Transplantation proceedings · 2017
Should Interventional Radiology or Open Surgery Be the First Choice for the Management of Ureteric Stenosis After Transplantation? Dual-Center Study.
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Simsek C, Dogan S M, Piskin T, Okut G, Cayhan K, Aykas A, Tatar E, Uslu A
Аннотация
BACKGROUND: Ureteric stenosis (US) is the most common urologic complication after kidney transplantation. In this dual-center retrospective study we compared the efficacy and safety of open surgery versus interventional radiology for the management of US.
METHODS: From 2009 to January 2016, US was treated by surgical revision in 22 (7.8%) out of 281 recipients at one center (group 1) and managed by percutaneous nephrostomy with antegrade nephroureteral stenting (PNAS) in 22 (14.2%) out of 155 recipients at the other center (group 2).
RESULTS: Three patients in group 1 required reintervention and again were treated with open surgery. With a mean follow-up of 42.1 ± 38.7 months, graft function improved in all but one patients (95%). Three patients in group 2 were admitted with relapse of US not amenable to 2nd PNAS, and 2 of them were managed with surgery. These 3 and 2 other cases with improved graft function after PNAS lost their grafts and returned to hemodialysis. The remaining 17 patients (77%) still have functioning grafts. There was no statistically significant difference between the efficacy of PNAS and open surgery for the management of post-transplantation US. However; a benefit in favor of open surgery existed for type 2 urinary tract obstruction in terms of decreased reintervention rate and much better protection of the graft function and survival.
CONCLUSIONS: Both interventional radiology and open surgery have acceptable efficacy rates in the management of ureteric complications after renal transplantation. Open surgery is a better treatment option for type 2 obstruction.
METHODS: From 2009 to January 2016, US was treated by surgical revision in 22 (7.8%) out of 281 recipients at one center (group 1) and managed by percutaneous nephrostomy with antegrade nephroureteral stenting (PNAS) in 22 (14.2%) out of 155 recipients at the other center (group 2).
RESULTS: Three patients in group 1 required reintervention and again were treated with open surgery. With a mean follow-up of 42.1 ± 38.7 months, graft function improved in all but one patients (95%). Three patients in group 2 were admitted with relapse of US not amenable to 2nd PNAS, and 2 of them were managed with surgery. These 3 and 2 other cases with improved graft function after PNAS lost their grafts and returned to hemodialysis. The remaining 17 patients (77%) still have functioning grafts. There was no statistically significant difference between the efficacy of PNAS and open surgery for the management of post-transplantation US. However; a benefit in favor of open surgery existed for type 2 urinary tract obstruction in terms of decreased reintervention rate and much better protection of the graft function and survival.
CONCLUSIONS: Both interventional radiology and open surgery have acceptable efficacy rates in the management of ureteric complications after renal transplantation. Open surgery is a better treatment option for type 2 obstruction.