Long-Term Results of Percutaneous Balloon Dilatation of Ureteral Stricture after Kidney Transplantation. (July 2018) - Mor, Eytan
Abstract : Ureteral obstruction occurs in 2–10% of renal transplant patients post-transplant, usually presenting within the first year. The reported success rate of percutaneous dilatation (PTD) and stenting is between 62% and 86%. However that approach is often associated with recurrent urinary tract infections and prolong hospitalization. We sought to determine the long-term outcome of PTD for treatment of ureteral strictures in our program. Material and Methods: Data collected from the Invasive Radiology charts on kidney transplant patients undergoing nephrostomy followed by dilatation to treat ureteral stricture. The following parameters were looked at: patient age, type of transplant (live- or deceased-donor), the interval after transplant for diagnosis of stricture, number of procedures, interval between procedures, the rate of UTI and bactermia and length of hospital stay. The success rate was assessed by the freedom from stent after dilatation with long-term preservation of normal graft function. Surgical repair after PTD was considered as a failure. Results: Between 1/2000- 12/2014 twenty seven patients were treated by PTD for ureter stricture after kidney transplantation which makes an incidence of 2%. Lich-Gregoir technique for ureteral-vescical anastomosis was used in 12 patients, JJ stent was placed in 11 patient. Most patients had a distal stricture (25/27). The median number of percutaneous procedures was 2.5: five patients had 1, eight patients had 2, eight patients had 3, five patients had 4, and two patients had 5 procedures. The number of patients with UTI requiring hospitalization was 50%; 3 of them had also bacteremia. The median hospital stay was 32 days. Sixteen patients (59.3%) underwent surgery to finally resolve the problem. Four patients lost their graft at an interval of 4 -70 months after diagnosis of stricture another 3 patient died. Conclusions: Percutaneos dilatation of ureter stricture after transplant is associated with high morbidity and prolonged hospitalization. Surgical revision should be considered at an early stage after failure of one or two sessions of PTD.