title: Retrograde balloon dilation >10 weeks after renal transplantation for transplant ureter stenosis - our experience and review of the literature.
abstract: OBJECTIVE
  Despite many efforts to prevent ureteric stenosis in a transplanted kidney, this complication occurs in 3-5% of renal transplant recipients. Balloon dilatation (BD) is a possible minimally invasive approach for treatment, but reports to date refer only to the antegrade approach; we analysed our experience with retrograde BD (RBD) and reviewed previous reports.
  
  
  METHODS
  From October 2008 to February 2011, eight patients after renal transplantation (RTX) underwent RBD for transplant ureteric stenosis at our hospital. We retrospectively analysed the outcome and reviewed previous reports.
  
  
  RESULTS
  The eight recipients (five men and three women; median age 55 years, range 38-69) were treated with one or two RBDs for transplant ureteric stenosis. There were no complications. The median (range) time after RTX was 4.5 (2.5-11) months. Long-term success was only achieved in one recipient, while five patients were re-operated on (three with a new implant, two by replacement of transplanted ureter with ileum) after a median (range) of 2.8 (0.7-7.0) months after unsuccessful RBD(s). For two recipients the success remained unclear (one graft loss due to other reasons, one result pending). When the first RBD was unsuccessful there was no improvement with a second.
  
  
  CONCLUSIONS
  RBD is technically feasible, but our findings and the review of previous reports on antegrade ureteric dilatation suggest that the success rate is low when the ureter is dilated at ⩾10 weeks after RTX. From our results we cannot recommend RBD for transplant ureteric stenosis at ⩾10 weeks after RTX, while previous reports show favourable results of antegrade BD in the initial 3 months after RTX.
authors.affiliation: Department of Urology, Heinrich Heine University Hospital Duesseldorf, Germany.
authors.forename: Robert
authors.initials: R
authors.lastname: Rabenalt
authors.affiliation: Department of Urology, Heinrich Heine University Hospital Duesseldorf, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Winter
authors.affiliation: Department of Nephrology, Heinrich Heine University Hospital Duesseldorf, Germany.
authors.forename: Sebastian A
authors.initials: SA
authors.lastname: Potthoff
authors.affiliation: Department of General, Visceral and Pediatric Surgery, Heinrich Heine University Hospital Duesseldorf, Germany.
authors.forename: Claus-Ferdinand
authors.initials: CF
authors.lastname: Eisenberger
authors.affiliation: Department of Vascular Surgery, Heinrich Heine University Hospital Duesseldorf, Germany.
authors.forename: Klaus
authors.initials: K
authors.lastname: Grabitz
authors.affiliation: Department of Urology, Heinrich Heine University Hospital Duesseldorf, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Albers
authors.affiliation: Department of Urology, Heinrich Heine University Hospital Duesseldorf, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Giessing
keywords: (R)BD, (retrograde) balloon dilatation; Balloon dilatation; PNS, percutaneous nephrostomy; RTX, renal transplantation; Renal transplantation; Ureteric stricture