Summary
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 to 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=.0163).
Of those treated within 6 months after transplantation, two patients (25%) required
surgery for persistent obstruction (p=.06). All patients treated > 1 year after transplantation
had persistent obstruction following ureteroplasty (p=.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.
Keywords
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Article info
Publication history
Accepted:
January 13,
2023
Received in revised form:
December 19,
2022
Received:
September 1,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Published by Elsevier Ltd on behalf of Journal of Pediatric Urology Company.
