Retrograde Endoureterotomy for Persistent Ureterovesical Anastomotic Strictures in Renal Transplant Kidneys After Failed Antegrade Balloon Dilation

Mano, Roy; Golan, Shay; Holland, Ronen; Livne, Pinhas M.; Lifshitz, David A.

doi:10.1016/j.urology.2012.02.030

Cited by 34 publications

(25 citation statements)

References 21 publications

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“…The ureterovesical anastomosis is most commonly involved. The reported incidence varies from 1% to 4.5% [6]. Stricture formation usually results from ureteral devascularization, but extrinsic obstruction (e.g., lymphocele, fibrosis) and errors in surgical technique may also occur.…”

Section: Resultsmentioning

confidence: 99%

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The Current Role of Endourologic Management of Renal Transplantation Complications

Duty

Conlin

Fuchs

et al. 2013

Advances in Urology

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Introduction. Complications following renal transplantation include ureteral obstruction, urinary leak and fistula, urinary retention, urolithiasis, and vesicoureteral reflux. These complications have traditionally been managed with open surgical correction, but minimally invasive techniques are being utilized frequently. Materials and Methods. A literature review was performed on the use of endourologic techniques for the management of urologic transplant complications. Results. Ureterovesical anastomotic stricture is the most common long-term urologic complication following renal transplantation. Direct vision endoureterotomy is successful in up to 79% of cases. Urinary leak is the most frequent renal transplant complication early in the postoperative period. Up to 62% of patients have been successfully treated with maximal decompression (nephrostomy tube, ureteral stent, and Foley catheter). Excellent outcomes have been reported following transurethral resection of the prostate shortly after transplantation for patients with urinary retention. Vesicoureteral reflux after renal transplant is common. Deflux injection has been shown to resolve reflux in up to 90% of patients with low-grade disease in the absence of high pressure voiding. Donor-gifted and de novo transplant calculi may be managed with shock wave, ureteroscopic, or percutaneous lithotripsy. Conclusions. Recent advances in equipment and technique have allowed many transplant patients with complications to be effectively managed endoscopically.

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Section: Resultsmentioning

confidence: 99%

“…The endoureterotomy may be made with a cold knife, electrocautery, or Holmium laser. The overall success rate from five series was 79% (range 63% to 100%) at a mean follow-up of 29 months [6, 14–17]. However, these were small, heterogeneous studies that included all three techniques performed from both antegrade and retrograde approaches.…”

Section: Resultsmentioning

confidence: 99%

The Current Role of Endourologic Management of Renal Transplantation Complications

Duty

Conlin

Fuchs

et al. 2013

Advances in Urology

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“…[ 19 20 ] Balloon dilatation has successfully been combined with cold knife and bugbee endoureterotomy. [ 21 ] The success rate of balloon dilatation is about 50%, its failures can be salvaged by endoureterotomy and the success rate is about 83%. [ 21 ] Repeat dilatation has poor results (25%).…”

Section: Resultsmentioning

confidence: 99%

The development and current status of minimally invasive surgery to manage urological complications after renal transplantation

et al. 2016

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Introduction:In the past, urological complications after renal transplantation were associated with significant morbidity. With the development and application of endourological procedures, it is now possible to manage these cases with minimally invasive techniques.Materials and Methods:A MEDLINE search for articles published in English using key words for the management of urological complications after renal transplantation was undertaken. Forty articles were selected and reviewed.Results:The incidence of urological complications postrenal transplantation was reported to be 2–13%. Ureteric leaks occurred in up to 8.6%, and 55% were managed endourologically. The incidence of lymphocele was as high as 20%, and less that 12% of the cases required treatment. Ureteric stricture was the most common complication, and endourological management was successful in 50–70%. The occurrence of complicated vesicoureteral reflux was 4.5%, and 90% of low-grade reflux cases were successfully treated with deflux injections. Stones and obstructive voiding dysfunction occurred in about 1% of kidney transplant recipients.Conclusion:Minimally invasive techniques have a critical role in the management of urological complications after renal transplantation. Urinary leakage should be managed with complete decompression. Percutaneous drainage should be the first line of treatment for lymphocele that is symptomatic or causing ureteric obstruction. Laparoscopic lymphocele deroofing is successful in aspiration-resistant cases. Deflux is highly successful for the management of complicated low-grade kidney transplant reflux. The principles of stone management in a native solitary kidney are applied to the transplanted kidney. Early identification and treatment of bladder outlet obstruction after renal transplantation can prevent urinary leakage and obstructive uropathy.

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“…Mano and colleagues had a success rate of 83% in nine ureterovesical anastomotic strictures of less than 1 cm treated with retrograde laser endoureterotomy; mean follow up was 44.4 months [Mano et al 2012]. He and colleagues have retrospectively reviewed endoureterotomy in eight patients with ureterovesical strictures and achieved 62.5% patency at 16 months follow up.…”

Section: Endoureterotomymentioning

confidence: 99%

Current status of minimally invasive endoscopic management of ureteric strictures

Kachrilas

Bourdoumis

Karaolides

et al. 2013

Therapeutic Advances in Urology

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Endourological techniques are used more often nowadays in the treatment of ureteric strictures of various etiologies. Advances in technology have provided new tools to the armamentarium of the endoscopic urological surgeon. Numerous studies exist that investigate the efficiency and safety of each of the therapeutic modalities available. In this review, we attempt to demonstrate the available and contemporary evidence supporting each minimally invasive modality in the management of ureteric strictures.

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Retrograde Endoureterotomy for Persistent Ureterovesical Anastomotic Strictures in Renal Transplant Kidneys After Failed Antegrade Balloon Dilation

Cited by 34 publications

References 21 publications

The Current Role of Endourologic Management of Renal Transplantation Complications

The Current Role of Endourologic Management of Renal Transplantation Complications

The development and current status of minimally invasive surgery to manage urological complications after renal transplantation

Current status of minimally invasive endoscopic management of ureteric strictures

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