ureteral stenosis after kidney transplant jonathan b. yuval md
TRANSCRIPT
case
• 23 YOF• Idiopathic renal failure• Renal Tx on 27/4/13 from a live donor• Normal operative course (ischemia of in upper
pole)• Normal immediate post-op course
case
• One month after Tx readmitted d/t elevevated Cr
• Hydronephrosis on US• Retrograde pyelography demonstrated a
ureteral stricture• Underwent nephrostomy insertion
case
• 5/2013 insertion of stent from renal pelvis to urinary bladder + Nephrostomy
• 6/2013 Urosepsis w/ KP. IV ABX. Closure of Nephrostomy.
• 7/2013 Endo-urological Tx of stenosis• 7/2013 UTI w/KP. IV ABX. Closure of
Nephrostomy. Prophylactic fosfomycin.• 9/2013. Anterograde nephrostogram. Removal
of stent. Removal of Nephrostomy.
case
• 9/2013 Elevated Cr. ESBL in urine. IV ABX. Improvement of Cr.
• 10/2013 in Dr. Merhav’s clinic. No Sx of UTI. Normal Cr.
• Urological complications are the most common
• Stenosis/Leak in 5% of cases:
• The transplanted ureter is susceptible to stenosis d/t poor blood supply
• Most common cause of mechanical obstruction
• DDX: Stones, Rejection, BKV, external compression
• Increased peri-op morbidity and re-operation• Does not affect graft survival if treated early
Risk Factors
• Donor Age• Number of transplanted arteries• CIT• Method of organ retrieval• Preservation of gonadal vessels• Technique (UU/intravesical/extravesical)• Ureteral stent • Preservation of peri-pelvic/ureteric fat
Tx
• Endo-Surgery• Surgical options– Re-insertion– Reconstruction w/native ureter– Pyelo-ureterostomy– Vesiculo-pyelostomy– Uretero-urererostomy– Reconstruction/Elongation of the bladder– Ileal interposition– Artificial ureter interposition
