Ureteral Stenosis After Renal Transplantation—A Single-Center 10-Year Experience

Gil-Sousa, D.; Oliveira-Reis, Daniel; Teves, Frederico; Príncipe, Paulo; Castro-Henriques, António; Soares, José; Fraga, Avelino; Silva-Ramos, Miguel

doi:10.1016/j.transproceed.2017.01.050

Cited by 24 publications

(18 citation statements)

References 29 publications

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“…9,12,14,15 However, the success obtained with interventional radiological methods is significantly reduced in late-stage obstructions and long-segment ureteral stenosis. 10,14,19,20 In this study, we present our results for the novel TVP technique used for the restoration of urinary continuity in 28 patients with types 2 and 3 stenosis. The majority of cases underwent ureteral reconstruction several years posttransplant, suggesting most were ischemic ureteral strictures.…”

Section: Discussionmentioning

confidence: 99%

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Tubular vesicopyelostomy for the management of types 2 and 3 (long-segment) ureteric stenosis after kidney transplantation

et al. 2018

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Late ureteral stenosis following kidney transplantation needs immediate correction in order to protect allograft function and requires a complicated surgical procedure. In this study, we present the long-term results of tubular bladder reconfiguration and cystopyelostomy (tubular vesicopyelostomy), an innovative and practical procedure for the management of long-segment ureteric stenosis (types 2 and 3) after transplantation. Between 2002 and 2017, 722 kidney transplant patients were monitored at the University of Medical Sciences, Bozyaka Organ Transplantation and Research Center. Twenty-eight of these patients underwent tubular vesicopyelostomy operation; 17 male and 11 female patients with a mean age of 45.6 ± 10.5 years. Time to surgical intervention for urinary tract obstruction was 122.5 ± 114.7 months. The mean serum creatinine values previous to and 3 days following the tubular vesicopyelostomy operation were 3.46 ± 1.5 mg/dL and 1.75 ± 0.7 mg/dL, respectively (p < 0.0001). Within a mean follow-up period of 55.1 ± 40.9 months, functional grafts were recorded in 22 patients with a mean serum creatinine value of 1.92 ± 0.8 mg/dL. Only one patient developed anastomotic stenosis after the tubular vesicopyelostomy procedure, giving an overall success rate for tubular vesicopyelostomy of 96.4%. Six patients returned to hemodialysis. In five, the underlying etiology was not related to recurrent obstruction or surgical complications. Sixteen patients underwent allograft biopsy after the operation, but features of tubulointerstitial nephritis were seen in only one. Tubular vesicopyelostomy operation is a safe and successful method for the surgical treatment of late and complicated ureteral obstructions with excellent long-term results. It may be a good, practical alternative to other more sophisticated surgical options.

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Section: Discussionmentioning

confidence: 99%

“…9,12,14,15 However, the success obtained with interventional radiological methods is significantly reduced in late-stage obstructions and long-segment ureteral stenosis. 10,14,19,20…”

Section: Discussionmentioning

confidence: 99%

Tubular vesicopyelostomy for the management of types 2 and 3 (long-segment) ureteric stenosis after kidney transplantation

et al. 2018

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“…9 Reported incidences range from 0.5 to 6.8% [2][3][4][5][9][10][11][12][13][14][15][16][17][18][19] and the majority of cases occur within three months post KT. 14,17,20 Early cases are thought to be related to surgical technique of KT or ischemic fibrosis, whereas later cases are attributed to ureteral fibrosis or compression by the surrounding fibrotic tissue. 6 Some reported risk factors for ureteral strictures include older donor age (> 65 years), recipient male sex, kidneys with more than 2 arteries, delayed graft function, prolonged cold ischemia, fluid collections around the ureter, and BK virus infections.…”

Section: Introductionmentioning

confidence: 99%

“…6 Some reported risk factors for ureteral strictures include older donor age (> 65 years), recipient male sex, kidneys with more than 2 arteries, delayed graft function, prolonged cold ischemia, fluid collections around the ureter, and BK virus infections. 11,[16][17][21][22] There is disagreement regarding the role of surgical technique as a risk factor, with some studies reporting a link, 6,[16][17]21 while others do not, 23 and this may be related to whether a refluxing or non-refluxing anastomosis technique is utilized.…”

Section: Introductionmentioning

confidence: 99%

“…There is also a lack of consensus regarding the best clinical management for these complications. Some studies report immediate open surgical repair (surgical reimplantation of the ureter) as the gold standard and optimal first line of treatment, 5,10,17,[19][20] whereas other cohorts benefited more from minimally invasive treatments, such as percutaneous nephrostomy (PN) with balloon dilation. 11,14,24 Yet others report no significant differences in the success or negative outcomes between the two types of interventions, calling for a case-by-case approach.…”

Section: Introductionmentioning

confidence: 99%

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Ureteral strictures post-kidney transplantation: Trends, impact on patient outcomes, and clinical management

Minkovich¹,

Famure²,

Li³

et al. 2021

CUAJ

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Introduction: Ureteral strictures post-kidney transplantation (KT) can be a significant morbidity to the patient, often requiring surgical intervention and impacting graft function. We sought to investigate the incidence, clinical management, and outcomes of ureteral strictures among kidney transplant recipients (KTRs) at a large, multi-organ transplant center. Methods: We conducted a single-center cohort study looking at KTRs who had transplant surgery from January 1, 2005 to March 31, 2017 with at least one-year followup (n=1742). Any KTRs done outside of our center or simultaneous multiorgan transplants were excluded. The Kaplan-Meier product-limit method was used to determine the incidence of ureteral strictures. Risk factors for ureteric strictures and clinical outcomes among patients with vs. without ureteric strictures were analyzed using Cox proportional hazards models. Results: The incidence of ureteral strictures was 1.31 (95% confidence interval [CI] 0.85, 2.01) per 100 person-years or a cumulative incidence of 1.2%. We did not find any donor or recipient demographic variables that were independently associated with an increased risk of ureteral stricture development. A large proportion was managed successfully with radiologic intervention alone (47.6%). Ureteral strictures were associated with death-censored graft failure (hazard ratio [HR] 7.17, 95% CI 2.81, 18.30), total graft failure (HR 3.04, 95% CI 1.41, 6.59), and hospital re-admission (HR 2.52, 95% CI 1.58, 4.00). Conclusions: Although uncommon, ureteral strictures can significantly impact patient outcomes after KT. A better understanding of risk factors and clinical management will be important to ensure optimal graft outcomes.

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Effectiveness of endourological management of ureteral stenosis in kidney transplant patients: EAU-YAU kidney transplantation working group collaboration

et al. 2023

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Purpose Ureteral stenosis (US) in kidney transplant (KT) recipients is associated with poorer long-term graft survival. Surgical repair is the standard of care, and endoscopic treatment represents an alternative for stenosis < 3 cm. We aimed to determine the effectiveness and safety of endourological management of US in KT patients and predictors of failure. Methods A retrospective multicenter study was conducted in four European referral centers, including all KT patients with US managed endoscopically between 2009 and 2021. Clinical success was defined as the absence of upper urinary tract catheterization, surgical repair or transplantectomy during follow-up. Results A total of 44 patients were included. The median time to US onset was 3.5 months (IQR 1.9–10.8), the median length of stricture was 10 mm (IQR 7–20). Management of US involved balloon dilation and laser incision in 34 (79.1%) and 6 (13.9%) cases, respectively, while 2 (4.7%) received both. Clavien–Dindo complications were infrequent (10%); only one Clavien ≥ III complication was reported. Clinical success was 61% at last follow-up visit (median = 44.6 months). In the bivariate analysis, duckbill-shaped stenosis (vs. flat/concave) was associated with treatment success (RR = 0.39, p = 0.04, 95% CI 0.12–0.76), while late-onset stenosis (> 3 months post KT) with treatment failure (RR = 2.00, p = 0.02, 95% CI 1.01–3.95). Conclusions Considering the acceptable long-term results and the safety of these procedures, we believe that the endoscopic treatment should be offered as a first-line therapy for selected KT patients with US. Those with a short and duckbill-shaped stenosis diagnosed within 3 months of KT seem to be the best candidates.

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Ureteral Stenosis After Renal Transplantation—A Single-Center 10-Year Experience

Cited by 24 publications

References 29 publications

Tubular vesicopyelostomy for the management of types 2 and 3 (long-segment) ureteric stenosis after kidney transplantation

Tubular vesicopyelostomy for the management of types 2 and 3 (long-segment) ureteric stenosis after kidney transplantation

Ureteral strictures post-kidney transplantation: Trends, impact on patient outcomes, and clinical management

Effectiveness of endourological management of ureteral stenosis in kidney transplant patients: EAU-YAU kidney transplantation working group collaboration

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