Reconstruction of late-onset transplant ureteral stricture disease

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 center dot To describe our experience with surgical management of transplant ureteral strictures over a 6-year period. PATIENTS AND METHODS center dot 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. center dot Baseline clinical characteristics were documented, including age at transplantation and reconstruction, serum creatinine levels, immunosuppressive drug regimen, and comorbidities. center dot Postoperative complications were noted, including urinary tract infections, stricture recurrence and graft failure. center dot Successful reconstructions were defined as stable allograft function with unobstructed outflow not requiring repeat dilation, ureterotomy or stent placement. RESULTS center dot Median age at the time of reconstruction was 51 years and the mean time from transplantation was 62 months. center dot Seven of the 13 patients had failed previous balloon dilation. center dot The patients were followed for a median of 41 months and a successful repair was achieved in 10 of 13 patients. center dot Ureteral strictures recurred in two patients who received ureteroneocystostomies, which were subsequently managed with chronic stent exchanges. center dot 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 center dot 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. center dot Further investigation involving a larger patient cohort is required to confirm these initial results.