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Title: Outcomes of Percutaneous Management of Anastomotic Ureteral Strictures in Renal Transplantation: Chronic Nephroureteral Stent Placement with and without Balloon Dilatation

Abstract

PurposeThis study was designed o evaluate outcomes of percutaneous management of anastomotic ureteral strictures in renal transplants using nephroureteral stents with or without balloon dilatation.MethodsA retrospective audit of 1,029 consecutive renal transplants was performed. Anastomotic ureteral strictures were divided into two groups: nephroureteral stent only (NUS) and NUS+PTA (nephroureteral stent plus percutaneous transluminal angioplasty), with each cohort subdivided into early versus late presentation (obstructive uropathy occurring <90 day or >90 days from transplant, respectively). Overall and 6-month technical success were defined as removal of NUS any time with <30 % residual stenosis (any time lapse less or more than 6 months) and at >6 months, respectively. Patency was evaluated from NUS removal to last follow-up for both groups and compared.ResultsSixty-seven transplant patients with 70 ureteric anastomotic strictures (6.8 %, n = 70/1,029) underwent 72 percutaneous treatments. 34 % were late (>90 days, n = 24/70), and 66 % were early (<90 days, n = 46/70). Overall technical success was 82 % (n = 59/72) and 6-month success was 58 % (n = 42/72). Major and minor complications were 2.8 % (n = 2/72), and 12.5 % (n = 9/72). NUS+PTA did not improve graft survival (p = 0.354) or patency (p = 0.9) compared with NUS alone. There was no difference in graft survival between treated and nontreated groups (p = 0.74).ConclusionsThere is no advantage to PTA in addition to placement of NUS, althoughmore » PTA did not negatively impact graft survival or long-term patency and both interventions were safe and effective. Neither the late or early groups benefited from PTA in addition to NUS. Earlier obstructions showed greater improvement in serum creatinine than later obstructions.« less

Authors:
; ;  [1];  [2];  [3];  [4]
  1. University of Virginia/Interventional Radiology (United States)
  2. UVA Health System/Radiology (United States)
  3. VCU Medical Center/Radiology (United States)
  4. University of Michigan Health System (United States)
Publication Date:
OSTI Identifier:
22469937
Resource Type:
Journal Article
Journal Name:
Cardiovascular and Interventional Radiology
Additional Journal Information:
Journal Volume: 38; Journal Issue: 3; Conference: CIRSE 2015: Cardiovascular and Interventional Radiological Society of Europe congress, Lisbon (Portugal), 26-30 Sep 2015; Other Information: Copyright (c) 2015 Springer Science+Business Media New York and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE); http://www.springer-ny.com; Country of input: International Atomic Energy Agency (IAEA); Journal ID: ISSN 0174-1551
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; BIOMEDICAL RADIOGRAPHY; CREATININE; DESIGN; GRAFTS; KIDNEYS; PATIENTS; REMOVAL

Citation Formats

Uflacker, A., E-mail: andreuflacker@gmail.com, Sheeran, D., E-mail: dsheeran9@gmail.com, Khaja, M., E-mail: mkhaja@mac.com, Patrie, J., E-mail: jp4h@virginia.edu, Elias, G., E-mail: gae2y@virginia.edu, and Saad, W., E-mail: wspikes@yahoo.com. Outcomes of Percutaneous Management of Anastomotic Ureteral Strictures in Renal Transplantation: Chronic Nephroureteral Stent Placement with and without Balloon Dilatation. United States: N. p., 2015. Web. doi:10.1007/S00270-014-0952-8.
Uflacker, A., E-mail: andreuflacker@gmail.com, Sheeran, D., E-mail: dsheeran9@gmail.com, Khaja, M., E-mail: mkhaja@mac.com, Patrie, J., E-mail: jp4h@virginia.edu, Elias, G., E-mail: gae2y@virginia.edu, & Saad, W., E-mail: wspikes@yahoo.com. Outcomes of Percutaneous Management of Anastomotic Ureteral Strictures in Renal Transplantation: Chronic Nephroureteral Stent Placement with and without Balloon Dilatation. United States. doi:10.1007/S00270-014-0952-8.
Uflacker, A., E-mail: andreuflacker@gmail.com, Sheeran, D., E-mail: dsheeran9@gmail.com, Khaja, M., E-mail: mkhaja@mac.com, Patrie, J., E-mail: jp4h@virginia.edu, Elias, G., E-mail: gae2y@virginia.edu, and Saad, W., E-mail: wspikes@yahoo.com. Mon . "Outcomes of Percutaneous Management of Anastomotic Ureteral Strictures in Renal Transplantation: Chronic Nephroureteral Stent Placement with and without Balloon Dilatation". United States. doi:10.1007/S00270-014-0952-8.
@article{osti_22469937,
title = {Outcomes of Percutaneous Management of Anastomotic Ureteral Strictures in Renal Transplantation: Chronic Nephroureteral Stent Placement with and without Balloon Dilatation},
author = {Uflacker, A., E-mail: andreuflacker@gmail.com and Sheeran, D., E-mail: dsheeran9@gmail.com and Khaja, M., E-mail: mkhaja@mac.com and Patrie, J., E-mail: jp4h@virginia.edu and Elias, G., E-mail: gae2y@virginia.edu and Saad, W., E-mail: wspikes@yahoo.com},
abstractNote = {PurposeThis study was designed o evaluate outcomes of percutaneous management of anastomotic ureteral strictures in renal transplants using nephroureteral stents with or without balloon dilatation.MethodsA retrospective audit of 1,029 consecutive renal transplants was performed. Anastomotic ureteral strictures were divided into two groups: nephroureteral stent only (NUS) and NUS+PTA (nephroureteral stent plus percutaneous transluminal angioplasty), with each cohort subdivided into early versus late presentation (obstructive uropathy occurring <90 day or >90 days from transplant, respectively). Overall and 6-month technical success were defined as removal of NUS any time with <30 % residual stenosis (any time lapse less or more than 6 months) and at >6 months, respectively. Patency was evaluated from NUS removal to last follow-up for both groups and compared.ResultsSixty-seven transplant patients with 70 ureteric anastomotic strictures (6.8 %, n = 70/1,029) underwent 72 percutaneous treatments. 34 % were late (>90 days, n = 24/70), and 66 % were early (<90 days, n = 46/70). Overall technical success was 82 % (n = 59/72) and 6-month success was 58 % (n = 42/72). Major and minor complications were 2.8 % (n = 2/72), and 12.5 % (n = 9/72). NUS+PTA did not improve graft survival (p = 0.354) or patency (p = 0.9) compared with NUS alone. There was no difference in graft survival between treated and nontreated groups (p = 0.74).ConclusionsThere is no advantage to PTA in addition to placement of NUS, although PTA did not negatively impact graft survival or long-term patency and both interventions were safe and effective. Neither the late or early groups benefited from PTA in addition to NUS. Earlier obstructions showed greater improvement in serum creatinine than later obstructions.},
doi = {10.1007/S00270-014-0952-8},
journal = {Cardiovascular and Interventional Radiology},
issn = {0174-1551},
number = 3,
volume = 38,
place = {United States},
year = {2015},
month = {6}
}