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Obstructive uropathy in the transplanted kidney: definitive management with percutaneous nephrostomy and prolonged
P Pappas1, A Giannopoulos, K G Stravodimos
1Department of Radiology, Laiko Hospital, Athens, Greece.
Background And Purpose:
Renal transplantation is an effective treatment for end-stage renal disease. Ureteral stenosis is the most frequent urologic complication. We report our experience with percutaneous nephrostomy and antegrade ureteral stenting, which may offer a primary and definitive alternative to open surgery.
Patients And Methods:
Fifteen patients with renal allograft obstructive uropathy were managed with percutaneous nephrostomy and prolonged ureteral stenting.
Results:
Percutaneous nephrostomies were successfully performed in all 15 kidneys: In 13 patients, antegrade ureteral stenting was attempted, this being successful in 11 (85%). After prolonged ureteral stenting (mean duration 15 months), the stent was removed in eight patients, and six of them (75%) did not have recurrences. During follow-up, urea, creatinine, sodium, and potassium determinations and ultrasound scans were performed, and success was confirmed by the decline of creatinine and reduction in hydronephrosis. No major complication was observed.
Conclusion:
Percutaneous nephrostomy and ureteral stenting is a safe and effective treatment for renal allograft obstructive uropathy. Prolonged ureteral stenting may offer a definitive treatment with low morbidity.