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Retrograde balloon dilation >10 weeks after renal transplantation for transplant ureter stenosis - our experience and review of the literature.

Rabenalt R, Winter C, Potthoff SA, Eisenberger CF, Grabitz K, Albers P, Giessing M - Arab J Urol (2011)

Bottom Line: Long-term success was only achieved in one recipient, while five patients were re-operated on (three with a new implant, two by replacement of transplanted ureter with ileum) after a median (range) of 2.8 (0.7-7.0) months after unsuccessful RBD(s).For two recipients the success remained unclear (one graft loss due to other reasons, one result pending).When the first RBD was unsuccessful there was no improvement with a second.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, Heinrich Heine University Hospital Duesseldorf, Germany.

ABSTRACT

Objective: Despite many efforts to prevent ureteric stenosis in a transplanted kidney, this complication occurs in 3-5% of renal transplant recipients. Balloon dilatation (BD) is a possible minimally invasive approach for treatment, but reports to date refer only to the antegrade approach; we analysed our experience with retrograde BD (RBD) and reviewed previous reports.

Patients and methods: From October 2008 to February 2011, eight patients after renal transplantation (RTX) underwent RBD for transplant ureteric stenosis at our hospital. We retrospectively analysed the outcome and reviewed previous reports.

Results: The eight recipients (five men and three women; median age 55 years, range 38-69) were treated with one or two RBDs for transplant ureteric stenosis. There were no complications. The median (range) time after RTX was 4.5 (2.5-11) months. Long-term success was only achieved in one recipient, while five patients were re-operated on (three with a new implant, two by replacement of transplanted ureter with ileum) after a median (range) of 2.8 (0.7-7.0) months after unsuccessful RBD(s). For two recipients the success remained unclear (one graft loss due to other reasons, one result pending). When the first RBD was unsuccessful there was no improvement with a second.

Conclusion: RBD is technically feasible, but our findings and the review of previous reports on antegrade ureteric dilatation suggest that the success rate is low when the ureter is dilated at ⩾10 weeks after RTX. From our results we cannot recommend RBD for transplant ureteric stenosis at ⩾10 weeks after RTX, while previous reports show favourable results of antegrade BD in the initial 3 months after RTX.

No MeSH data available.


Related in: MedlinePlus

Retrograde balloon dilation. Stenosis of the distal transplant ureter of a renal transplant with 2 ureters (second ureter not opacified). The right image shows successful dilation with full expansion of the balloon.
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f0005: Retrograde balloon dilation. Stenosis of the distal transplant ureter of a renal transplant with 2 ureters (second ureter not opacified). The right image shows successful dilation with full expansion of the balloon.

Mentions: RBD of ureteric stenosis was done under general anaesthesia and antibiotic prophylaxis. Briefly, the transplant ureteric orifice was identified by transurethral cystoscopy. After retrograde transplant ureterography and exact localisation of the stricture site, a guidewire (ZipWire™ or Sensor™, Boston Scientific, Pierreux, France) was advanced to the transplant renal pelvis. The balloon dilation system (Cook Urological Inc., Spencer, Indiana, USA) was introduced into the ureter over a guidewire and the balloon extended with a 1:1 mixture of contrast medium/sodium chloride to the maximum diameter (6 mm/18 F) and maximum pressure (2.0 MPa) at the stricture site. Thus, the stricture was initially seen as a hourglass-like impression of the dilated balloon, which disappeared on maximum balloon expansion. Then the dilator was kept in place for 3–5 min. As we wanted to apply as little contrast medium as necessary in this retrograde approach, and as in low-volume retrograde ureterography a stenosis might be not detected after dilatation of the stricture, we slid the inflated balloon of the dilator through the rest of the transplant ureter to assure its patency over the whole length. At the end of the RBD procedure, a JJ stent (Visiostar Standard™, 7 F/22 cm, Urovision, Germany) was inserted, the cystoscope was withdrawn, and a 16 F Foley catheter was placed for 1–3 days (Fig. 1). The stent was removed with a flexible cystoscope under local anaesthesia at 14–21 days after the intervention. After this, the follow-up consisted of regular ultrasonographic assessment and creatinine assay in the Department of Nephrology. When there was an increase in creatinine level and/or dilatation of the transplant renal pelvis, the patient was re-evaluated for further intervention (stent insertion, repeated RBD, open operation).


Retrograde balloon dilation >10 weeks after renal transplantation for transplant ureter stenosis - our experience and review of the literature.

Rabenalt R, Winter C, Potthoff SA, Eisenberger CF, Grabitz K, Albers P, Giessing M - Arab J Urol (2011)

Retrograde balloon dilation. Stenosis of the distal transplant ureter of a renal transplant with 2 ureters (second ureter not opacified). The right image shows successful dilation with full expansion of the balloon.
© Copyright Policy - CC BY-NC-ND
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4150591&req=5

f0005: Retrograde balloon dilation. Stenosis of the distal transplant ureter of a renal transplant with 2 ureters (second ureter not opacified). The right image shows successful dilation with full expansion of the balloon.
Mentions: RBD of ureteric stenosis was done under general anaesthesia and antibiotic prophylaxis. Briefly, the transplant ureteric orifice was identified by transurethral cystoscopy. After retrograde transplant ureterography and exact localisation of the stricture site, a guidewire (ZipWire™ or Sensor™, Boston Scientific, Pierreux, France) was advanced to the transplant renal pelvis. The balloon dilation system (Cook Urological Inc., Spencer, Indiana, USA) was introduced into the ureter over a guidewire and the balloon extended with a 1:1 mixture of contrast medium/sodium chloride to the maximum diameter (6 mm/18 F) and maximum pressure (2.0 MPa) at the stricture site. Thus, the stricture was initially seen as a hourglass-like impression of the dilated balloon, which disappeared on maximum balloon expansion. Then the dilator was kept in place for 3–5 min. As we wanted to apply as little contrast medium as necessary in this retrograde approach, and as in low-volume retrograde ureterography a stenosis might be not detected after dilatation of the stricture, we slid the inflated balloon of the dilator through the rest of the transplant ureter to assure its patency over the whole length. At the end of the RBD procedure, a JJ stent (Visiostar Standard™, 7 F/22 cm, Urovision, Germany) was inserted, the cystoscope was withdrawn, and a 16 F Foley catheter was placed for 1–3 days (Fig. 1). The stent was removed with a flexible cystoscope under local anaesthesia at 14–21 days after the intervention. After this, the follow-up consisted of regular ultrasonographic assessment and creatinine assay in the Department of Nephrology. When there was an increase in creatinine level and/or dilatation of the transplant renal pelvis, the patient was re-evaluated for further intervention (stent insertion, repeated RBD, open operation).

Bottom Line: Long-term success was only achieved in one recipient, while five patients were re-operated on (three with a new implant, two by replacement of transplanted ureter with ileum) after a median (range) of 2.8 (0.7-7.0) months after unsuccessful RBD(s).For two recipients the success remained unclear (one graft loss due to other reasons, one result pending).When the first RBD was unsuccessful there was no improvement with a second.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, Heinrich Heine University Hospital Duesseldorf, Germany.

ABSTRACT

Objective: Despite many efforts to prevent ureteric stenosis in a transplanted kidney, this complication occurs in 3-5% of renal transplant recipients. Balloon dilatation (BD) is a possible minimally invasive approach for treatment, but reports to date refer only to the antegrade approach; we analysed our experience with retrograde BD (RBD) and reviewed previous reports.

Patients and methods: From October 2008 to February 2011, eight patients after renal transplantation (RTX) underwent RBD for transplant ureteric stenosis at our hospital. We retrospectively analysed the outcome and reviewed previous reports.

Results: The eight recipients (five men and three women; median age 55 years, range 38-69) were treated with one or two RBDs for transplant ureteric stenosis. There were no complications. The median (range) time after RTX was 4.5 (2.5-11) months. Long-term success was only achieved in one recipient, while five patients were re-operated on (three with a new implant, two by replacement of transplanted ureter with ileum) after a median (range) of 2.8 (0.7-7.0) months after unsuccessful RBD(s). For two recipients the success remained unclear (one graft loss due to other reasons, one result pending). When the first RBD was unsuccessful there was no improvement with a second.

Conclusion: RBD is technically feasible, but our findings and the review of previous reports on antegrade ureteric dilatation suggest that the success rate is low when the ureter is dilated at ⩾10 weeks after RTX. From our results we cannot recommend RBD for transplant ureteric stenosis at ⩾10 weeks after RTX, while previous reports show favourable results of antegrade BD in the initial 3 months after RTX.

No MeSH data available.


Related in: MedlinePlus