title: Ureteric reconstruction for the management of transplant ureteric stricture: a decade of experience from a single centre.
abstract: This study was conducted to review the outcomes of patients who had undergone surgical repair of a ureteric stricture following renal transplantation. All patients who developed a ureteric stricture and underwent ureteric reconstruction following renal transplantation, between December 2003 and November 2013, were reviewed. One thousand five hundred and sixty renal transplants were performed during the study period. Forty patients required surgical repair of a ureteric stricture (2.5%, 25 male, median age 48 [14-78]). The median time to stricture was 3 [1-149] months. 19 patients were reconstructed by reimplantation to the bladder, 18 utilized a Boari flap, two were a pre-existing ileal conduit and one was an anastomosis to a native ureter. In one patient, reconstruction was impossible and consequently an extra-anatomic stent was used. Two patients required re-operation for restricture and kinking. Median serum creatinine at 12 months following surgery was 148 [84-508] μmol/l. There was no 90-day mortality. Eleven grafts were lost at the time of this study, a median time of 11 [1-103] months after reconstruction. The incidence of ureteric stricture following renal transplant is low. Surgical reconstruction of the transplant ureter is the optimal treatment and is successful in the majority of patients.
authors.affiliation: Division of Surgery, Department of Transplantation, St James's University Hospital, Leeds, West Yorkshire, UK.
authors.forename: Thomas W
authors.initials: TW
authors.lastname: Pike
authors.forename: Sanjay
authors.initials: S
authors.lastname: Pandanaboyana
authors.forename: Thea
authors.initials: T
authors.lastname: Hope-Johnson
authors.forename: Lutz
authors.initials: L
authors.lastname: Hostert
authors.forename: Niaz
authors.initials: N
authors.lastname: Ahmad
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003251:Constriction, Pathologic / Q000601:surgery; D003404:Creatinine / Q000097:blood; D005260:Female; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D057234:Preoperative Period; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D013524:Surgical Flaps; D014513:Ureter / Q000601:surgery*; D014517:Ureteral Obstruction / Q000601:surgery*; D055815:Young Adult
chemical_list: D003404:Creatinine
keywords: Boari flap; kidney transplant; reconstruction; ureteric stricture