THE CONSERVATIVE MANAGEMENT OF OBSTRUCTED RENAL-TRANSPLANTS BY ENDOSCOPIC URETERAL STENTING

The aim of this study was to assess the conservative treatment of obst ructed renal transplants by the method of endoscopic ureteric stenting (a minimally invasive procedure), in terms of morbidity, mortality an d preservation of renal function. During a 30-month period between Jan uary 1989 and September 1992, 32 patients (14 men and 18 women) with o bstructed renal transplants, demonstrated ultrasonically and confirmed by subsequent fall in serum creatinine after nephrostomy drainage, we re treated by initial antegrade placement of a double J stent, followe d subsequently by repeated retrograde replacement of the stent endosco pically under general anaesthetic. The median duration of stent time w as 3 months (range 2-6 months). The mean serum creatinine after the mo st recent stent change in each patient (220.6 mmol/L) was significantl y less than the serum creatinine at presentation (329.5 mmol/L, P = 0. 002), but not significantly different compared to the creatinine after initial nephrostomy drainage (203 mmol/L, P = 0.5), indicating that r enal function was well maintained. No significant morbidity was encoun tered, and there were no transplant nephrectomies due to stent morbidi ty. Thirteen (41%) patients are now stent free. Endoscopic retrograde ureteric stenting is a safe and effective method by which to treat pat ients with obstructed renal allografts, renal function being well main tained by regular stent change.