Analysis of Patients with Urethral Stricture in Kidney Transplant Recipients

Background: We aimed to assess the rates of urethral stricture in transplant recipients, analyse patients with urethral strictures and present the posttreatment follow-up outcomes. Methods: Between 2004 and 2023, a retrospective examination was conducted on kidney transplant recipients who underwent removal of ureteral catheters through retrograde cystoscopy at our facility or referred from external centres. The collected data encompassed patient demographics, preand posttransplant maximum urinary flow rate, specifics of stenosis, surgical interventions and outcomes from a 1-year follow-up. The treatment approach for urethral strictures was contingent on the severity, length and location, which encompass methods, such as dilation and transurethral internal urethrotomy. Urethra reconstruction was performed to address the instances of recurring strictures. Treatment decisions were made in accordance with established guidelines, which evolved with contemporary methodologies throughout the study period. Results: This study included 497 transplant patients, with a 3.4% rate of urethral strictures observed in 17 patients (average age: 39.8 years). All patients with urethral stricture were male. Posttransplant, cystourethroscopy aided catheter removal and retrograde urethrography diagnosed membranous urethra strictures in 64.7% of the patients. The average stricture length was 1.05 cm. The symptoms varied, and 64.7% were asymptomatic. Treatment comprised dilatation (23.5%), internal urethrotomy (70.5%) and urethroplasty (5.8%). The average maximum urinary flow rate at 3 and 12 months postoperatively reached 22.2 (range: 14-30) and 19.1 (range: 16-26), respectively. Conclusions: Urethral strictures post kidney transplantation are uncommon and can be safely and efficiently managed through urethral dilation, internal urethrotomy or urethra reconstruction. Mitigation of the risk of this complication involves the prevention of iatrogenic injuries and minimization of catheterisation duration.