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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

Follow-up X-ray after 27 months showing the position of the Memokath 051® inside the mesh wire stent without any signs of re-encrustation.
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f0015: Follow-up X-ray after 27 months showing the position of the Memokath 051® inside the mesh wire stent without any signs of re-encrustation.

Mentions: Recovery after surgery was unremarkable, with a good urinary output from the conduit. Ultrasonography showed persistent resolution of the hydronephrosis. The renal function remained normal, so that the patient could be discharged 2 days later after removing the nephrostomy tube. At the most recent follow-up consultation 27 months after this intervention, the patient was clinically well with no UTIs, and had normal renal function. The GFR had improved to 81 mL/min, the serum creatinine level to 99 μmol/L (normal range <110 μmol/L) and blood urea to 7.2 mmol/L. A follow-up abdominal plain film showed the position of the Memokath 051 inside the mesh wire stent, with no signs of re-encrustation (Fig. 3).


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)

Follow-up X-ray after 27 months showing the position of the Memokath 051® inside the mesh wire stent without any signs of re-encrustation.
© Copyright Policy - CC BY-NC-ND
Related In: Results  -  Collection

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

f0015: Follow-up X-ray after 27 months showing the position of the Memokath 051® inside the mesh wire stent without any signs of re-encrustation.
Mentions: Recovery after surgery was unremarkable, with a good urinary output from the conduit. Ultrasonography showed persistent resolution of the hydronephrosis. The renal function remained normal, so that the patient could be discharged 2 days later after removing the nephrostomy tube. At the most recent follow-up consultation 27 months after this intervention, the patient was clinically well with no UTIs, and had normal renal function. The GFR had improved to 81 mL/min, the serum creatinine level to 99 μmol/L (normal range <110 μmol/L) and blood urea to 7.2 mmol/L. A follow-up abdominal plain film showed the position of the Memokath 051 inside the mesh wire stent, with no signs of re-encrustation (Fig. 3).

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