Therapeutic management of ureteric strictures in renal transplantation

Objective: Ureteric strictures, with a reported incidence ranging from 2% to 7.5%, are the most frequent urological complication of renal transplantation. This article reports the results of open surgery and percutaneous or endoscopic techniques used to treat these strictures, based on a single-centre retrospective series of renal transplantations.

Methods: From January 1990 to December 2002, in a series of 1787 consecutive renal transplantations performed in our centre, 74 were complicated by ureteric stricture (4.1% of cases). Strictures occurred at the ureterovesical implantation in 82.4% of cases and during the first year in 88% of cases. The mean time to management of the stricture after transplantation was 9 months (range: 6 days-120 months). Criteria of success were defined by regression or even resolution of ultrasound signs of dilatation associated with stabilization of serum creatinine obtained by the external urinary diversion. Surgical or percutaneous revisions (particularly repeated changes of double J stents) were considered to be treatment failures.

Results: 44 strictures (59.5% of cases) were treated by open surgery and 30 (40.5%) were treated by a first-line endoscopic or percutaneous technique. In our hands, open surgical techniques (ureteropelvic anastomosis: 80% of success (n=5), ureterovesical reimplantation: 82% of success (n=11), ureteroureteric anastomosis: 100% of success (n=4)) gave better results than endourological techniques (endoscopic electrical incision: 61.5% of success (n=13), double J stent: 61.5% of success (n=13), balloon catheter dilatation: no success (n=4)).

Conclusions: Classical open surgical revision remains the reference treatment for ureteric strictures in renal transplantation for our team.