TY - JOUR
T1 - Ureteral stricture after pediatric kidney transplantation
T2 - Is there a role for percutaneous antegrade ureteroplasty?
AU - Bachtel, Hannah Agard
AU - Hussaini, S. Hamza
AU - Austin, Paul F.
AU - Janzen, Nicolette K.
AU - Chau, Alex
AU - Pezeshkmehr, Amir
AU - Nguyen Galvan, N. Thao
AU - Brewer, Eileen D.
AU - Swartz, Sarah
AU - Hernandez, J. Alberto
AU - Gardner, Greg
AU - Cotton, Ronald T.
AU - O'Mahony, Christine A.
AU - Koh, Chester J.
AU - Kukreja, Kamlesh U.
N1 - Copyright © 2023. Published by Elsevier Ltd.
PY - 2023/6
Y1 - 2023/6
N2 - INTRODUCTION: Ureteral obstruction following pediatric kidney transplantation occurs in 5-8% of cases. We describe our experience with percutaneous antegrade ureteroplasty for the treatment of ureteral stricture in pediatric kidney transplant patients.METHODS: We retrospectively reviewed all pediatric kidney transplantation patients who presented with ureteral stricture and underwent percutaneous antegrade ureteroplasty at our institution from July 2009 to July 2021. Variables included patient demographics, timing of presentation, location and extent of stricture, ureteroplasty technique and clinical outcomes. Our primary outcome was persistent obstruction of the kidney transplant.RESULTS: Twelve patients met inclusion criteria (4.2% of all transplants). Median age at time of ureteroplasty was 11.5 years (range: 3-17.5 years). Median time from kidney transplantation to ureteroplasty was 3 months. Patency was maintained in 50% of patients. Seven patients (58.3%) required additional surgery. Four patients developed vesicoureteral reflux. Patients with persistent obstruction had a longer time from transplant to ureteroplasty compared to those who achieved patency (19.3 vs 1.3 months, p = 0.0163). Of those treated within 6 months after transplantation, two patients (25%) required surgery for persistent obstruction (p = 0.06). All patients treated >1 year after transplantation had persistent obstruction following ureteroplasty (p = 0.06).CONCLUSION: Percutaneous antegrade ureteroplasty can be considered a viable minimally invasive treatment option for pediatric patients who develop early ureteral obstruction (<6 months) following kidney transplantation. In patients who are successfully treated with ureteroplasty, 67% can develop vesicoureteral reflux into the transplant kidney. Patients who fail early percutaneous ureteroplasty or develop obstruction >1 year after transplantation are best managed with surgical intervention.
AB - INTRODUCTION: Ureteral obstruction following pediatric kidney transplantation occurs in 5-8% of cases. We describe our experience with percutaneous antegrade ureteroplasty for the treatment of ureteral stricture in pediatric kidney transplant patients.METHODS: We retrospectively reviewed all pediatric kidney transplantation patients who presented with ureteral stricture and underwent percutaneous antegrade ureteroplasty at our institution from July 2009 to July 2021. Variables included patient demographics, timing of presentation, location and extent of stricture, ureteroplasty technique and clinical outcomes. Our primary outcome was persistent obstruction of the kidney transplant.RESULTS: Twelve patients met inclusion criteria (4.2% of all transplants). Median age at time of ureteroplasty was 11.5 years (range: 3-17.5 years). Median time from kidney transplantation to ureteroplasty was 3 months. Patency was maintained in 50% of patients. Seven patients (58.3%) required additional surgery. Four patients developed vesicoureteral reflux. Patients with persistent obstruction had a longer time from transplant to ureteroplasty compared to those who achieved patency (19.3 vs 1.3 months, p = 0.0163). Of those treated within 6 months after transplantation, two patients (25%) required surgery for persistent obstruction (p = 0.06). All patients treated >1 year after transplantation had persistent obstruction following ureteroplasty (p = 0.06).CONCLUSION: Percutaneous antegrade ureteroplasty can be considered a viable minimally invasive treatment option for pediatric patients who develop early ureteral obstruction (<6 months) following kidney transplantation. In patients who are successfully treated with ureteroplasty, 67% can develop vesicoureteral reflux into the transplant kidney. Patients who fail early percutaneous ureteroplasty or develop obstruction >1 year after transplantation are best managed with surgical intervention.
KW - Kidney transplantation
KW - Pediatrics
KW - Percutaneous antegrade ureteroplasty
KW - Ureteral obstruction
KW - Constriction, Pathologic/etiology
KW - Humans
KW - Child, Preschool
KW - Ureteral Obstruction/etiology
KW - Treatment Outcome
KW - Vesico-Ureteral Reflux/etiology
KW - Kidney Transplantation/adverse effects
KW - Adolescent
KW - Ureter/surgery
KW - Retrospective Studies
KW - Child
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UR - http://www.scopus.com/inward/citedby.url?scp=85148715116&partnerID=8YFLogxK
U2 - 10.1016/j.jpurol.2023.01.010
DO - 10.1016/j.jpurol.2023.01.010
M3 - Article
C2 - 36750396
AN - SCOPUS:85148715116
SN - 1477-5131
VL - 19
SP - 296.e1-296.e8
JO - Journal of Pediatric Urology
JF - Journal of Pediatric Urology
IS - 3
ER -