Percutaneous therapy of ureteral obstructions and leak after renal transplantation: long-term results

• Published in: Cardiovascular and interventional radiology 2007-11, Vol.30 (6), p.1178-1184
• Main Authors: Aytekin, Cüneyt, Boyvat, Fatih, Harman, Ali, Ozyer, Umut, Colak, Turan, Haberal, Mehmet
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Catheterization - methods; Child; EXTRACTION; Female; Humans; Kidney Transplantation; KIDNEYS; Male; Middle Aged; Nephrostomy, Percutaneous - methods; Postoperative Complications - diagnosis; Postoperative Complications - therapy; RADIOLOGY AND NUCLEAR MEDICINE; Stents; SURGERY; THERAPY; TRANSPLANTS; Transplants & implants; Treatment Outcome; ULTRASONOGRAPHY; Ultrasonography, Interventional; Ureteral Obstruction - diagnosis; Ureteral Obstruction - etiology; Ureteral Obstruction - therapy
• ISSN: 0174-1551; 1432-086X
• DOI: 10.1007/s00270-007-9031-8

The purpose of this study was to evaluate the long-term outcome of percutaneous therapy of ureteral complications after renal transplantation. Between January 2000 and June 2006 we percutaneously treated 26 renal transplant patients with ureteral obstruction (n=19) and leak (n=7). Obstructions were classified as early (2 months). Patients with leak were treated with nephro-ureteral catheter placement and subsequent double-J stenting. Balloon dilatation, stent placement, and basket extraction were used to treat ureteral obstructions. Patients were followed with ultrasonography. No major procedure-related complication occurred. The mean follow-up time was 34.3 months (range: 6 to 74 months). Initial clinical success was achieved in all 19 patients with obstruction and 6 of 7 patients with leak. Four of 9 early obstructions and 4 of 10 late obstructions recurred during the follow-up. All recurrences were initially managed again with percutaneous methods, including cutting balloon technique and metallic stent placement. Although there was no recurrence in patients with successfully treated leak, stricture was seen at the previous leak site in two patients. These strictures were also successfully managed percutaneously. We conclude that in the treatment of ureteral obstruction and leak following renal transplantation, percutaneous therapy is an effective alternative to surgery. However, further interventions are usually needed to maintain long-term patency.