Classification of Ureteral Stenosis and Associated Strategy for Treatment After Kidney Transplant

He, Bulang; Bremner, Alexandra; Han, Ying

doi:10.6002/ect.2012.0179

Cited by 14 publications

(16 citation statements)

References 24 publications

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“…However, 11 of these patients had successful balloon dilatation and would have been subjected to unnecessary surgical intervention when following this classification. 12 Based on the results of our cohort, we would advise performing a balloon dilatation before surgical revision, as it is less invasive, irrespective of the proposed grading system. There are some limitations to this study.…”

Section: Discussionmentioning

confidence: 98%

“…In their study, they defined 3 grades of ureteral strictures: grade 1 included hydronephrosis without an evidently strictured segment, grade 2 included hydronephrosis with ≤ 1-cm strictured segment, and grade 3 included hydronephrosis with > 1-cm strictured segment. 12 They proposed the following treatment options: grade 1 cases would receive prolonged stent insertion for 6 weeks, grade 2 cases would receive cystoscopy with incision or balloon dilatation followed by stent insertion for 6 weeks, and grade 3 would have surgery. When we applied this classification and treatment strategy to our cohort, 17 patients would fit the grade 2 classification; in 9 of these patients, balloon dilatation was successful.…”

Section: Discussionmentioning

confidence: 99%

“…On the basis of the available literature, double J catheter placement has a favorable outcome; however, this would indicate that an additional cystoscopy would be necessary to remove the double J catheter. 9,12 A drain in the PCNU position would give the benefit of a stented stricture postdilatation treatment, lacking the risks of an additional cystoscopy.…”

Section: Discussionmentioning

confidence: 99%

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Ooms

Moelker²,

Roodnat³

et al. 2018

Exp Clin Transplant

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Objectives: The aim of this study was to investigate the effects of antegrade balloon dilatation on ureteral strictures that developed after kidney transplant. Materials and Methods: The hospital databases of the Erasmus Medical Center (Rotterdam, The Netherlands) and the Academic Medical Center (Amsterdam, The Netherlands) were retrospectively screened for patients who underwent balloon dilatation after kidney transplant. Balloon dilatation was technically successful whenever it was able to pass the strictured segment with the guidewire followed by balloon inflation; the procedure was clinically successful if no further interventions (for example, surgical revision of the ureteroneocystostomy or prolonged double J placement) were necessary. Results: Fifty patients (2.4%) of 2075 kidney transplant recipients underwent antegrade balloon dilatation because of urinary outflow obstruction. Median time between transplant and balloon dilatation was 3 months (range, 0-139 mo). In 43 patients (86%), balloon dilatation was technically successful. In the remaining 7 patients (14%), it was impossible to pass the strictured segment with the guidewire. In 20 of 43 patients (47%) having a technically successful procedure, the procedure was also clinically successful, with median follow-up after balloon dilatation of 35.5 months (range, 0-102 mo). We did not identify any patient or stricture characteristic that influenced the outcome of treatment. Conclusions: Balloon dilatation is a good option for ureter stricture treatment after kidney transplant as it is minimal invasive and can prevent surgical exploration in almost 50% of cases.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Untitled

Ooms

Moelker²,

Roodnat³

et al. 2018

Exp Clin Transplant

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“…However, they still have risk of causing full‐thickness ureteral incisions resulting in urine extravasation 19 . In addition, high rate of recurrence of stenosis has been previously reported after using cutting balloons for ureteral strictures greater than 1 cm in length 21,22 . The mechanism may be similar to the exuberant healing response and fibrosis due to microtome trauma, which is seen in porcine coronary endothelium after application of cutting balloons 23 …”

Section: Discussionmentioning

confidence: 99%

Comparison of tandem ureteral stents, cryoplasty, and cutting balloon ureteroplasty in treatment of refractory transplant ureteral strictures

Jalaeian

Talaie

Hunter

et al. 2020

Clinical Transplantation

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The objective of study was to compare clinical outcome of cryoplasty, tandem stents, and cutting balloon ureteroplasty as “bailout procedures” to prevent surgical intervention or stent dependency in renal transplant patients with refractory ureteral stricture. All patients who underwent a bailout procedure from June 11, 2003, to August 8, 2015, at a single institution were reviewed retrospectively. Refractory ureteral stricture was defined as ureteral stenosis not responding to at least two prior percutaneous plain balloon ureteroplasties. Primary patency was defined as stable allograft function following the procedure with unobstructed urine outflow, not requiring indwelling ureteral stent, repeat ureteroplasty, or surgical revision. Sixty‐one procedures were performed on 51 patients. Patients were followed up for a median of 286 days. Overall primary patency rate was 26.1%. Primary patency rate by method was 38.1%, 23.1%, and 14.3% after cryoplasty, tandem stent placement, and cutting balloon dilatation, respectively (P = .260). Primary patency rate was higher in early (<3 months post‐transplant) ureteral strictures (35.7% vs 13.3%; P = .047). More complications identified in patients who had tandem ureteral stents (P = .00754). As some renal transplant patients may not be good operative candidates for ureteral revision, it would be reasonable to attempt one of these “bailout” interventions as long as the clinical team and patient are aware of overall low potential for achieving primary patency.

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“…In addition to VUR, ureteral leakage and stenosis are frequent postoperative complications that increase the risk of impaired graft function or even graft loss. Both may present as hydronephrosis or pelvic fluid collection on ultrasonography . Another common complication is the occurrence of urinary tract infections (UTIs) facilitated by immunosuppressive treatment and exposure to nosocomial pathogens .…”

Section: Introductionmentioning

confidence: 99%

Gender has no influence on VUR rates after renal transplantation

et al. 2014

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SummaryThe influence of recipient gender on urological complications including vesicoureteral reflux (VUR) after renal transplantation has not yet been established. In this study, post-transplantation voiding cystourethrography and ultrasonography were used to evaluate the upper and lower urinary tract in 598 consecutive renal transplant recipients. Our cohort included 209 females and 389 males, respectively. Gender-specific urological complications and potential confounders were analyzed in relation to long-term allograft outcomes. Postoperative urinary retention occurred more frequently in men (P = 0.004). Urinary tract infections (UTIs) were diagnosed more frequently in women after transplantation (P = 0.05). In a multivariate analysis, gender was not a risk factor for VUR [HR, 1.35 (CI, 0.90-1.96); P = 0.14]. VUR rates were influenced by the surgeon's experience level at the time of transplantation [HR, 0.59 (CI, 0.40-0.87); P = 0.008]. No gender-specific differences were seen for ureteral stenosis, leakage, hydronephrosis, death-censored graft or patient survival, and long-term allograft function. Donor/recipient gender mismatch had no impact on postoperative complication rates. In conclusion, male transplant recipients are at risk for developing postoperative urinary retention, whereas female patients more likely develop UTIs. Surgeon's experience level is a risk factor for developing VUR.

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Classification of Ureteral Stenosis and Associated Strategy for Treatment After Kidney Transplant

Cited by 14 publications

References 24 publications

Untitled

Untitled

Comparison of tandem ureteral stents, cryoplasty, and cutting balloon ureteroplasty in treatment of refractory transplant ureteral strictures

Gender has no influence on VUR rates after renal transplantation

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