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Ureteral Stenosis after Kidney Transplant

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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Ureteral Stenosis after Kidney Transplant

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  1. Ureteral Stenosis after Kidney Transplant Jonathan B. Yuval MD

  2. 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

  3. case • One month after Tx readmitted d/t elevevated Cr • Hydronephrosis on US • Retrograde pyelography demonstrated a ureteral stricture • Underwent nephrostomy insertion

  4. 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.

  5. 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.

  6. Urological complications are the most common • Stenosis/Leak in 5% of cases:

  7. The transplanted ureter is susceptible to stenosis d/t poor blood supply • Most common cause of mechanical obstruction • DDX: Stones, Rejection, BKV, external compression

  8. Increased peri-op morbidity and re-operation • Does not affect graft survival if treated early

  9. 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

  10. 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

  11. Thanks!!

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