Small but Mighty Magnet: A Minimally Invasive Revolution in the Management of Ureterostenosis After Kidney Transplantation.

BACKGROUND

Ureterostenosis affects 1%-8.3% of kidney transplant recipients, causing graft hydronephrosis, dysfunction, and potential loss. Traditional surgical repairs are invasive, technically challenging, and have a high recurrence risk. Magnetic compression anastomosis (MCA) presents a novel, minimally invasive alternative.

METHODS

A systematic case series was conducted of 14 transplant recipients with ureterostenosis who were treated with MCA between January 2018 and January 2023. All patients underwent initial percutaneous nephrostomy decompression. Under ureteroscopic guidance, a daughter magnet was advanced antegrade via the percutaneous nephrostomy tract to the stricture. A parent magnet was positioned retrograde cystoscopically. Magnets were aligned under visual guidance for compression.

RESULTS

MCA was technically successful in all 14 patients; the mean operative time was 89.9 ± 17.1 min, and blood loss was minimal. Magnets detached spontaneously in 13 patients (mean 15.4 ± 2.5 d). One patient with prior failed open revision required endoscopic magnet removal at 72 d. Postrecanalization, 2 F6 double-J stents were placed for 3-6 mo. The follow-up time was >2 y. One patient (7.1%) developed recurrence after stent removal, managed successfully with restenting. Kidney function stabilized/improved in all. Five patients were diagnosed with urinary tract infections and were cured after anti-infective treatment.

CONCLUSIONS

MCA shows significant advantages over conventional treatments for ureterostenosis after kidney transplantation. It is technically feasible, minimally invasive, with short operative times, negligible blood loss, rapid recovery, high primary success, and excellent preservation of graft function. MCA emerges as a promising, reliable first-line option, especially for short-segment strictures.