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Endoureteral Management of Renal Graft Ureteral Stenosis by the Use of Long-Term Metal Stent: An Appealing Treatment Option

View Article: PubMed Central - PubMed

ABSTRACT

Background:: Ureteral stenosis is part of the common complications of renal graft reported in 3% to 7% of cases. Multiple treatments have been introduced regarding length and position of the stenosis. Metal stents for urologic purpose were created in 1998. Double percutaneous antegrade and transurethral retrograde access to a ureteral stenosis to a long-term metal stent procedure has been rarely described.

Case presentation:: Here, we present a case of a ureteral stricture in a double ipsilateral kidney graft with a common ureter. A 67-year-old patient presented with obstructive nephritis associated with acute renal failure 6 years after a double renal graft with a uretero-ureteral end-to-side anastomosis. Abdominal CT scan showed double pelvic dilation. The patient underwent double percutaneous nephrostomies and antegrade pyelogram showed both renal pelvic and ureter dilations caused by a severe chronic ureteral stenosis at junction into the bladder. A Double-J ureteric stent was then inserted retrogradely over a guidewire as first-line treatment. Due to recurrent urinary tract infections (UTIs), removal and replacement of Double-J stents were carried out by placing a thermoexpandable metal stent Memokath® 051 (Bard, Pnn Medical) through the common ureter by a double antegrade and retrograde approach. Treatment was effective with a good renal function maintained after a 3-year follow-up without UTIs.

Conclusion:: Double antegrade and retrograde access to a long-term metal stent treatment can be seen as an alternative treatment to either endoscopy or open surgery. Further studies should be continued using larger series.

No MeSH data available.


Related in: MedlinePlus

Thermoexpandable metal stent placement on a ureteral stenosis. This figure show obstructive pyelonephritis in a 67-year-old patient with a double renal graft and a uretero-ureteral end-to-side anastomosis. A puncture of the superior graft was carried out demonstrating a major renal pelvic dilation of the graft on antegrade pyelogram (A). Fifteen minutes later, (B) a double renal pelvic dilation associated with a ureteral dilation was noted above the severe ureteral stenosis on the common iliac ureter (arrowhead). A 0.035 Terumo® guidewire was placed through the stenosis into the bladder. Through the wire, a dilatation of the ureteral stenosis was performed with a 5 mm high pressure (at 10 atm) dilator (C), with effectiveness (D) (arrowheads). Then, a cystosocopy collected the wire by a retrograde approach. After dilatation, an access sheath was left on the stenosis, through a retrograde approach, allowing the correct placement of Memokath® 051 over the stenosis (E). An effective expansion of the metal stent was achieved after removal of the sheath using 60°C hot water (F).
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f1: Thermoexpandable metal stent placement on a ureteral stenosis. This figure show obstructive pyelonephritis in a 67-year-old patient with a double renal graft and a uretero-ureteral end-to-side anastomosis. A puncture of the superior graft was carried out demonstrating a major renal pelvic dilation of the graft on antegrade pyelogram (A). Fifteen minutes later, (B) a double renal pelvic dilation associated with a ureteral dilation was noted above the severe ureteral stenosis on the common iliac ureter (arrowhead). A 0.035 Terumo® guidewire was placed through the stenosis into the bladder. Through the wire, a dilatation of the ureteral stenosis was performed with a 5 mm high pressure (at 10 atm) dilator (C), with effectiveness (D) (arrowheads). Then, a cystosocopy collected the wire by a retrograde approach. After dilatation, an access sheath was left on the stenosis, through a retrograde approach, allowing the correct placement of Memokath® 051 over the stenosis (E). An effective expansion of the metal stent was achieved after removal of the sheath using 60°C hot water (F).

Mentions: The patient underwent double percutaneous nephrostomies in the grafts and was effectively cured by antibiotics. One week later, an antegrade pyelogram showed both major renal pelvic and ureter dilations caused by a severe ureteral stricture at the junction of the common ureter into the bladder (Fig. 1A). One 6/16 Double-J stent was temporarily passed over a guidewire from the inferior graft through the stenosis. Although this was initially effective, overtime, multiple acute UTIs were reported with rising serum creatinine.


Endoureteral Management of Renal Graft Ureteral Stenosis by the Use of Long-Term Metal Stent: An Appealing Treatment Option
Thermoexpandable metal stent placement on a ureteral stenosis. This figure show obstructive pyelonephritis in a 67-year-old patient with a double renal graft and a uretero-ureteral end-to-side anastomosis. A puncture of the superior graft was carried out demonstrating a major renal pelvic dilation of the graft on antegrade pyelogram (A). Fifteen minutes later, (B) a double renal pelvic dilation associated with a ureteral dilation was noted above the severe ureteral stenosis on the common iliac ureter (arrowhead). A 0.035 Terumo® guidewire was placed through the stenosis into the bladder. Through the wire, a dilatation of the ureteral stenosis was performed with a 5 mm high pressure (at 10 atm) dilator (C), with effectiveness (D) (arrowheads). Then, a cystosocopy collected the wire by a retrograde approach. After dilatation, an access sheath was left on the stenosis, through a retrograde approach, allowing the correct placement of Memokath® 051 over the stenosis (E). An effective expansion of the metal stent was achieved after removal of the sheath using 60°C hot water (F).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5035826&req=5

f1: Thermoexpandable metal stent placement on a ureteral stenosis. This figure show obstructive pyelonephritis in a 67-year-old patient with a double renal graft and a uretero-ureteral end-to-side anastomosis. A puncture of the superior graft was carried out demonstrating a major renal pelvic dilation of the graft on antegrade pyelogram (A). Fifteen minutes later, (B) a double renal pelvic dilation associated with a ureteral dilation was noted above the severe ureteral stenosis on the common iliac ureter (arrowhead). A 0.035 Terumo® guidewire was placed through the stenosis into the bladder. Through the wire, a dilatation of the ureteral stenosis was performed with a 5 mm high pressure (at 10 atm) dilator (C), with effectiveness (D) (arrowheads). Then, a cystosocopy collected the wire by a retrograde approach. After dilatation, an access sheath was left on the stenosis, through a retrograde approach, allowing the correct placement of Memokath® 051 over the stenosis (E). An effective expansion of the metal stent was achieved after removal of the sheath using 60°C hot water (F).
Mentions: The patient underwent double percutaneous nephrostomies in the grafts and was effectively cured by antibiotics. One week later, an antegrade pyelogram showed both major renal pelvic and ureter dilations caused by a severe ureteral stricture at the junction of the common ureter into the bladder (Fig. 1A). One 6/16 Double-J stent was temporarily passed over a guidewire from the inferior graft through the stenosis. Although this was initially effective, overtime, multiple acute UTIs were reported with rising serum creatinine.

View Article: PubMed Central - PubMed

ABSTRACT

Background:: Ureteral stenosis is part of the common complications of renal graft reported in 3% to 7% of cases. Multiple treatments have been introduced regarding length and position of the stenosis. Metal stents for urologic purpose were created in 1998. Double percutaneous antegrade and transurethral retrograde access to a ureteral stenosis to a long-term metal stent procedure has been rarely described.

Case presentation:: Here, we present a case of a ureteral stricture in a double ipsilateral kidney graft with a common ureter. A 67-year-old patient presented with obstructive nephritis associated with acute renal failure 6 years after a double renal graft with a uretero-ureteral end-to-side anastomosis. Abdominal CT scan showed double pelvic dilation. The patient underwent double percutaneous nephrostomies and antegrade pyelogram showed both renal pelvic and ureter dilations caused by a severe chronic ureteral stenosis at junction into the bladder. A Double-J ureteric stent was then inserted retrogradely over a guidewire as first-line treatment. Due to recurrent urinary tract infections (UTIs), removal and replacement of Double-J stents were carried out by placing a thermoexpandable metal stent Memokath® 051 (Bard, Pnn Medical) through the common ureter by a double antegrade and retrograde approach. Treatment was effective with a good renal function maintained after a 3-year follow-up without UTIs.

Conclusion:: Double antegrade and retrograde access to a long-term metal stent treatment can be seen as an alternative treatment to either endoscopy or open surgery. Further studies should be continued using larger series.

No MeSH data available.


Related in: MedlinePlus