Surgical Treatment for Ureteral Obstruction After Kidney Transplantation

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Abstract

Introduction

Ureteral obstruction occurs in 2% to 10% of renal transplant patients postoperatively, usually presenting within the first few weeks or the first year. Ureteric ischemia is the most common cause, accounting for around 90% of occurrences. The first option for treatment is interventional radiological methods. Percutaneous therapy of ureteral strictures consists of balloon dilatation with or without temporary stenting. If all of these methods are unsuccessful, surgical treatment should be applied. We evaluate the outcomes of 5 patients who treated with surgical teqniques for ureteral obstruction.

Materials and Methods

Since November 1975, we performed 2646 RT procedures at two different centers by the same transplantation team. At our institution, we perform ureteral anastomoses by means of a corner saving technique. We performed 7 surgical procedures for ureteral obstructions. All patients with ureteral occlusion had recurrent urinary tract infection before surgical treatment and interventional radiological procedures were performed prior to surgery.

Results

Four of the patients were living donor kidney transplantation and 3 of them were deceased donor transplantation. Four of them were female. For 4 patients, the old ureteroneocystostomy was terminated and new ureteroneocystostomy was performed. In 1 patient, we performed native nephrectomy and end-to-side anastomosis between the native ureter and graft’s renal pelvis. In 2 patients, we performed ureteroureterostomy and side-to-side anastomosis between the native and graft ureters. During the surgical procedure, double J stent was placed in to the anastomosis and removed in the first month. After reconstruction procedure urinary tract infection did not occur. During the follow up period graft functions are normal.

Conclusions

Ureteral strictures are rare complications that can lead to graft loss. Prompt diagnosis and remedial treatment are vital to prevent graft loss. The interventional radiological methods are the first choice for treatment, surgical procedures should be performed in patients who do not benefit from these treatments.

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