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Muacevic A, Adler JR, Bawazir AO, Alammari A, Junaid I. Post-Transplant Ureteric Stricture Managed By Extra-Anatomical Stenting With Modification on the Originally Described Stent Location: A Case Report. Cureus 2023; 15:e33335. [PMID: 36741626 PMCID: PMC9896131 DOI: 10.7759/cureus.33335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2023] [Indexed: 01/06/2023] Open
Abstract
Ureteric strictures are a relatively uncommon complication following renal transplant, which may be managed endoscopically or surgically by repairing the stricture. Extra-anatomical bypass is a useful procedure in complex cases that bypasses the ureter by creating a subcutaneous route, although it is uncommonly used given its rare indication. We report a case of renal transplant ureteric stricture, in which we utilized a modified extra-anatomical stenting technique with a Detour® stent to avoid the fibrotic planes surrounding the lateral aspect of the kidney graft.
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Laso-García IM, Lorca-Álvaro J, Arias-Fúnez F, Díaz-Pérez D, Santiago-González M, Duque-Ruiz G, Burgos-Revilla FJ. Long-term results of the treatment of complex ureteral stenosis with extra-anatomic ureteral bypasses. Cent European J Urol 2020; 73:213-219. [PMID: 32782842 PMCID: PMC7407785 DOI: 10.5173/ceju.2020.0008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 05/06/2020] [Accepted: 05/12/2020] [Indexed: 11/26/2022] Open
Abstract
Introduction Complex ureteral obstruction is a pathology that has always been a challenge for the urologist, especially in patients with high surgical risk or with a short life expectancy. Material and methods Between 2002 and 2017, 13 extra-anatomical bypasses were placed. A descriptive retrospective study was carried out. An analysis of the permeability time of the prosthesis was performed using Kaplan-Meyer curves. Demographic and etiological characteristics as well as early and late complications were analysed. Results Etiologies were benign in 39% (including 3 transplant recipients) and malignant in 69%. Permeability rates were 90.9% at each of 12, 24 and 48 months, respectively, and 75.8% at 60 months. There were no deaths in the early postoperative period, nor intraoperative complications. The most frequent complications were infections. Three of them were associated with bypass extrusion, which needed to be removed. A total of 5 prosthesis had to be removed. 40% of the patients did not present complications. Conclusions The extra-anatomical ureteral bypass is an alternative to permanent nephrostomy in the treatment of complex ureteral strictures. Their patency rates after long-term follow-up vary from 90% to 75% at 48 and 60 months, respectively. Their complication rates can be considered acceptable in the patients’ clinical contexts.
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Affiliation(s)
- Inés M Laso-García
- Ramón y Cajal University Hospital, Department of Urology, Alcalá University, IRYCIS, Madrid, Spain
| | - Javier Lorca-Álvaro
- Ramón y Cajal University Hospital, Department of Urology, Alcalá University, IRYCIS, Madrid, Spain
| | - Fernando Arias-Fúnez
- Ramón y Cajal University Hospital, Department of Urology, Alcalá University, IRYCIS, Madrid, Spain
| | - David Díaz-Pérez
- Ramón y Cajal University Hospital, Department of Urology, Alcalá University, IRYCIS, Madrid, Spain
| | - Marta Santiago-González
- Ramón y Cajal University Hospital, Department of Urology, Alcalá University, IRYCIS, Madrid, Spain
| | - Gemma Duque-Ruiz
- Ramón y Cajal University Hospital, Department of Urology, Alcalá University, IRYCIS, Madrid, Spain
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Chong JJ, Kum F, Hadjipavlou M, Mahmalji W, Hale J, Dickinson A, Glass J. Extra-Anatomic Stents in Ureteric Obstruction: Our Experience. J Endourol 2019; 33:242-247. [DOI: 10.1089/end.2018.0610] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- James J.Y. Chong
- Department of Urology, Guy's and St Thomas' Hospitals, London, United Kingdom
| | - Francesca Kum
- Department of Urology, Guy's and St Thomas' Hospitals, London, United Kingdom
| | - Marios Hadjipavlou
- Department of Urology, Guy's and St Thomas' Hospitals, London, United Kingdom
| | - Wasim Mahmalji
- Department of Urology, Guy's and St Thomas' Hospitals, London, United Kingdom
| | - Jemma Hale
- Department of Urology, Guy's and St Thomas' Hospitals, London, United Kingdom
| | - Andrew Dickinson
- Department of Urology, Derriford Hospital, Plymouth, United Kingdom
| | - Jonathan Glass
- Department of Urology, Guy's and St Thomas' Hospitals, London, United Kingdom
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Sedigh O, Barale M, Preto M, Bosio A, Diena D, Rossi L, Righi D, Biancone L, Gontero P, Dalmasso E. Self-Expandable Covered Metallic Stent (UVENTA) to Treat a Ureteral Stricture After Renal Transplant: A Case Report. EXP CLIN TRANSPLANT 2018; 18:116-119. [PMID: 30084759 DOI: 10.6002/ect.2017.0197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We present the use of a self-expandable covered metallic stent (UVENTA; TaeWoong Medical, Gyeonggi-do, South Korea) to treat a ureteral stricture after kidney transplant. In this report, we describe the procedure and short-term outcomes of a patient with a recurrent distal stricture who did not respond to percutaneous balloon dilation. We decided to place this temporary stent as an alternative to complex surgery. The aim of the procedure was to get a chronic dilation of the stricture up to 7 mm to stabilize the fibrotic tissue. The procedure was easily and quickly performed by an antegrade and retrograde combined approach. The postoperative course was uneventful. The stent was left in situ for 7 months. No complications were noted, and the renal function remained stable. The stent was easily removed, and 5 months later there were no signs of recurrence. The UVENTA device was shown to be an easy, safe, and effective minimally invasive treatment for ureteral stricture in renal transplant. Proper permanence time and long-term results need to be explored.
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Affiliation(s)
- Omid Sedigh
- From the Department of Urology, Città della Salute e della Scienza di Torino, Molinette Hospital, University of Turin, Turin, Italy
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Slaba S, Zaarour Y, Smayra T. Percutaneous Transvesical Retrograde Ureteral Stent Insertion for Neoplastic Stricture. Cardiovasc Intervent Radiol 2016; 40:144-146. [PMID: 27460256 DOI: 10.1007/s00270-016-1430-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 07/20/2016] [Indexed: 11/25/2022]
Affiliation(s)
- Sami Slaba
- Department of Radiology, School of Medicine, Hotel-Dieu de France Hospital, Saint-Joseph University, Alfred Naccache Street, Beirut, Lebanon
| | - Youssef Zaarour
- Department of Radiology, School of Medicine, Hotel-Dieu de France Hospital, Saint-Joseph University, Alfred Naccache Street, Beirut, Lebanon
| | - Tarek Smayra
- Department of Radiology, School of Medicine, Hotel-Dieu de France Hospital, Saint-Joseph University, Alfred Naccache Street, Beirut, Lebanon.
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Putz J, Leike S, Wirth MP. [Management of urological complications after renal transplantation]. Urologe A 2015; 54:1385-92. [PMID: 26459581 DOI: 10.1007/s00120-015-3908-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Urological complications after kidney transplantation can cause a major reduction in renal function. Surgical complications like urinary leakage and ureteral obstruction need to be solved by a specialist in the field of endourological procedures and open surgical interventions. The article summarizes this and other common urological problems after kidney transplantation.
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Affiliation(s)
- J Putz
- Klinik und Poliklinik für Urologie, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland
| | - S Leike
- Klinik und Poliklinik für Urologie, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland
| | - M P Wirth
- Klinik und Poliklinik für Urologie, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland.
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Urological Consequences following Renal Transplantation: A Review of the Literature. Urologia 2015; 82:211-8. [DOI: 10.5301/uro.5000132] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2015] [Indexed: 01/25/2023]
Abstract
Renal transplant (RT) represents the treatment of choice for end-stage renal disease (ESRD) but harbours a wide range of possible complications and therapeutic challenges of urological competence. Dialysis years and clinical medical background of these patients are risk factors for sexual dysfunction and lower urinary tract symptoms (LUTS). On the contrary, RT itself may have a number of possible surgical complications such as ureteral stenosis and urinary leakage, while immunosuppressive treatment is a known risk factor for de-novo malignancies. The present review describes the main urologic problems of RT patients and their up-to-date treatment options according to the most recently available literature evidences.
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Pike TW, Pandanaboyana S, Hope-Johnson T, Hostert L, Ahmad N. Ureteric reconstruction for the management of transplant ureteric stricture: a decade of experience from a single centre. Transpl Int 2015; 28:529-34. [PMID: 25557065 DOI: 10.1111/tri.12508] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Revised: 11/26/2014] [Accepted: 12/29/2014] [Indexed: 11/28/2022]
Abstract
This study was conducted to review the outcomes of patients who had undergone surgical repair of a ureteric stricture following renal transplantation. All patients who developed a ureteric stricture and underwent ureteric reconstruction following renal transplantation, between December 2003 and November 2013, were reviewed. One thousand five hundred and sixty renal transplants were performed during the study period. Forty patients required surgical repair of a ureteric stricture (2.5%, 25 male, median age 48 [14-78]). The median time to stricture was 3 [1-149] months. 19 patients were reconstructed by reimplantation to the bladder, 18 utilized a Boari flap, two were a pre-existing ileal conduit and one was an anastomosis to a native ureter. In one patient, reconstruction was impossible and consequently an extra-anatomic stent was used. Two patients required re-operation for restricture and kinking. Median serum creatinine at 12 months following surgery was 148 [84-508] μmol/l. There was no 90-day mortality. Eleven grafts were lost at the time of this study, a median time of 11 [1-103] months after reconstruction. The incidence of ureteric stricture following renal transplant is low. Surgical reconstruction of the transplant ureter is the optimal treatment and is successful in the majority of patients.
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Affiliation(s)
- Thomas W Pike
- Division of Surgery, Department of Transplantation, St James's University Hospital, Leeds, West Yorkshire, UK
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