Ureteral Stenosis after Kidney Transplant

Ureteral Stenosis after Kidney Transplant

Jonathan B. Yuval MD

http://www.hadassah.org.il/english

case

• 23 YOF• Idiopathic renal failure• Renal Tx on 27/4/13 from a live donor• Normal operative course (ischemia of in upper

pole)• Normal immediate post-op course


case

• One month after Tx readmitted d/t elevevated Cr

• Hydronephrosis on US• Retrograde pyelography demonstrated a

ureteral stricture• Underwent nephrostomy insertion


case

• 5/2013 insertion of stent from renal pelvis to urinary bladder + Nephrostomy

• 6/2013 Urosepsis w/ KP. IV ABX. Closure of Nephrostomy.

• 7/2013 Endo-urological Tx of stenosis• 7/2013 UTI w/KP. IV ABX. Closure of

Nephrostomy. Prophylactic fosfomycin.• 9/2013. Anterograde nephrostogram. Removal

of stent. Removal of Nephrostomy.


case

• 9/2013 Elevated Cr. ESBL in urine. IV ABX. Improvement of Cr.

• 10/2013 in Dr. Merhav’s clinic. No Sx of UTI. Normal Cr.


• Urological complications are the most common

• Stenosis/Leak in 5% of cases:


• The transplanted ureter is susceptible to stenosis d/t poor blood supply

• Most common cause of mechanical obstruction

• DDX: Stones, Rejection, BKV, external compression


• Increased peri-op morbidity and re-operation• Does not affect graft survival if treated early


Risk Factors

• Donor Age• Number of transplanted arteries• CIT• Method of organ retrieval• Preservation of gonadal vessels• Technique (UU/intravesical/extravesical)• Ureteral stent • Preservation of peri-pelvic/ureteric fat


Tx

• Endo-Surgery• Surgical options– Re-insertion– Reconstruction w/native ureter– Pyelo-ureterostomy– Vesiculo-pyelostomy– Uretero-urererostomy– Reconstruction/Elongation of the bladder– Ileal interposition– Artificial ureter interposition


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Ureteral Stenosis after Kidney Transplant

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