Login to Access Video or Poster Abstract: MP74-03
Sources of Funding: none

Introduction

Ureteral stricture is the most common urologic complication following renal transplantation. In patients who are poor candidates for open or endoscopic repair or in patients who failed repair attempts, an indwelling ureteral stent (DJS) may be the only option. The ureterovesical anastomosis in kidney transplant patients is often placed at the dome of the urinary bladder; thus, DJS placement or exchange can be challenging._x000D_ The loss of access during the procedure could be deleterious, necessitating insertion of a percutaneous nephrostomy tube to the transplanted kidney in patients who are often treated with antiaggregants or anticoagulants. _x000D_ Herein we describe a safe and reproducible technique for the exchange or initial placement of DJS in transplant kidneys in cases where direct cystoscopic approach may be difficult and fluoroscopic control insertion is required._x000D_

Methods

Tecnique: During cystoscopy the DJS, if present and the neo-orifice are identified. A hydrophilic coated guide wire (GW) is placed alongside the ureteral stent into the transplant renal pelvis. A 5Fr ureteral catheter (UC) is then negotiated over the guide. A super stiff (SS) wire is passed through the UC and the indwelling ureteral stent is withdrawn. An access sheath (AS) is then passed over the SS wire and advanced up to the proximal ureter. The SS wire is now exchanged for the GW that passing through the AS allowing easy and smooth passage of the DJS into the upper pole calix. In most cases, particularly after dilation of a ueretero-vesical stricture a unique 8/12Fr 16cm silicone DJ stent is used. _x000D_ A total of 32 stent replacement or insertion were performed during the study period with a median stent indwelling time and follow-up time of 12.8 and 32 months, respectively._x000D_

Results

Successful stent placement or exchange in the first attempt was achieved in 31/32 renal units with an overall success rate of 96.9%. No intraoperative or postoperative complications occurred. No patient developed hydronephrosis on a follow-up ultrasound. Renal function remained stable in 11 patients and in 3 patients function declined due to non-urological etiology.

Conclusions

Our results indicate that the standardized transplant stent placement technique is almost always successful despite technical challenges with an overall success rate of 96.8%. In this group of patients, periodic replacement of indwelling ureteral stent using our novel technique is effective, reproducible and safe with stable renal function during a long follow-up.

Funding

none