MANAGEMENT OF URETERAL STENOSIS AFTER RENAL-TRANSPLANTATION

BACKGROUND: Ureteral stenosis is the most common urologic complication of renal transplantation. Preferred management options for this compl ication vary among centers. Ureteral stenosis occurred in 24 (3.4 perc ent) of 692 consecutive renal transplants. The diagnosis was confirmed by antegrade pyelogaphy after ultrasonography in all instances. An at tempt was made to treat all patients by percutaneous stenting, usually with dilatation of the meter, which was possible in 21 patients. In t hree patients, a wire could not be passed across the stricture and the se patients were treated surgically. STUDY DESIGNS The patients were d ivided into two groups. Patients in group 1 (14 patients) presented wi thin three months from the date of transplantation and patients in gro up 2 (seven patients) presented after three months. RESULTS: The site of stenosis was the ureterovesical junction in 80 percent of the patie nts and the ureteropelvic junction in 20 percent. Urinary tract infect ion occurred in 70 percent of the patients in group 1 and 100 percent of patients in group 2. The success rate of percutaneous stenting was 71 percent (ten of 14 patients) in group 1, but only 29 percent (two o f seven patients) in group 2. The failures were treated by repeated st enting (one patient in each group) or by operation. One allograft (7 p ercent) was lost in group 1 and two (28 percent) were lost in group 2. The average follow-up period was 38 months in group 1 and 56 months i n group 2. There was no mortality in this series. CONCLUSIONS: Uretera l stenosis in the early postrenal transplant period can be safely and effectively treated by percutaneous dilatation and stenting, with few side effects and long-term success. This method is specially efficacio us in patients who present within three months from the time of their transplant. In patients who have ureteric strictures developing after three months from transplantation, percutaneous stenting is of limited value and most patients require surgical correction.