title: A Rationale to Use Bladder Boari Flap Reconstruction for Late Kidney Transplant Ureteral Strictures.
abstract: OBJECTIVE
  To evaluate the efficacy of Boari flap reconstruction (BFR) in the management of late-onset transplant ureteral strictures (TUS).
  
  
  METHODS
  Between March 2007 and March 2014, there were 730 patients who underwent kidney transplant (KTx) at our institution. We identified 16 patients with TUS, occurring more than 60 days after KTx. Baseline clinical and posttransplant characteristics were reviewed and stratified upon treatment modality. Outcomes for each treatment modality were determined.
  
  
  RESULTS
  Median time from transplant to the treatment of TUS was 703 days (range, 65-2617 days). BFR was the most common treatment modality and was used in 87.5% of patients (n = 14/16). This procedure was performed as both a primary treatment and as a salvage procedure in recurrent TUS refractory to balloon dilation and neoureterocystotomy. Incidence of BFR failure was 6.3% (n = 1/14). BFR as a primary treatment was more successful compared to other methods (P  <  .01).
  
  
  CONCLUSIONS
  Late TUS after KTx is a difficult complication to treat. Our study suggests that BFR can provide a higher success rate of primary treatment compared to other common treatment options. BFR can be used as a primary treatment of TUS or as a salvage procedure with similar success. Additional follow-up is necessary to evaluate the long-term efficacy of BFR for the treatment of late-onset TUS.
authors.affiliation: Department of Urology, Tulane University School of Medicine, New Orleans, LA. Electronic address: aboonjin@tulane.edu.
authors.forename: Aaron
authors.initials: A
authors.lastname: Boonjindasup
authors.affiliation: Tulane University School of Medicine, New Orleans, LA.
authors.forename: Alison
authors.initials: A
authors.lastname: Smith
authors.affiliation: Tulane Abdominal Transplant Institute, New Orleans, LA.
authors.forename: Anil
authors.initials: A
authors.lastname: Paramesh
authors.affiliation: Tulane University School of Medicine, New Orleans, LA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Rittenberg
authors.affiliation: Tulane Abdominal Transplant Institute, New Orleans, LA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Buell
authors.affiliation: Tulane Abdominal Transplant Institute, New Orleans, LA.
authors.forename: Mary
authors.initials: M
authors.lastname: Killackey
authors.affiliation: Department of Urology, Tulane University School of Medicine, New Orleans, LA.
authors.forename: Raju
authors.initials: R
authors.lastname: Thomas
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013524:Surgical Flaps; D014517:Ureteral Obstruction / Q000209:etiology* / Q000601:surgery*; D001743:Urinary Bladder / Q000637:transplantation; D013520:Urologic Surgical Procedures / Q000379:methods; D055815:Young Adult