title: Use of tandem double J stents in the management of recurrent and recalcitrant ureteral stenosis after kidney transplantation.
abstract: OBJECTIVE
  To evaluate the use of tandem double J stents in recalcitrant ureteral stenosis after kidney transplant.
  
  
  METHODS
  We reviewed patients who underwent tandem double J stent placement after kidney transplant, assessing demographics (gender, age, cause of renal failure, recipient implantation site, blood pressure, donor status), renal function, biopsy results, site of stenosis, dilations, time with tandem stents, and outcome. Success was defined as ureteral patency without reconstructive surgery. Student t test was used for creatinine levels. Multivariate survival analysis identified risk factors for failure.
  
  
  RESULTS
  A total of 19 patients (mean age 36.6 years) were included. The most common site of ureteral stenosis was distal (79%). Average number of biopsies before tandem stents was 1.8 (0-5) and, pathology results showed acute rejection in 16%. Percutaneous nephrostomy was performed after 66.8 ± 140.8 weeks from transplantation date. Dilations averaged 2 ± 1.1 (0-4) before tandem placement. Renal function improved after tandem stents (P < .01) and remained stable throughout follow-up (P = .147). The patency success rate was 58% with a mean of 48.7 ± 48 weeks with tandem in place. The failure rate was 26%, with a mean of 16 ± 7 weeks for tandem time. No perioperative complications were identified. Number of dilations before tandem was the only factor associated with failure (hazard ratio = 2.61; confidence interval = 1.150-5.908, P < .03). Proximal strictures (P = .072) and renal function (P = .067) were associated with a trend for tandem stent failure.
  
  
  CONCLUSIONS
  Tandem stents can treat recurrent and recalcitrant ureteral stenosis after kidney transplantation that failed previous balloon dilation or ureteral reconstruction.
authors.affiliation: Department of Urologic Surgery, University of Minnesota, Minneapolis, Minnesota 55455, USA.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Miyaoka
authors.forename: Olga L
authors.initials: OL
authors.lastname: Duran-Castro
authors.forename: Shaheen
authors.initials: S
authors.lastname: Alanee
authors.forename: Manoj
authors.initials: M
authors.lastname: Monga
authors.forename: David W
authors.initials: DW
authors.lastname: Hunter
mesh_terms: D000293:Adolescent; D000328:Adult; D001706:Biopsy; D002404:Catheterization; D002648:Child; D003251:Constriction, Pathologic / Q000209:etiology / Q000601:surgery; D004867:Equipment Design; D005260:Female; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous / Q000379:methods; D012008:Recurrence; D015607:Stents / Q000009:adverse effects*; D016896:Treatment Outcome; D014517:Ureteral Obstruction / Q000209:etiology / Q000601:surgery*