The utility of native ureter in the management of ureteral complications in children after renal transplantation

Abstract

Background: Ureteral complications after renal transplantation in children are a major source of morbidity. Management is complex and variable.Methods: With IRB approval, health records were retrospectively reviewed of patients who: were <18 years, underwent kidney transplant between 1997 and 2017, had at least 2 years of follow-up, and underwent interventions due to post-transplant ureteral complications.Results: Of 136 patients, seventeen (13%) required ureteral intervention due to stricture (n = 3), reflux (n = 12), or both (n = 2). Transplant occurred at median 10.5 years (3.1-14.7). Reconstruction occurred at median 10 months (7-15) after transplant.Pre-existing bladder pathology was present in 6 (35%) patients. Four of five patients with strictures had at least one endoscopic balloon dilation. Ultimate management included reimplantation, ureteroureterostomy of native to transplant ureter, pyeloureterostomy to native ureter, multiple endoscopic interventions followed by a Boari flap, or multiple failed endoscopic interventions. Fourteen patients with VUR underwent reimplantation (n = 5), ureteroureterostomy of native to transplant ureter (n = 4), pyeloureterostomy to native ureter (n = 4), and one underwent endoscopic injection with Deflux of the transplant ureter. Only one patient had a non-functioning graft due to ureteral complication. All patients were alive at follow-up (median 17 years [12][13][14][15][16][17][18][19]). Conclusions:Transplant ureteral reflux and stricture are significant complications following pediatric renal transplantation and may require surgical management. In our population, reflux or stricture requiring ureteral reconstruction occurred in 10% and 4%, respectively. Endoscopic interventions were rarely successful. Native ureters were used for ureteral reconstruction in more than two thirds of patients should be considered in management of ureteral complications.

Ultrashort anisoperistaltic end-to-side ureteroureterostomy in renal transplantation

“…Although most kidney transplant groups reserve ureteroureterostomy as a salvage technique for kidney transplants with ureteral complications, few articles in the literature observed a lower rate of reoperation with this technique. One of the explanations is that impaired vascularization of the graft’s distal ureter would be responsible for stenosis and necrosis of the ureter’s tip, with urine leakage 8 , 9 .…”

An experimental study of magnetic compression technique for ureterovesical anastomosis in rabbits

“…Ureterostenosis is a complicated disease that is usually associated with hydronephrosis or nonfunctioning kidneys, leading to severe adverse effects and a poor quality of life, especially in patients after a kidney transplantation 1 – 3 . Conventional treatment options, including percutaneous balloon ureteroplasty, nephroureteral stenting, and surgical ureteral reconstruction have been widely applied for the treatment of benign ureteral strictures.…”

Magnetic compression technique for ureterovesical anastomosis: An experimental study in rabbits

“…Ureterostenosis is a complicated disease that is usually associated with hydronephrosis or nonfunctioning kidneys, leading to severe adverse effects and a poor quality of life, especially in patients after a kidney transplantation [1][2][3] . Conventional treatment options, including percutaneous balloon ureteroplasty, nephroureteral stenting, and surgical ureteral reconstruction have been widely applied for the treatment of benign ureteral strictures.…”