Abstract:
BACKGROUND:The management of ureteral strictures in transplanted kidney is challenging. Open surgical treatment is effective but entails significant convalescence. Holmium:yttrium-aluminum-garnet (Ho:YAG) laser endoureterotomy is useful for other types of ureteral obstruction, and we aimed to assess its long-term success for strictures of transplant kidney ureters. METHODS:We reviewed the course of 12 kidney transplant patients managed with Ho:YAG laser endoureterotomy and/or percutaneous ureteroscopic balloon dilatation for ureterovesical anastomotic strictures or ureteropelvic junction obstruction. Success was defined as stable serum creatinine and no hydronephrosis on follow-up. RESULTS:Of the patients, nine had ureterovesical anastomotic strictures. Of the six treated with balloon dilatation and Ho:YAG laser endoureterotomy, the success rate was 67% (58 months mean follow-up). Both strictures with failure were longer than 10 mm. Of the three patients treated with balloon dilatation only, there was success in only one (14 months follow-up) and both strictures with failure were shorter than 10 mm. There were three patients treated for ureteropelvic junction obstruction, one with balloon dilatation and two with balloon dilatation plus Ho:YAG laser endoureterotomy, all successfully (57 months mean follow-up). Overall, of the eight strictures 10 mm or shorter, there was success rate in six (75%), with 52 months mean follow-up, including five of five (100%) treated with laser endoureterotomy and one of three (33%) treated with only balloon dilation. CONCLUSIONS:Our results suggest that Ho:YAG laser endoureterotomy should be a first line treatment for ureteral strictures of length 10 mm or shorter in kidney transplant patients.
journal_name
Transplantationjournal_title
Transplantationauthors
Gdor Y,Gabr AH,Faerber GJ,Wolf JS Jrdoi
10.1097/TP.0b013e31816c7f19subject
Has Abstractpub_date
2008-05-15 00:00:00pages
1318-21issue
9eissn
0041-1337issn
1534-6080pii
00007890-200805150-00017journal_volume
85pub_type
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