Should Interventional Radiology or Open Surgery Be the First Choice for the Management of Ureteric Stenosis After Transplantation? Dual-Center Study.
BACKGROUND
Ureteric stenosis (US) is the most common urologic complication after kidney transplantation. In this dual-center retrospective study we compared the efficacy and safety of open surgery versus interventional radiology for the management of US.


METHODS
From 2009 to January 2016, US was treated by surgical revision in 22 (7.8%) out of 281 recipients at one center (group 1) and managed by percutaneous nephrostomy with antegrade nephroureteral stenting (PNAS) in 22 (14.2%) out of 155 recipients at the other center (group 2).


RESULTS
Three patients in group 1 required reintervention and again were treated with open surgery. With a mean follow-up of 42.1 ± 38.7 months, graft function improved in all but one patients (95%). Three patients in group 2 were admitted with relapse of US not amenable to 2nd PNAS, and 2 of them were managed with surgery. These 3 and 2 other cases with improved graft function after PNAS lost their grafts and returned to hemodialysis. The remaining 17 patients (77%) still have functioning grafts. There was no statistically significant difference between the efficacy of PNAS and open surgery for the management of post-transplantation US. However; a benefit in favor of open surgery existed for type 2 urinary tract obstruction in terms of decreased reintervention rate and much better protection of the graft function and survival.


CONCLUSIONS
Both interventional radiology and open surgery have acceptable efficacy rates in the management of ureteric complications after renal transplantation. Open surgery is a better treatment option for type 2 obstruction.
Izmir Bozyaka Education and Research Hospital, Department of General Surgery and Transplantation, Izmir, Turkey.
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Simsek
Inonu University, Turgut Ozal School of Medicine, Department of General Surgery and Transplantation, Malatya, Turkey.
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Dogan
Inonu University, Turgut Ozal School of Medicine, Department of General Surgery and Transplantation, Malatya, Turkey.
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Piskin
Izmir Bozyaka Education and Research Hospital, Department of General Surgery and Transplantation, Izmir, Turkey.
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Okut
Izmir Bozyaka Education and Research Hospital, Department of General Surgery and Transplantation, Izmir, Turkey.
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Cayhan
Izmir Bozyaka Education and Research Hospital, Department of General Surgery and Transplantation, Izmir, Turkey.
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Aykas
Izmir Bozyaka Education and Research Hospital, Department of Nephrology and Transplantation, Izmir, Turkey.
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Tatar
Izmir Bozyaka Education and Research Hospital, Department of General Surgery and Transplantation, Izmir, Turkey. Electronic address: adam_uslu@hotmail.com.
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Uslu
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D015641:Radiography, Interventional / Q000009:adverse effects / Q000379:methods*; D012086:Reoperation; D012189:Retrospective Studies; D014513:Ureter / Q000601:surgery; D014517:Ureteral Obstruction / Q000209:etiology / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000009:adverse effects / Q000379:methods*