Reconstruction of late‐onset transplant ureteral stricture disease

Study Type – Therapy (case series) Level of Evidence 4 What’s known on the subject? and What does the study add? Most of the published literature reporting on ureteral obstruction after renal transplantation details the outcomes of management when performed within a few months post‐transplantation. The present study attempts to document the management and outcomes of patients who develop delayed ureteral strictures after renal transplant. OBJECTIVE • To describe our experience with surgical management of transplant ureteral strictures over a 6‐year period. PATIENTS AND METHODS • The present study identified patients who underwent open reconstruction for transplant ureteral strictures between March 2002 and May 2008 after kidney or kidney–pancreas transplantation. • Baseline clinical characteristics were documented, including age at transplantation and reconstruction, serum creatinine levels, immunosuppressive drug regimen, and comorbidities. • Postoperative complications were noted, including urinary tract infections, stricture recurrence and graft failure. • Successful reconstructions were defined as stable allograft function with unobstructed outflow not requiring repeat dilation, ureterotomy or stent placement. RESULTS • Median age at the time of reconstruction was 51 years and the mean time from transplantation was 62 months. • Seven of the 13 patients had failed previous balloon dilation. • The patients were followed for a median of 41 months and a successful repair was achieved in 10 of 13 patients. • Ureteral strictures recurred in two patients who received ureteroneocystostomies, which were subsequently managed with chronic stent exchanges. • Another recurrence involved a 1.5‐cm anastomotic stricture 6 months postoperatively, which was balloon‐dilated and has remained recurrence‐free for 16 months. CONCLUSIONS • Patients who present >6 months after renal transplantation with ureteral strictures that are recalcitrant to endoscopic management can safely undergo open surgical ureteral reconstruction without subsequent renal or graft failure. • Further investigation involving a larger patient cohort is required to confirm these initial results.