Double-Puncture Technique for Management of Severe Ureteropelvic Obstruction in Kidney Transplant

Ureteral obstruction is one of the most common urological complications after kidney transplant. The definitive treatment of ureteral obstruction has been surgicalrevision. Because ofthe increased morbidity of surgery, minimally invasive percutaneous procedures have gained more acceptance in recent years. Presently, interventional radiological procedures are recommended as the first step in treatment of ureteral obstructions. Ureteral occlusions or near-occlusion high-grade stenoses require greater catheter backup force. Antegrade interventions generally prefer upper- to-middle calyx puncture. Cranial/superior proximal ureter stenoses cause severe angulations. Steep angulations of proximal ureter and ureteropelvic tight stenoses may require direct puncture of the renal pelvis or another calyx to achieve a less difficult angle. The double-puncture technique may help to manage severe angulations of proximal ureter and near- occlusion tight stenosis of the ureteropelvic junction.