title: Endourological management is better in early-onset ureteral stenosis in kidney transplantation.
abstract: BACKGROUND
  The incidence of ureteral stenosis in kidney transplant recipients is 3%-8%. The treatment of ureteral stenosis has been traditionally operative reconstruction, although such intervention is associated with high rates of serious complications, including graft loss and even perioperative mortality. More recently, endourological treatment has been proposed due to its low morbidity.
  
  
  OBJECTIVE
  The objective of this study was to assess the usefulness of balloon percutaneous dilatation as a treatment technique for ureteral stenosis in kidney transplant recipients.
  
  
  METHODS
  Among 1000 kidney transplantations performed between 1980 and 2004, the coexistence of high creatinine values and urinary tract dilatation in the postoperative period, after discarding concomitant causes, was managed with a percutaneous nephrostomy. Once renal function recovered, antegrade pyelography was performed to confirm the presence and determine the location of ureteral stenosis. Ureteral dilatation was performed using a 5-French balloon-fitted angioplasty catheter.
  
  
  RESULTS
  Fifty-six patients were diagnosed with ureteral stenosis during follow-up, an incidence of 5.6%. Transluminal balloon dilatation was the first therapeutic option in 45 cases, whereas surgery was performed directly on 11 patients. Disappearance of the stenosis as well as maintenance of an improved creatinine level was verified in 45% of cases (20 patients). Two patients experienced graft loss. Both a short time to diagnosis after transplantation (P = .06) and the presence of a previous acute rejection episode (P < .05) were good prognosis factors for the endourologic solution of a ureteral stricture.
  
  
  CONCLUSIONS
  Balloon dilatation may be considered the definitive procedure for treatment of ureteral stenosis in selected cases. Percutaneous nephrostomy should be used for initial diagnosis and improvement in the renal function before attempting an open procedure.
authors.affiliation: Department of Urology, Fundació Puigvert, Barcelona, Spain. urologia@fundacio-puigvert.es
authors.forename: B
authors.initials: B
authors.lastname: Juaneda
authors.forename: A
authors.initials: A
authors.lastname: Alcaraz
authors.forename: A
authors.initials: A
authors.lastname: Bujons
authors.forename: L
authors.initials: L
authors.lastname: Guirado
authors.forename: J M
authors.initials: JM
authors.lastname: Díaz
authors.forename: J
authors.initials: J
authors.lastname: Martí
authors.forename: P
authors.initials: P
authors.lastname: de la Torre
authors.forename: S
authors.initials: S
authors.lastname: Sabaté
authors.forename: H
authors.initials: H
authors.lastname: Villavicencio
mesh_terms: D000328:Adult; D002404:Catheterization; D005260:Female; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000379:methods; D008297:Male; D008875:Middle Aged; D009926:Organ Preservation; D011183:Postoperative Complications / Q000453:epidemiology / Q000628:therapy*; D012189:Retrospective Studies; D013997:Time Factors; D014515:Ureteral Diseases / Q000453:epidemiology / Q000628:therapy*