Endourological management of ureteral obstruction after renal transplantation.
OBJECTIVE
We evaluated endourological treatment of ureteral obstruction after renal transplantation.


METHODS
Between January 1986 and December 1993, 582 kidney transplantations were performed at our center, and ureteral obstruction was suspected in 31 cases (5.3%).


RESULTS
Initial treatment consisted of retrograde placement of an internal stent in 6 patients and percutaneous nephrostomy in 25. Due to upper tract dilatation obstruction could not be diagnosed in 3 patients, and rejection was the cause of decreasing renal function. Obstruction was temporary in 8 of the remaining 28 patients, including 6 in whom a Double-J stent was introduced in a retrograde manner without anesthesia. In the other 2 patients was well as the 20 with definitive obstruction, cannulation of the transplant orifice without anesthesia was unsuccessful and percutaneous nephrostomy drainage was necessary. Even with general anesthesia a guide wire could not be passed along the stricture in a retrograde or antegrade fashion in 7 of the 20 patients with definitive obstruction and open surgery was performed. The remaining 13 patients underwent dilation with (9) or without (4) diathermic incision. All 4 patients treated with dilation only had recurrent obstruction, while 9 treated with dilation and incision had no recurrence after a minimum followup of 27 months (mean 58).


CONCLUSIONS
Modern endourological procedures have replaced open reconstructive surgery in the majority of patients with ureteral obstruction after renal transplantation.
Bosma
R J
RJ
Department of Urology, University Hospital Groningen, The Netherlands.
van Driel
M F
MF
van Son
W J
WJ
de Ruiter
A J
AJ
Mensink
H J
HJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous; D015607:Stents; D014517:Ureteral Obstruction / Q000209:etiology / Q000628:therapy*