ENDOUROLOGICAL MANAGEMENT OF URETERAL OBSTRUCTION AFTER RENAL-TRANSPLANTATION

Purpose: We evaluated endourological treatment of ureteral obstruction after renal transplantation. Materials and Methods: Between January 1 986 and December 1993, 582 kidney transplantations were performed at o ur center, and ureteral obstruction was suspected in 31 cases (5.3%). Results: Initial treatment consisted of retrograde placement of an int ernal stent in 6 patients and percutaneous nephrostomy in 25. Due to u pper tract dilatation obstruction could not be diagnosed in 3 patients , and rejection was the cause of decreasing renal function. Obstructio n was temporary in 8 of the remaining 28 patients, including 6 in whom a Double-J stent was introduced in a retrograde manner without anest hesia. In the other 2 patients as well as the 20 with definitive obstr uction, cannulation of the transplant orifice without anesthesia was u nsuccessful and percutaneous nephrostomy drainage was necessary. Even with general anesthesia a guide wire could not be passed along the str icture in a retrograde or antegrade fashion in 7 of the 20 patients wi th definitive obstruction and open surgery was performed. The remainin g 13 patients underwent dilation with (9) or without (4) diathermic in cision. All 4 patients treated with dilation only had recurrent obstru ction, while 9 treated with dilation and incision had no recurrence af ter a minimum followup of 27 months (mean 58). Conclusions: Modern end ourological procedures have replaced open reconstructive surgery in th e majority of patients with ureteral obstruction after renal transplan tation.