Reconstruction of late-onset transplant ureteral stricture disease

Brian T. Helfand, Jessica P. Newman, Anne K. Mongiu, Parth Modi, Joshua J. Meeks, Christopher M. Gonzalez

Research output: Contribution to journalArticle

15 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)982-987
Number of pages6
JournalBJU International
Volume107
Issue number6
DOIs
StatePublished - Mar 2011

Keywords

  • Kidney transplant
  • Outcomes
  • Pyelovesicostomy
  • Transplant ureteral stricture
  • Ureteroneocystostomy

ASJC Scopus subject areas

  • Urology

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    Helfand, B. T., Newman, J. P., Mongiu, A. K., Modi, P., Meeks, J. J., & Gonzalez, C. M. (2011). Reconstruction of late-onset transplant ureteral stricture disease. BJU International, 107(6), 982-987. https://doi.org/10.1111/j.1464-410X.2010.09559.x