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Ureteral Stenosis after Kidney Transplant - PowerPoint PPT Presentation


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Ureteral Stenosis after Kidney Transplant. Jonathan B. Yuval MD. case. 23 YOF Idiopathic renal failure Renal Tx on 27/4/13 from a live donor Normal operative course (ischemia of in upper pole) Normal immediate post-op course. case. One month after Tx readmitted d/t elevevated Cr

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Presentation Transcript
slide2
case
  • 23 YOF
  • Idiopathic renal failure
  • Renal Tx on 27/4/13 from a live donor
  • Normal operative course (ischemia of in upper pole)
  • Normal immediate post-op course
slide3
case
  • One month after Tx readmitted d/t elevevated Cr
  • Hydronephrosis on US
  • Retrograde pyelography demonstrated a ureteral stricture
  • Underwent nephrostomy insertion
slide4
case
  • 5/2013 insertion of stent from renal pelvis to urinary bladder + Nephrostomy
  • 6/2013 Urosepsis w/ KP. IV ABX. Closure of Nephrostomy.
  • 7/2013 Endo-urological Tx of stenosis
  • 7/2013 UTI w/KP. IV ABX. Closure of Nephrostomy. Prophylactic fosfomycin.
  • 9/2013. Anterograde nephrostogram. Removal of stent. Removal of Nephrostomy.
slide5
case
  • 9/2013 Elevated Cr. ESBL in urine. IV ABX. Improvement of Cr.
  • 10/2013 in Dr. Merhav’s clinic. No Sx of UTI. Normal Cr.
slide8

The transplanted ureter is susceptible to stenosis d/t poor blood supply

  • Most common cause of mechanical obstruction
  • DDX: Stones, Rejection, BKV, external compression
slide9

Increased peri-op morbidity and re-operation

  • Does not affect graft survival if treated early
risk factors
Risk Factors
  • Donor Age
  • Number of transplanted arteries
  • CIT
  • Method of organ retrieval
  • Preservation of gonadal vessels
  • Technique (UU/intravesical/extravesical)
  • Ureteral stent
  • Preservation of peri-pelvic/ureteric fat
slide11
Tx
  • Endo-Surgery
  • Surgical options
    • Re-insertion
    • Reconstruction w/native ureter
    • Pyelo-ureterostomy
    • Vesiculo-pyelostomy
    • Uretero-urererostomy
    • Reconstruction/Elongation of the bladder
    • Ileal interposition
    • Artificial ureter interposition