Boari Flap Reconstruction Offers Superior Treatment for Late Transplant Ureter Strictures.

Abstract

Appropriate management of late transplant ureteral strictures (TUS) after kidney transplant (KTx) is difficult. We evaluated risk factors, treatment and management outcomes of TUS over a 5-year period. 562 patients underwent KTx at our center from 3/07 to 3/12. We identified 15 (2.66%) patients with late (> 1 mo) TUS. Baseline clinical and post-transplant characteristics were reviewed. Time to development of TUS along with location and length of the stricture was identified. Treatment modalities and outcomes were reviewed. Baseline patient demographics and post-transplant characteristics are displayed on Tables I and II. Median follow-up period was 1071 days (range 361-2025 days). 5 TUS were considered short segment (≤2 cm) strictures. Median time from transplant to the treatment of TUS was 317 days (range, 37-1771 days). 4 patients (26.7%) underwent balloon dilation of TUS, but none had long-term success, all subsequently undergoing Boari flap reconstruction (BFR). Neoureterocystotomy was performed in 3/15 (20.0%) patients, with 1 failure requiring subsequent BFR. BFR was created in 13/15 (86.7%) patients. 1 BFR re-strictured and required revision surgery. BFR was associated with an increased success rate compared to other treatment methods (p<0.01). Late TUS is a difficult entity to treat. In our experience, endoscopic treatments were all unsuccessful and neoureterocystostomy may be unsuccessful due to difficulty in estimating the extent of scarred ureter. BFR can be used as a salvage procedure after more conservative efforts. BFR offers good surgical outcomes with long term follow up.Table: No Caption available.Table: No Caption available.