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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

“Through and trough wire” in the now encrustations-free mesh wire stent following percutaneous nephroscopy.
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f0010: “Through and trough wire” in the now encrustations-free mesh wire stent following percutaneous nephroscopy.

Mentions: As an initial emergency treatment the transplanted kidney was drained with a percutaneous nephrostomy, and under antibiotic treatment the patient’s kidney function and inflammatory values quickly returned to normal, indicating good kidney function and recovery potential. When the situation had stabilized, the patient was taken to theatre for a combined antegrade percutaneous and retrograde transurethral procedure, while supine. Percutaneous access to the transplant kidney was gained through the previously placed nephrostomy tube. After dilatation of the tract and insertion of the nephroscope, the stone on the upper end of the mesh stent, and the heavily encrusted lumen, were cleared by electrohydraulic intracorporeal lithotripsy. The stone attached to the bladder side of the mesh stent was removed transurethrally in the same fashion. The now freed stent (Fig. 2) was completely overgrown by urothelium, making its removal impossible.


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)

“Through and trough wire” in the now encrustations-free mesh wire stent following percutaneous nephroscopy.
© Copyright Policy - CC BY-NC-ND
Related In: Results  -  Collection

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

f0010: “Through and trough wire” in the now encrustations-free mesh wire stent following percutaneous nephroscopy.
Mentions: As an initial emergency treatment the transplanted kidney was drained with a percutaneous nephrostomy, and under antibiotic treatment the patient’s kidney function and inflammatory values quickly returned to normal, indicating good kidney function and recovery potential. When the situation had stabilized, the patient was taken to theatre for a combined antegrade percutaneous and retrograde transurethral procedure, while supine. Percutaneous access to the transplant kidney was gained through the previously placed nephrostomy tube. After dilatation of the tract and insertion of the nephroscope, the stone on the upper end of the mesh stent, and the heavily encrusted lumen, were cleared by electrohydraulic intracorporeal lithotripsy. The stone attached to the bladder side of the mesh stent was removed transurethrally in the same fashion. The now freed stent (Fig. 2) was completely overgrown by urothelium, making its removal impossible.

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