Late ureteral stenosis following renal transplantation. Metal stents for urologic purpose were created in 1998. Risk factors and impact on patient and graft survival. Guidelines recommend that all patients with chronic. The current role of endourologic management of renal.
The eau renal transplantation guidelines panel consists of an international multidisciplinary group of urological surgeons, a nephrologist and a pathologist. Article in french canton f, gelet a, bouchou f, martin x, similon b, cadi po, faure jl, dubernard jm. Urologic complications in renal transplants choate. Post transplant ureteric stenosis causing allograft. Selfexpanding metallic ureteral stents for treatment of ureteral stenosis after kidney transplantation f.
There are many predisposing factors for ischemic stenosis. The effect of peritoneal dialysis on postkidney transplantation complications have been discussed but its effect on ureteral stenosis is unknown. Management of bilateral ureteral obstruction after. Ureteric reconstruction for the management of transplant.
Is peritoneal dialysis prior to kidney transplantation a. The 5year survival rate for patients with a functioning renal transplant is markedly better than that for individuals on dialysis 85. Workup and management of acute renal insufficiency after transplantation. Major urinary complications such as urinary leaks, stenosis or urinary tract infections after kidney transplantation can lead to graft or patient loss. Management of ureteral complications in renal transplantation. Read ureteral stenosis after kidney transplantation, transplant international on deepdyve, the largest online rental service for scholarly research with thousands of academic publications available at your fingertips.
The aim of this study is to determine the optimal timing for ureteric stent removal after ktx. Endoureteral management of renal graft ureteral stenosis. The most common urological complications following renal transplantation are ureteral stenosis or obstruction, constituting a significant. The placement of ureteral stent urst at kidney transplantation reduces major urological complications but increases the risk for developing nephropathy from the bk virus. Percutaneous balloon dilatation for the treatment of early and late ureteral strictures after renal transplantation. One patient showed severe stenosis of the distal ureter and ureterovesical anastomosis.
Ureteral stenosis after renal transplantationa single. Clinical urology stenting for management of transplant ureteral obstruction international braz j urol vol. Kidney transplantation kt is the definitive treatment for endstage renal disease. Laparoscopic ureterovesical reimplantation for ureteral. In this patient, the procedure failed as well as in one patient with proximal stenosis. Pdf ureteral stenosis after kidney transplantation a. Conventional management includes open surgical repair, although more recently, percutaneous ureteral dilation has been performed. Causes of renal transplant ureteral obstruction the main causes and risk factors for ureteral obstruction. Acucise endoureterotomy for transplant ureteral stricture kaohsiung j med sci may 2007 vol 23 no 5 263 5. The treatment of fistulae and ureteral stenosis after. Bachar gn, mor e, bartal g, atar e, goldberg n, belenky a. When you share what its like to have ureteral stenosis through your profile, those stories and data appear here too.
Multiple treatments have been introduced regarding length and position of the stenosis. Pdf ureteral obstruction following renal transplantation. Got a question about living with ureteral stenosis. Benign ureteric strictures after renal transplantation can be surgically corrected, and good results have been reported 7,8but with a risk of. Urinary leakage and subsequent formation of periureteral fibrosis may also lead to ureteral stenosis.
Longterm graft and patient survival after balloon dilation of. An additional 11 patients were referred from other centers. Ureteral stenosis after kidney transplantation springerlink. Ureteral stenosis definition of ureteral stenosis by. Ureteral obstructions and leaks after renal transplantation.
Timing of ureteric stent removal and occurrence of. Prolonged ureteral stenting in obstruction after renal. Ureteral stenosis due to bk virus infection among kidney. Selfexpanding metallic ureteral stents for treatment of. Pdf renal transplantation, first performed successfully in the 1950s, is the. By continuing to use our website, you are agreeing to our use of cookies. From december 1976 to december 1997, 869 kidney grafts were performed by. The incidence of urological complications after kidney transplantation varies from 3% to. Pdf ureteral stenosis after kidney transplantation. From december 1976 to december 1997, 869 kidney grafts were performed by our kidney transplantation group, 96 from living. Out of 953 kidney transplantations performed in lyon up to the end of 1984, we observed 28 2. Ureteral stenosis after kidney transplantation wiley online library.
Ureteral stenosis is part of the common complications of renal graft reported in 3% to 7% of cases. Percutaneous management of ureteral stenosis of transplanted. Request pdf the treatment of fistulae and ureteral stenosis after kidney transplantation introduction. Late ureteral stenosis after kidney transplantation. The published incidence of ureteral obstruction in renal transplant patients varies from 1. Ureteral stenosis after renal transplantation a singlecenter 10year experience. Decreased incidence of ureteral complications after kidney transplantation is the result of improvements in harvesting techniques, with better preservation of ureteral vasculature, use of a shorter ureter with or without a doublej stent, 1 and a sharp decrease in mean cumulative steroid dosage. Of the 422 consecutive patients after renal transplantation in our center 10 patients had ureteral strictures. A ureteral stricture is characterized by a narrowing of the ureteral lumen, causing functional obstruction. It is unclear whether urst placement increases nephropathy risk by increasing risk of precursor viral replication or by other mechanisms. Three out of five patients with ureteral obstruction after renal transplantation were treated successfully by acucise.
To our knowledge, bilateral ureteral obstruction after pediatric en bloc kidney transplantation has not been reported in the past. In patients with ureteral stenosis, percutaneous nephrostomy pcn was performed and, after two weeks, antegrade pyelography was also. Ureteral stenosis occurs in 210% of renal transplant recipients, which presents with nausea, vomiting, decreased urine output and increased creatinine. We report our experience with percutaneous balloon dilatation pbd for the treatment of ureteral strictures in patients with renal allografts. Ureteral obstruction with impaired urine flow is the most common urological complication following renal transplantation. In the renal transplant setting, ureteral stenosis which occurs from 0. The incidence of ureteral stenosis due to bk virus infection among renal allograft recipients is approximately 3 percent. The management and outcome of all seven allograft ureteral strictures treated with balloon dilation. Diagnosis and management of ureteral complications following. Extensive ureteral stricture eus after renal transplantation rtx is an important urological complication that adversely affects the longterm function of the allograft and therefore the morbidity and mortality of the recipients. In four cases the ureteropelvic junction was affected. To identify the risk factors for ureteral stenosis after renal transplantation and to evaluate their impact on both graft and patient survival. Ischemic distal ureteric obstruction resulting from.
These data suggest an important role for donor age, number of renal arteries and dgf for the occurrence of ureteral stenosis following renal transplantation. Ureteral stenosis is the most common posttransplant complication resulting in hydronephrosis that also requires surgical intervention 6. Ureteral obstruction necessitating intervention occurs in 2% to 7. Ischemia is the most common cause of ureteral stenosis and is the result of excessive hilar dissection and poor anastomotic technique. Treatment of transplant ureteral stricture with acucise. There is limited data regarding management of less common urologic complications after renal transplantation including ureteral kinking, ureteral torsion, clot formation causing obstruction, and bleeding after renal biopsy. Read prolonged ureteral stenting in obstruction after renal transplantation.
Mechanical, ischemic, or congenital anomalies are possible causes for ureteral obstruction. Ureteral obstruction occurs in 210% of renal transplant patients postoperatively, usually presenting within the first few weeks, or the first year. Complications of renal transplantation rsna publications online. Ureteral stenosis after kidney transplantation, transplant. Balloon dilation of ureteral strictures after renal. These complications all have an incidence of less than 1%.
Ureterovesical anastomotic strictures result from technical error or ureteral. Ureteral stenosis after renal transplantationa singlecenter 10year experience. Nevertheless, malignant ureteric stricture should be considered if the stenosis develops late after transplantation, because the incidence of. The most common cause of ureteral stricture is ureteropelvic junction upj obstruction, which is characterized by a congenital or acquired narrowing at the level of the upj see ureteropelvic junction obstruction. Transplant ureteral obstruction masquerading as recurrent. Pdf diagnosis and management of ureteral complications. Laparoscopic ureterovesical reimplantation for ureteral stricture after renal transplantation hao yichang, hou xiaofei, zhao lei, xiao chunlei, liu zhuo, zhang fan, ma lulin department of urology, peking university third hospital, beijing, 100191, china. Vesicoureteral reflux after renal transplant is common. Factors associated with an increased risk of ureteral stenosis development variable odds ratio. Ureteral stent placement increases the risk for developing. Longterm outcomes have been improved significantly with the use of current immunosuppressive regimens. Compare treatments taken by people with ureteral stenosis. Ischemic distal ureteric obstruction resulting from transplant renal artery stenosis. Management of ureteral stenosis after renal transplantation.
This article is based on evidence from large registries, case series, clinical trials where available, and national guidelines. Ten ureteral strictures that developed in nine patients after renal transplantation were managed with balloon catheter dilation and placement of a ureteral stent. Transplantationvascular surgery stanford university. Ureteral obstruction following renal transplantation. From december 1976 to december 1997, 869 kidney grafts were performed by our kidney transplantation group, 96 from living related donors and 773 from cadaver donors 736 first grafts and 37 regrafts. Up to 62% of patients have been successfully treated with maximal decompression nephrostomy tube, ureteral stent, and foley catheter.
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