitrant to endoscopic management can safely undergo open surgical ureteral reconstruction without subsequent renal or graft failure. • Further investigation involving a larger patient cohort is required to confirm these initial results.

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Post‐Transplant Diagnostic Imaging

Ratnam

Patel

2012

Handbook of Renal and Pancreatic Transplantation

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Endourological Management is Better in Early-Onset Ureteral Stenosis in Kidney Transplantation

Cited by 53 publications

References 6 publications

The Current Role of Endourologic Management of Renal Transplantation Complications

The Current Role of Endourologic Management of Renal Transplantation Complications

Reconstruction of late‐onset transplant ureteral stricture disease

Post‐Transplant Diagnostic Imaging

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