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Outcomes of Percutaneous Management of Anastomotic Ureteral Strictures in Renal Transplantation: Chronic Nephroureteral Stent Placement with and without Balloon Dilatation

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Abstract

Purpose

This study was designed o evaluate outcomes of percutaneous management of anastomotic ureteral strictures in renal transplants using nephroureteral stents with or without balloon dilatation.

Methods

A retrospective audit of 1,029 consecutive renal transplants was performed. Anastomotic ureteral strictures were divided into two groups: nephroureteral stent only (NUS) and NUS+PTA (nephroureteral stent plus percutaneous transluminal angioplasty), with each cohort subdivided into early versus late presentation (obstructive uropathy occurring <90 day or >90 days from transplant, respectively). Overall and 6-month technical success were defined as removal of NUS any time with <30 % residual stenosis (any time lapse less or more than 6 months) and at >6 months, respectively. Patency was evaluated from NUS removal to last follow-up for both groups and compared.

Results

Sixty-seven transplant patients with 70 ureteric anastomotic strictures (6.8 %, n = 70/1,029) underwent 72 percutaneous treatments. 34 % were late (>90 days, n = 24/70), and 66 % were early (<90 days, n = 46/70). Overall technical success was 82 % (n = 59/72) and 6-month success was 58 % (n = 42/72). Major and minor complications were 2.8 % (n = 2/72), and 12.5 % (n = 9/72). NUS+PTA did not improve graft survival (p = 0.354) or patency (p = 0.9) compared with NUS alone. There was no difference in graft survival between treated and nontreated groups (p = 0.74).

Conclusions

There is no advantage to PTA in addition to placement of NUS, although PTA did not negatively impact graft survival or long-term patency and both interventions were safe and effective. Neither the late or early groups benefited from PTA in addition to NUS. Earlier obstructions showed greater improvement in serum creatinine than later obstructions.

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Conflict of interest

Andre Uflacker , Daniel Sheeran , Minhajuddin Khaja , James Patrie , Gustavo Elias , Wael Saad have no conflict of interest.

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Authors and Affiliations

  1. University of Virginia/Interventional Radiology, FedEx: 1215 Lee Street, PO Box 800170, Charlottesville, VA, 22908, USA

    A. Uflacker, D. Sheeran & M. Khaja

  2. University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA

    W. Saad

  3. UVA Health System/Radiology, Charlottesville, VA, USA

    J. Patrie

  4. VCU Medical Center/Radiology, 1101 East Marshall Street, Room 4-052, Richmond, 23298, VA, USA

    G. Elias

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  1. A. Uflacker
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  2. D. Sheeran
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Correspondence to A. Uflacker.

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Uflacker, A., Sheeran, D., Khaja, M. et al. Outcomes of Percutaneous Management of Anastomotic Ureteral Strictures in Renal Transplantation: Chronic Nephroureteral Stent Placement with and without Balloon Dilatation. Cardiovasc Intervent Radiol 38, 693–701 (2015). https://doi.org/10.1007/s00270-014-0952-8

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  • DOI: https://doi.org/10.1007/s00270-014-0952-8

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