Endoscopic retrograde stenting for allograft hydronephrosis

Background and Objectives: Ureteral obstruction occurs in 2% to 10% of all renal transplant recipients. Antegrade endourologic intervention has been t he gold standard of therapy but carries significant morbidity, This study w as designed to investigate the feasibility of retrograde stenting of these difficult meters and to determine whether it can be performed with minimal morbidity without general or regional anesthesia. Methods: Ninety-seven consecutive patients were found to have renal allogra ft hydronephrosis by ultrasonography, between August 1993 and March 1997, O f these, 61 (63%) had confirmation of obstruction by MAG-3 imaging, with eq uivocal results in 25 (26%), The remaining 11 patients had a rising creatin ine concentration despite Foley catheter drainage. All patients had retrogr ade stenting attempted under local anesthesia followed by intravenous sedat ion if necessary. If stent placement was unsuccessful, the procedure was re peated under regional or general anesthesia. Results: A total of 85 patients (88%) were managed successfully with retrog rade stenting. Of these procedures, 24 (28%) were performed under local ane sthesia alone, while 57 (67%) required both local anesthesia and intravenou s sedation. Only 4 patients (5%) required general anesthesia. No patient su ffered any morbidity associated with retrograde stenting, Of the 12 patient s in whom retrograde stenting failed, 2 had renal allograft rupture and 10 had ureteral necrosis at surgical exploration. Conclusions: Retrograde stenting of the hydronephrotic renal allograft can be achieved with a high success rate and minimal morbidity, usually without general or regional anesthesia. If the ureter cannot be managed in a retro grade fashion, a high index of suspicion for a serious allograft complicati on should exist.