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

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• 作者：A. Uflacker ; D. Sheeran ; M. Khaja ; J. Patrie…
• 关键词：Nephrostomy/Nephrostogram ; Urogenital interventions ; Urogenital ; End stage renal disease ; Urinary tract ; Recanalization/Recanalisation ; Nephroureteral stent
• 刊名：CardioVascular and Interventional Radiology
• 出版年：2015
• 出版时间：June 2015
• 年：2015
• 卷：38
• 期：3
• 页码：693-701
• 全文大小：502 KB
• 参考文献：1.Organ Procurement and Transplantation Network: Transplants by Donor Type [Internet].(2014) http://?optn.?transplant.?hrsa.?gov/?latestData/?rptData.?asp . Accessed 20 Mar 2014
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  8.Fontana I, Bertocchi M, Rossi AM, Gasloli G, Santori G, Barabani C et al (2010) Late ureteral stenosis after kidney transplantation: a single-center experience. Transplant Proc 42(4):1174-175View Article PubMed
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  15.Miyaoka R, Duran-Castro OL, Alanee S, Monga M, Hunter DW (2011) Use of tandem double J stents in the management of recurrent and recalcitrant ureteral stenosis after kidney transplantation. Urology 77(6):1299-303View Article PubMed
  16.Atar E, Bachar GN, Bartal G, Mor E, Neyman H, Graif F et al (2005) Use of peripheral cutting balloon in the management of resistant benign ureteral and biliary strictures. J Vasc Interv Radiol 16(2):241-45View Article PubMed
  17.Fontaine AB, Nijjar A, Rangaraj R (1997) Update on the use of percutaneous nephrostomy/balloon dilation for the treatment of renal transplant leak/obstruction. J Vasc Interv Radiol 8(4):649-53View Article PubMed
  18.Yong AA, Ball ST, Pelling MX, Gedroyc WMW, Morgan RA (1999) Management of ureteral strictures in renal transplants by antegrade balloon dilatation and temporary internal stenting. Cardiovasc Intervent Radiol 22(5):385-88View Article PubMed
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• 作者单位：A. Uflacker (1)
  D. Sheeran (1)
  M. Khaja (1)
  J. Patrie (3)
  G. Elias (4)
  W. Saad (2)
  
  1. University of Virginia/Interventional Radiology, FedEx: 1215 Lee Street, PO Box 800170, Charlottesville, VA, 22908, USA
  3. UVA Health System/Radiology, Charlottesville, VA, USA
  4. VCU Medical Center/Radiology, 1101 East Marshall Street, Room 4-052, Richmond, 23298, VA, USA
  2. University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA
  
• 刊物类别：Medicine
• 刊物主题：Medicine & Public Health
  Imaging and Radiology
  Nuclear Medicine
  Ultrasound
  Cardiology
  
• 出版者：Springer New York
• ISSN：1432-086X

文摘

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.