Reconstruction of late-onset transplant ureteral stricture disease.
OBJECTIVE
• To describe our experience with surgical management of transplant ureteral strictures over a 6-year period.


METHODS
• The present study identified patients who underwent open reconstruction for transplant ureteral strictures between March 2002 and May 2008 after kidney or kidney-pancreas transplantation. • Baseline clinical characteristics were documented, including age at transplantation and reconstruction, serum creatinine levels, immunosuppressive drug regimen, and comorbidities. • Postoperative complications were noted, including urinary tract infections, stricture recurrence and graft failure. • Successful reconstructions were defined as stable allograft function with unobstructed outflow not requiring repeat dilation, ureterotomy or stent placement.


RESULTS
• Median age at the time of reconstruction was 51 years and the mean time from transplantation was 62 months. • Seven of the 13 patients had failed previous balloon dilation. • The patients were followed for a median of 41 months and a successful repair was achieved in 10 of 13 patients. • Ureteral strictures recurred in two patients who received ureteroneocystostomies, which were subsequently managed with chronic stent exchanges. • Another recurrence involved a 1.5-cm anastomotic stricture 6 months postoperatively, which was balloon-dilated and has remained recurrence-free for 16 months.


CONCLUSIONS
• Patients who present > 6 months after renal transplantation with ureteral strictures that are recalcitrant to endoscopic management can safely undergo open surgical ureteral reconstruction without subsequent renal or graft failure. • Further investigation involving a larger patient cohort is required to confirm these initial results.
Helfand
Brian T
BT
Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
Newman
Jessica P
JP
Mongiu
Anne K
AK
Modi
Parth
P
Meeks
Joshua J
JJ
Gonzalez
Christopher M
CM
D000293:Adolescent; D000328:Adult; D002404:Catheterization / Q000379:methods*; D003251:Constriction, Pathologic / Q000209:etiology / Q000601:surgery; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery; D016896:Treatment Outcome; D014513:Ureter / Q000601:surgery; D014515:Ureteral Diseases / Q000209:etiology / Q000601:surgery*; D055815:Young Adult