title: Endoureteral Management of Renal Graft Ureteral Stenosis by the Use of Long-Term Metal Stent: An Appealing Treatment Option.
abstract: Background:Ureteral stenosis is part of the common complications of renal graft reported in 3% to 7% of cases. Multiple treatments have been introduced regarding length and position of the stenosis. Metal stents for urologic purpose were created in 1998. Double percutaneous antegrade and transurethral retrograde access to a ureteral stenosis to a long-term metal stent procedure has been rarely described.Case Presentation:Here, we present a case of a ureteral stricture in a double ipsilateral kidney graft with a common ureter. A 67-year-old patient presented with obstructive nephritis associated with acute renal failure 6 years after a double renal graft with a uretero-ureteral end-to-side anastomosis. Abdominal CT scan showed double pelvic dilation. The patient underwent double percutaneous nephrostomies and antegrade pyelogram showed both renal pelvic and ureter dilations caused by a severe chronic ureteral stenosis at junction into the bladder. A Double-J ureteric stent was then inserted retrogradely over a guidewire as first-line treatment. Due to recurrent urinary tract infections (UTIs), removal and replacement of Double-J stents were carried out by placing a thermoexpandable metal stent Memokath®051 (Bard, Pnn Medical) through the common ureter by a double antegrade and retrograde approach. Treatment was effective with a good renal function maintained after a 3-year follow-up without UTIs.Conclusion:Double antegrade and retrograde access to a long-term metal stent treatment can be seen as an alternative treatment to either endoscopy or open surgery. Further studies should be continued using larger series.
authors.affiliation: Department of Urology, Hôpital Pasteur 2, Nice Sophia-Antipolis University , France .
authors.forename: Patrick-Julien
authors.initials: PJ
authors.lastname: Treacy
authors.affiliation: Department of Urology, MSSM , New York City, New York.
authors.forename: Art R
authors.initials: AR
authors.lastname: Rastinehad
authors.affiliation: Department of Urology, Hôpital Pasteur 2, Nice Sophia-Antipolis University , France .
authors.forename: Laetitia
authors.initials: L
authors.lastname: Imbert de la Phalecque
authors.affiliation: Department of Kidney Transplantation, Hôpital Pasteur 2, Nice Sophia-Antipolis University , France .
authors.forename: Laetitia
authors.initials: L
authors.lastname: Albano
authors.affiliation: Department of Urology, Hôpital Pasteur 2, Nice Sophia-Antipolis University, France.; Department of Urology, MSSM, New York City, New York.; INSERM, U1189, ONCO-THAI, Lille, France.
authors.forename: Matthieu
authors.initials: M
authors.lastname: Durand
keywords: imaging; long-term metal stent; renal graft; ureteral stricture