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Endourological management of ureteric strictures after kidney transplantation: Stenting the stent.

Bach C, Kabir M, Zaman F, Kachrilas S, Masood J, Junaid I, Buchholz N - Arab J Urol (2011)

Bottom Line: The standard treatment remains open surgical revision, but this is associated with significant morbidity and potential complications.Because the patient had several previous surgeries, we first considered endourological solutions.After re-canalising the ureter and mesh wire stent by a minimally invasive procedure, we inserted a Memokath® (PNN Medical, Kvistgaard, Denmark) through the embedded mesh wire stent.

View Article: PubMed Central - PubMed

Affiliation: Endourology and Stone Services, Department of Urology, Barts and the London NHS Trust, West Smithfield, London EC1A 7BE, UK.

ABSTRACT
The incidence of ureteric obstruction after kidney transplantation is 3-12.4%, and the most common cause is ureteric stenosis. The standard treatment remains open surgical revision, but this is associated with significant morbidity and potential complications. By contrast, endourological approaches such as balloon dilatation of the ureter, ureterotomy or long-term ureteric stenting are minimally invasive treatment alternatives. Here we discuss the available minimally invasive treatment options to treat transplant ureteric strictures, with an emphasis on long-term stenting. Using an example patient, we describe the use of a long-term new-generation ureteric metal stent to treat a transplant ureter where a mesh wire stent had been placed 5 years previously. The mesh wire stent was heavily encrusted throughout, overgrown by urothelium and impossible to remove. Because the patient had several previous surgeries, we first considered endourological solutions. After re-canalising the ureter and mesh wire stent by a minimally invasive procedure, we inserted a Memokath® (PNN Medical, Kvistgaard, Denmark) through the embedded mesh wire stent. This illustrates a novel method for resolving the currently rare but existing problem of ureteric mesh wire stents becoming dysfunctional over time, and for treating complex transplant ureteric strictures.

No MeSH data available.


Related in: MedlinePlus

Encrusted mesh wire stent with a stone at the bladder end and encrustations in the lumen and the renal end in a transplant ureter.
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f0005: Encrusted mesh wire stent with a stone at the bladder end and encrustations in the lumen and the renal end in a transplant ureter.

Mentions: Ultrasonography showed severe hydronephrosis of the transplanted kidney and a plain abdominal film showed pronounced calcifications adherent to the proximal end and lumen of the stent, as well as a stone of ≈15 × 10 mm at the distal end of the mesh stent that protruded into the bladder (Fig. 1).


Endourological management of ureteric strictures after kidney transplantation: Stenting the stent.

Bach C, Kabir M, Zaman F, Kachrilas S, Masood J, Junaid I, Buchholz N - Arab J Urol (2011)

Encrusted mesh wire stent with a stone at the bladder end and encrustations in the lumen and the renal end in a transplant ureter.
© Copyright Policy - CC BY-NC-ND
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4150573&req=5

f0005: Encrusted mesh wire stent with a stone at the bladder end and encrustations in the lumen and the renal end in a transplant ureter.
Mentions: Ultrasonography showed severe hydronephrosis of the transplanted kidney and a plain abdominal film showed pronounced calcifications adherent to the proximal end and lumen of the stent, as well as a stone of ≈15 × 10 mm at the distal end of the mesh stent that protruded into the bladder (Fig. 1).

Bottom Line: The standard treatment remains open surgical revision, but this is associated with significant morbidity and potential complications.Because the patient had several previous surgeries, we first considered endourological solutions.After re-canalising the ureter and mesh wire stent by a minimally invasive procedure, we inserted a Memokath® (PNN Medical, Kvistgaard, Denmark) through the embedded mesh wire stent.

View Article: PubMed Central - PubMed

Affiliation: Endourology and Stone Services, Department of Urology, Barts and the London NHS Trust, West Smithfield, London EC1A 7BE, UK.

ABSTRACT
The incidence of ureteric obstruction after kidney transplantation is 3-12.4%, and the most common cause is ureteric stenosis. The standard treatment remains open surgical revision, but this is associated with significant morbidity and potential complications. By contrast, endourological approaches such as balloon dilatation of the ureter, ureterotomy or long-term ureteric stenting are minimally invasive treatment alternatives. Here we discuss the available minimally invasive treatment options to treat transplant ureteric strictures, with an emphasis on long-term stenting. Using an example patient, we describe the use of a long-term new-generation ureteric metal stent to treat a transplant ureter where a mesh wire stent had been placed 5 years previously. The mesh wire stent was heavily encrusted throughout, overgrown by urothelium and impossible to remove. Because the patient had several previous surgeries, we first considered endourological solutions. After re-canalising the ureter and mesh wire stent by a minimally invasive procedure, we inserted a Memokath® (PNN Medical, Kvistgaard, Denmark) through the embedded mesh wire stent. This illustrates a novel method for resolving the currently rare but existing problem of ureteric mesh wire stents becoming dysfunctional over time, and for treating complex transplant ureteric strictures.

No MeSH data available.


Related in: MedlinePlus