ureteral stenosis after kidney transplant jonathan b. yuval md

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  • Ureteral Stenosis after Kidney Transplant Jonathan B. Yuval MD
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  • case 23 YOF Idiopathic renal failure Renal Tx on 27/4/13 from a live donor Normal operative course (ischemia of in upper pole) Normal immediate post-op course
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  • case One month after Tx readmitted d/t elevevated Cr Hydronephrosis on US Retrograde pyelography demonstrated a ureteral stricture Underwent nephrostomy insertion
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  • case 5/2013 insertion of stent from renal pelvis to urinary bladder + Nephrostomy 6/2013 Urosepsis w/ KP. IV ABX. Closure of Nephrostomy. 7/2013 Endo-urological Tx of stenosis 7/2013 UTI w/KP. IV ABX. Closure of Nephrostomy. Prophylactic fosfomycin. 9/2013. Anterograde nephrostogram. Removal of stent. Removal of Nephrostomy.
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  • case 9/2013 Elevated Cr. ESBL in urine. IV ABX. Improvement of Cr. 10/2013 in Dr. Merhavs clinic. No Sx of UTI. Normal Cr.
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  • Urological complications are the most common Stenosis/Leak in 5% of cases:
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  • The transplanted ureter is susceptible to stenosis d/t poor blood supply Most common cause of mechanical obstruction DDX: Stones, Rejection, BKV, external compression
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  • Increased peri-op morbidity and re-operation Does not affect graft survival if treated early
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  • Risk Factors Donor Age Number of transplanted arteries CIT Method of organ retrieval Preservation of gonadal vessels Technique (UU/intravesical/extravesical) Ureteral stent Preservation of peri-pelvic/ureteric fat
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  • Tx Endo-Surgery Surgical options Re-insertion Reconstruction w/native ureter Pyelo-ureterostomy Vesiculo-pyelostomy Uretero-urererostomy Reconstruction/Elongation of the bladder Ileal interposition Artificial ureter interposition
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  • Thanks!!
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