Ureteral stricture after pediatric kidney transplantation: Is there a role for percutaneous antegrade ureteroplasty?

Autor: Bachtel HA; Division of Pediatric Urology, Department of Surgery, Texas Children's Hospital and Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA. Electronic address: habachte@texaschildrens.org., Hussaini SH; Division of Interventional Radiology, Baylor College of Medicine/Texas Children's Hospital, Houston, TX, USA., Austin PF; Division of Pediatric Urology, Department of Surgery, Texas Children's Hospital and Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA., Janzen NK; Division of Pediatric Urology, Department of Surgery, Texas Children's Hospital and Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA., Chau A; Division of Interventional Radiology, Baylor College of Medicine/Texas Children's Hospital, Houston, TX, USA., Pezeshkmehr A; Division of Interventional Radiology, Baylor College of Medicine/Texas Children's Hospital, Houston, TX, USA., Nguyen Galvan NT; Division of Abdominal Transplantation, Department of Surgery, Baylor College of Medicine, Houston, TX, USA., Brewer ED; Renal Section, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA., Swartz S; Renal Section, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA., Hernandez JA; Division of Interventional Radiology, Baylor College of Medicine/Texas Children's Hospital, Houston, TX, USA., Gardner G; Division of Interventional Radiology, Baylor College of Medicine/Texas Children's Hospital, Houston, TX, USA., Cotton RT; Division of Abdominal Transplantation, Department of Surgery, Baylor College of Medicine, Houston, TX, USA., O'Mahony CA; Division of Abdominal Transplantation, Department of Surgery, Baylor College of Medicine, Houston, TX, USA., Koh CJ; Division of Pediatric Urology, Department of Surgery, Texas Children's Hospital and Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA., Kukreja KU; Division of Interventional Radiology, Baylor College of Medicine/Texas Children's Hospital, Houston, TX, USA.
Jazyk: angličtina
Zdroj: Journal of pediatric urology [J Pediatr Urol] 2023 Jun; Vol. 19 (3), pp. 296.e1-296.e8. Date of Electronic Publication: 2023 Jan 19.
DOI: 10.1016/j.jpurol.2023.01.010
Abstrakt: Introduction: Ureteral obstruction following pediatric kidney transplantation occurs in 5-8% of cases. We describe our experience with percutaneous antegrade ureteroplasty for the treatment of ureteral stricture in pediatric kidney transplant patients.
Methods: We retrospectively reviewed all pediatric kidney transplantation patients who presented with ureteral stricture and underwent percutaneous antegrade ureteroplasty at our institution from July 2009 to July 2021. Variables included patient demographics, timing of presentation, location and extent of stricture, ureteroplasty technique and clinical outcomes. Our primary outcome was persistent obstruction of the kidney transplant.
Results: Twelve patients met inclusion criteria (4.2% of all transplants). Median age at time of ureteroplasty was 11.5 years (range: 3-17.5 years). Median time from kidney transplantation to ureteroplasty was 3 months. Patency was maintained in 50% of patients. Seven patients (58.3%) required additional surgery. Four patients developed vesicoureteral reflux. Patients with persistent obstruction had a longer time from transplant to ureteroplasty compared to those who achieved patency (19.3 vs 1.3 months, p = 0.0163). Of those treated within 6 months after transplantation, two patients (25%) required surgery for persistent obstruction (p = 0.06). All patients treated >1 year after transplantation had persistent obstruction following ureteroplasty (p = 0.06).
Conclusion: Percutaneous antegrade ureteroplasty can be considered a viable minimally invasive treatment option for pediatric patients who develop early ureteral obstruction (<6 months) following kidney transplantation. In patients who are successfully treated with ureteroplasty, 67% can develop vesicoureteral reflux into the transplant kidney. Patients who fail early percutaneous ureteroplasty or develop obstruction >1 year after transplantation are best managed with surgical intervention.
(Copyright © 2023. Published by Elsevier Ltd.)
Databáze: MEDLINE
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