Ureteroscopic management of urological complications after renal transplantation

Objective. To determine the feasibility, safety and efficacy of diagnostic and therapeutic ureteroscopy in renal allograft ureters. Material and methods. We reviewed 1560 consecutive renal allografts performed between June 1989 and February 2002. A total of 28 patients ( 1.8%) had indications for an endoscopic procedure on the allograft ureter, as follows: obstructive ureteral calculi with a history of failed extracorporeal shock-wave lithotripsy, n = 6; suspected ureteral stricture, n = 3; upwardly migrated ureteral stents, n = 9; and ureteral stricture at the ureteroneocystostomy site, n = 10. Ureters were anastomosed to the bladder using the Leadbetter - Politano and Lich - Gregoire methods in six and 22 cases, respectively. Ureteroscopies were performed with a semi-rigid 9.8 F Wolf ureteroscope. Results. Identification of the ureteral orifice and insertion of a guide-wire into it was successful in 19 cases (68%). If we exclude the 10 patients with ureteral stricture, ureteroscopy was successful in 13/18 cases (72%). Four ureteral calculi (67%) were removed with the ureteroscope. Seven out of nine migrated stents (78%) were retrieved. Four patients with ureteral stricture at the ureteroneocystostomy site (40%) underwent successful ureteral dilatation and double-J ureteral catheters were also inserted. Diagnostic ureteroscopy was successful in all cases. Two complications ( one urinary leakage and one symptomatic urinary tract infection) occurred and were managed conservatively. Conclusions. Ureteral endoscopy is a safe and effective method for the management of urological complications after renal transplantation. This procedure can be considered the first choice, in preference to percutaneous and antegrade modalities.