Obstructive Uropathy in the Transplanted Kidney: Definitive Management with Percutaneous Nephrostomy and Prolonged Ureteral Stenting

Pappas, Paris; Giannopoulos, Aris; Stravodimos, Konstantinos; Zavos, G.; Alexopoulos, T.; Boletis, J.; Tzortzis, George; Kostakis, A.

doi:10.1089/08927790152596316

Cited by 17 publications

(7 citation statements)

References 18 publications

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“…Regan et al 3 also performed routine stent insertion and stated that stents caused less symptoms or complications and prevented morbidity. Pappas et al 2 did not perform routine stent insertion and experienced ureteric obstruction in 15 of the 932 patients only, which they could manage successfully.…”

Section: Discussionmentioning

confidence: 99%

Stent extrusion on the external surface of the transplanted kidney: unusual occurrence

2017

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Here we present the case of a 40-year-old man, who underwent deceased donor renal transplantation. Towards the end of this operation, open-ended double J stent was inserted in the transplanted kidney. Modified Lich-Gregoir ureterovesical anastomosis was performed. Prior to the abdominal closure, it was discovered that proximal end of the stent had pierced the renal parenchyma and extruded on the external surface of the transplanted kidney. We contemplated removing the stent and reinserting it but decided against that due to various reasons. The stent was left as such. The patient was managed conservatively with satisfactory outcome in the postoperative period. To the best of our knowledge, this is first such report of conservative management of stent extrusion in transplanted kidney in the literature.

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Section: Discussionmentioning

confidence: 99%

Stent extrusion on the external surface of the transplanted kidney: unusual occurrence

2017

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“…Pappas et al . [12] managed obstructive uropathy in transplanted kidneys with percutaneous nephrostomy and prolonged ureteric stenting. After prolonged ureteric stenting (mean duration 15 months), there was no recurrence of obstruction in six of eight patients.…”

Section: Discussionmentioning

confidence: 99%

“…[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%

“…After prolonged ureteric stenting (mean duration 15 months), 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[6,7,9–24]. The total long‐term success rate was 68%.…”

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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Endoscopic Management of Mid‐ureteral Obstruction

Abourbih

Baldwin

2018

Smith's Textbook of Endourology

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Obstructive Uropathy in the Transplanted Kidney: Definitive Management with Percutaneous Nephrostomy and Prolonged Ureteral Stenting

Abstract: Percutaneous nephrostomy and ureteral stenting is a safe and effective treatment for renal allograft obstructive uropathy. Prolonged ureteral stenting may offer a definitive treatment with low morbidity.

Cited by 17 publications

References 18 publications

Stent extrusion on the external surface of the transplanted kidney: unusual occurrence

Stent extrusion on the external surface of the transplanted kidney: unusual occurrence

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

Endoscopic Management of Mid‐ureteral Obstruction

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