Evaluation of the results of treatment of the ureteric strictures in kidney allograft

• Levkovich E.I.
• Nosik A.V.
• Liovina D.I.
• Moroz G.L.
• Komissarov K.S.
• Kalachik O.V.

Abstract

Background. Choice of optimal treatment for ureteral strictures of a kidney transplant remains a relevant task of modern transplantology. To date, there are several radical and minimally invasive methods, each of which has a number of benefits and drawbacks. The search for ways to optimize surgical treatment, including the expansion of the use of minimally invasive technologies, is still ongoing, but at the moment there is no unambiguous alternative to the open method.

Aim – to improve the results of treatment of ureteral strictures by identifying the most optimal surgical method.

Material and methods. The participants were divided into groups depending on the treatment performed. The group (REU) (47 patients) consisted of patients who underwent open surgery with the inposition of ureteroneocystoanastomosis. The participants of the NTN group (17 patients) had nitinol stent grafts installed in the stricture zone. The recipients of the PAL group (16 patients) underwent the installation of polyurethane Pig-tail stents.

Results. Improvement of graft function was noted in all study groups. The most effective restoration of function occurred during the first month. 12 months after stricture correction, an increase in creatinine levels was detected in the minimally invasive treatment groups: REU 115.5 (104.5–160) vs NTN 278.3 (150.85–477.6) vs POL 188.8 (162.1–339.9) mmol/l, p=0.002. Common postoperative complications such as leukocyturia, hematuria and bacteriuria were observed mainly after stenting. The use of polyurethane stents was more often associated with leukocyturia: REU 17/47 (36.17%) vs NTN 5/17 (29.41%) vs POL 9/16 (56.75%) of participants, p=0.24. The use of minimally invasive techniques contributed to a decrease in the duration of hospitalization: REU 12 (10–16), vs NTN 6 (4–11), vs POL 5 (3.5–15.5) days, p=0.004.

Conclusion. Open correction is preferable in most cases due to the radical elimination of the complication and a lower risk of recurrence. Stenting is a successful and preferable alternative to the open method for some groups of patients.

Keywords:kidney transplantation; ureterohydronephrosi; ureteral stricture; ureteroneocystoanastomosis; ureteral stenting

References

1.     Apel H., Rother U., Wach S., Schiffer M., Kunath F., Wullich B., et al. Transplant ureteral stenosis after renal transplantation: risk factor analysis. Urol. Int. 2022; 106 (5): 518–26.

2.     Friedersdorff F., Weinberger S., Biernath N., Plage H., Cash H., El-Bandar N. The ureter in the kidney transplant setting: ureteroneocystostomy surgical options, double-J stent considerations and management of related complications. Curr Urol Rep. 2020; 21 (1): 1–5.

3.     Jalaeian H., Field D.H., Cohen E.I. Transplant renal interventions. Tech Vasc Interv Radiol. 2023; 26 (4): 100925.

4.     Kayler L., Kang D., Molmenti E., Howard R. Kidney transplant ureteroneocystostomy techniques and complications: review of the literature. Transplant Proc. 2010; 42 (5): 1413–20.

5.     Rahnemai-Azar A.A., Gilchrist B.F., Kayler L.K. Independent risk factors for early urologic complications after kidney transplantation. Clin Transplant. 2015; 29 (5): 403–8.

6.     Saydulaev D.A., Miloserdov I.A., Got’e S.V. Prevention and surgical treatment of urological complications in kidney transplant recipient. Vestnik transplantologii i iskusstvennykh organov [Bulletin of Transplantology and Artificial Organs]. 2019; 21 (3): 166–73. (in Russian)

7.     Kwong J., Schiefer D., Aboalsamh G., Archambault J., Luke P.P., Sener A. Optimal management of distal ureteric strictures following renal transplantation: a systematic review. Transplant Int. 2016; 29 (5): 579–88.

8.     Arpali E., Al-Qaoud T., Martinez E., Redfield R.R. III, Leverson G.E., Kaufman D.B., et al. Impact of ureteral stricture and treatment choice on long-term graft survival in kidney transplantation. Am J Transplant. 2018; 18 (8): 1977–85.

9.     Urenkov S.B. Antegrade stenting of the ureter of a transplanted kidney in the treatment of urological complications in patients after transplantation using percutaneous surgical interventions [Almanac of Clinical Medicine]. 1998; (1): 350–6. (in Russian)

10. Gao X., Di X., Chen G., Wang W., Peng L., Chen J., et al. Metal ureteral stents for ureteral stricture: 2 years of experience with 246 cases. Int J Surg. 2023; 110 (1): 66–71.

11. Minkovich M., Famure O., Li Y., Ghanekar A., Selzner M., Kim S.J., et al. Ureteral strictures post-kidney transplantation: trends, impact on patient outcomes, and clinical management. Can Urol Assoc J. 2021; 15 (10): 524–30.

12. Gomes G., Nunes P., Castelo D., Parada B., Patrão R., Bastos C., et al. Ureteric stent in renal transplantation. Transplant Proc. 2013; 45 (3): 1099–01.

13. Karam G., Hétet J.F., Maillet F., Rigaud J., Hourmant M., Soulillou J.P., et al. Late ureteral stenosis following renal transplantation: risk factors and impact on patient and graft survival. Am J Transplant. 2006; 6 (2): 352–6.

14. Marzi V.L. The treatment of fistulae and ureteral stenosis after kidney transplantation. Transplant Proc. 2005; 37 (6): 2516–7.

15. Zhang J., Xue W., Tian P., Zheng J., Ding C., Li Y., et al. Effect of ureteral stricture in transplant kidney and choice of treatment on long-term graft survival. Int Urol Nephrol. 2023; 55 (9): 2193–203.

16. Xu G., Li X., He Y., Zhao H., Yang W., Xie Q. Use of self-expanding metallic ureteral stents in the secondary treatment of ureteral stenosis following kidney transplantation. J Endourol. 2015; 29 (10): 1199–203.

17. Santos Perez de la Blanca R., Medina-Polo J., PeñaVallejo H., Juste-Álvarez S., Pamplona-Casamayor M., DuarteOjeda J.M., et al. Ureteral stenosis and fistula after kidney transplantation. Urol Int. 2023; 107 (2): 157–64.

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