INTRODUCTION AND OBJECTIVES. Ureteral stenosis and vesicocoureteral reflux after renal
transplantation represent a key concern because of their incidence and the associated
morbidity. Prompt diagnosis and minimally invasive treatment are mandatory in immunosuppressed
patients with single kidney. The aim of this study is to evaluate the success rate
of the endourological techniques in the management of such complications.
MATERIALS AND METHODS. Between January 1996 and December 2006, 647 kidney transplants
were performed. Urinary tract continuity was re-established by ureteroneocystostomy according
to Gregoir-Lich technique. We observed 13 cases of ureteral stenosis (2%) and 11
cases of symptomatic vesicoureteric reflux (1.7%). The endourogical procedure was performed
in 13 patients: 5 cases of II-III grade vesicoureteric reflux, 4 early ureteral stenosis
and 4 late ureteral stenosis. Patients with vesicoureteric reflux underwent endoscopic injection
of macroplastique in 4 cases and Durasphere in 1. Early ureteral stenoses were treated
using balloon dilation in 2 cases, balloon dilation and laser endoureterotomy in 3, ureteral
stent placement in the other. Recipients with late stenosis underwent laser incision and
balloon dilation in 2 cases, balloon dilation in 1 and a laser incision only in the last case.
Combined antegrade and retrograde endoscopic approach was performed in 7 patients,
whereas retrograde access in 1.
RESULTS. Endourologic treatment was successful in 9 cases (69.2%); 2 patients required
open reconstructive surgery due to endourological technique failure (early ureteropelvic
junction stricture, late ureterovesical anastomotic stricture).
Vesicoureteric reflux was corrected in 3 patients (60%), 2 patients underwent uretero-ureterostomy
for recurrent reflux. No technique-related morbidity was observed. With a mean follow-
up of 81.6 months, 8 patients show normal renal function, 5 patients have returned to
haemodialysis (4 for chronic rejection, 1 for carcinoma in the graft).
CONCLUSIONS. Considering their low morbidity and the satisfactory success rate, we claim
that endourological procedures should be considered the preferred treatment for ureteral
stenosis and vesicoureteric reflux in selected patients