Stricture Research Articles

Dynamic renal scans as a modality for follow-up of flexible ureteroscopy.

To determine whether dynamic renal scans - DTPA or MAG3 - routinely performed after flexible ureteroscopies (f-URS) could detect the development of an obstruction and thus promote prompt early intervention for kidney preservation. In this retrospective study, with all the data recorded prospectively between April 2010 and October 2023, 250 renal units in 242 patients with upper urinary tract stones (UUTS) who underwent ureterorenoscopy by one surgeon in the same medical center were evaluated. Stone-free rate (SFR) was defined as no residual fragments at all using an intraoperative "triple test". The following characteristics were examined: gender, BMI, age, Hounsfield unit, stone diameter, laterality, renal/ureteral stones, stone-free rate, and auxiliary procedures per renal unit. The Clavien-Dindo classification was used to report complications. Renal units with residual stones were scheduled for a 2nd f-URS. Post- flexible ureteroscopy ureteral obstruction and renal function were detected using renal scan DTPA or MAG-3. The primary outcome was renal/ ureteral obstruction. The mean patient age was 53 years. The mean stone size was 12.3 mm. Stones in renal pelvis, upper, middle and lower calyces were treated in 9.2% (23), 27.6% (69), and 30.8% (77) of cases, respectively; 44% (110) ureteral stones were also treated. The single- and second-session SFRs were 94.8% and 99.7%, respectively. A third auxiliary procedure was needed in one renal unit (0.4%). The mean number of procedures per renal unit was 1.06 (264/250). Ureteral double-J stents were inserted in 53.6% (134) of the cases. In 37 (14.8%) cases, a stent was placed before surgery. Post-operative complications were minor, with readmission and pain control needed in only two patients (0.8%). No avulsion or perforation of the ureters was observed. In six patients with t1/2 between 10-20 minutes, a second renal scan revealed spontaneous improvement and no obstruction in five patients. One patient with large stones and a history of prior ureteroscopy developed a ureteral stricture (0.4%) and needed treatment with laser endoureterotomy. Post-flexible ureteroscopy obstruction due to ureteral stricture is very rare. A routine renal scan post-operatively may be used in potentially high-risk patients.

Differential expression of small bowel TGFβ1 and TGFβ3 characterizes intestinal strictures in patients with fibrostenotic Crohn's disease.

Small bowel strictures remain a debilitating consequence of Crohn's disease and contribute to poor outcomes for patients. Recently, TGFβ has been identified as an important driver of intestinal fibrosis. We studied the localization of TGFβ isoforms in ileal strictures of patients with Crohn's disease using in situ hybridization to understand TGFβ's role in stricture formation. The mucosa of strictures was characterized by higher TGFβ1 while the stricture submucosa showed higher TGFβ3 compared to normal ileum from patients without Crohn's disease (p = 0.02 and p = 0.044, respectively). We correlated these findings with single-cell transcriptomics which demonstrated that TGFβ3 transcripts overall are very rare, which may partially explain why its role in intestinal fibrosis has remained unclear to date. There were no significant differences in fibroblast or B cell TGFβ1 and/or TGFβ3 expression in inflamed vs. noninflamed ileum. We discuss the implications of these findings for therapeutic development strategies to treat patients with fibrostenotic Crohn's disease.

Ureteral Stricture Disease after Mitomycin Gel Treatment

Ureteral Stricture Disease after Mitomycin Gel Treatment

Robotic-assisted Laparoscopic Repair of Kidney Transplant Ureteral Strictures

Background and ObjectiveTo evaluate outcomes of robotic assisted transplant ureteral repair (RATUR) for the management of kidney transplant ureteral strictures (TUS). MethodsWe retrospectively analyzed 41 consecutive patients who underwent RATUR for TUS at multiple tertiary referral centers between January 2016 and December 2022. RATUR was performed utilizing a robotic assisted transperitoneal approach. The primary outcome was stricture recurrence rate and secondary outcomes included postoperative complicate rate, determining factors impacting with allograft functional recovery, and rate of conversion to open surgery. Categorical and continuous variables are displayed as total number (Percentage) or median [Interquartile Range] respectively. Pearson correlation coefficient was utilized to assess categorical variable correlation with creatinine. ResultsThe median age was 56 years [44, 66]. The female to male ratio was 1.1:1. Approximately 66% of patients were dialysis dependent prior to kidney transplantation. TUS was identified at a median time of 4 months [2, 15.5] following kidney transplant. Median stricture length was 2 cm [1.22, 2.9cm]. There were no TUS recurrences with a median follow-up of 36 months [24, 48]. There were 3 Clavien Grade 2 and 1 Clavien grade 3 complications (9.5%). No baseline characteristics or preoperative diagnostics were correlated with a long-term decline in renal allograft function. ConclusionRATUR has excellent and durable outcomes with low complication rates. These findings encourage the use of a minimally invasive definitive repair as a first line treatment option for the management of TUS.

Risk factors for migration of retrievable covered expandable metallic stent in patients with persistent benign ureter strictures

PurposeThe purpose of this study is to evaluate the incidence, risk factors, and salvage management of retrievable covered expandable metallic stent (RCEMS) migration in patients with persistent benign ureter strictures.Materials and methodsA retrospective study was performed on 117 consecutive patients who underwent implantation of RCEMS. Univariate and multivariate analyses were used to identify prognostic factors for stent migration, including stricture location and length, hydronephrosis–cortex ratio, ureteral dilation, and the diameter of the narrowest portion of the stricture.ResultsStent migration occurred in 22 (19.5%) of 113 patients who met inclusion criteria. Of the 22 patients, 16 (72.7%) had ordinary ureteral stricture, 3 (13.6%) had stricture in transplanted kidneys, and 3 patients (13.6%) had ureter stricture in orthotopic neobladders. The mean creatinine for the entire cohorts showed significant improvement (p = 0.038). Multivariate analysis identified the following prognostic factors for migration: distal ureteral stricture (p = 0.006), patients who underwent balloon dilation (p = 0.003), hydronephrosis–cortex ratio ≧10 (p = 0.017), larger diameter of wasting of RCEMS (p < 0.001), and patients with a shorter stricture length (p = 0.006). Salvage management was required in 4 of the 22 patients. The strictures in the remaining 18 patients improved with observation.ConclusionsStent migration is more likely to occur in patients with the five prognostic factors mentioned above. Our study developed a nomogram to predict stent migration in patients with ureteral strictures treated using RCEMS.

Predictive role of ureteral wall thickness and patient characteristics in endoscopic treatment outcomes for ureteral stricture disease following stone surgery

PurposeTo evaluate the role of certain radiological parameters and patient characteristics in predicting the success of endoscopic treatment in ureteral stricture disease.MethodsFifty one adult patients with ureteral stricture disease (< 1 cm) after developing due to upper ureteral stones with ureteroscopic laser disintegration were included and in addition to stone and patient parameters, radiological parameters including ureteral wall thickness (UWT) at the impacted stone site were also measured on computed tomography (CT) images. Patients were divided into two groups: Group 1: Patients with endoscopic treatment success and Group 2: Patients with endoscopic treatment failure. The possible relationship between the UWT values and other radiological parameter was comparatively evaluated.ResultsMean UWT value assessed at the treated stone site was significantly higher in cases unresponsive to endoscopic treatment with values of 2.77 ± 1.03 mm and 4.25 ± 1.32 mm in Group 1 and 2 respectively. A cut off value 3.55 mm for UWT was found to be highly predictive for endoscopic treatment failure.ConclusionsOur current results indicated that assessment of UWT value at the obstructing stone could be helpful enough to predict the likelihood of failure following endoscopic management of strictures with high sensitivity and specificity. Evaluation of this particular parameter could let the endourologists to look for more rational treatment alternatives with necessary measures taken on time.

A comparison between vapor tunnel and virtual basket for the treatment of proximal ureteral stones using holmium:YAG laser (Cyber Ho): which is the best tool to reduce retropulsion?

To compare vapor tunnel (VT) and virtual basket (VB) tools to reduce retropulsion in the treatment of proximal ureteral stones. Patients with a single proximal ureteral stone were randomly assigned to holmium laser lithotripsy with the use of VT (Group A) or VB (Group B) tool. The 150W holmium:YAG cyber Ho generator was used. We compared operative time, dusting time, need for flexible ureteroscopy due to stone push-up and occurrence of ureteral lesions. The stone-free rate (SFR) and the occurrence of postoperative ureteral strictures were assessed. 186 patients were treated, of which 92 with the VT (49.5%, Group A) and 94 with the VB (50.5%, Group B). Mean stone size was 0.92 vs. 0.91cm in Groups A vs. B (p = 0.32). Mean total operative time and dusting time were comparable between groups. 7 (7.6%) vs. 6 (6.4%) patients in Groups A vs. B required a flexible ureteroscope because of stone push-up (p = 0.12). Ureteral mucosa lesions were observed in 15 (16.3%) vs. 18 (19.1%) cases in the VT vs. VB group (p = 0.09). 1-Month SFR was comparable (97.8% vs. 95.7%, p = 0.41). We observed one case (1.1%) of postoperative ureteral stricture in the VT group vs. two cases (2.1%) in the VB group (p = 0.19). VT and VB are equally safe and effective tools in reducing retropulsion of ureteral stones. Operative time, dusting time and SFR were comparable. They also equally avoided stone push-up and prevented ureteral lesions, which may later occur in ureteral strictures.

Migration of double-J ureteral stent in patients with ureteroileal anastomosis stricture undergoing radical cystectomy and orthotopic neobladder: Analysis risk factors of stent migration.

The objective was to evaluate the incidence and degree of double-J ureteral stent (DJUS) migration. Additionally, we aimed to investigate the risk factors associated with stent migration in the orthotopic neobladder group. In this retrospective study, 61 consecutive patients were included; 35 patients (45 DJUS placements) underwent radical cystectomy with orthotopic neobladder and 26 patients (35 DJUS placements) underwent urinary bladder without cystectomy between July 2021 and March 2023. All the patients were treated with a DJUS for ureteric strictures. The technical success rate was 100% in each group. The DJUS migration was significantly higher in the orthotopic neobladder group, with 22 of 45 cases (48.9%), compared to the urinary bladder group, which had 4 of 35 cases (11.4%) (P ≤ .001). Among the patients in the orthotopic neobladder group who experienced DJUS migration, stent dysfunction occurred in 18 cases (81.8%), which was statistically significant (P = .003). Multivariate logistic regression analysis revealed that only the size of the DJUS was significantly and positively associated with migration (odds ratio:10.214, P = .010). DJUS migration can easily occur in patients undergoing radical cystectomy and orthotopic neobladder, and smaller stent sizes are associated with a higher incidence of migration.

Japanese survey of perioperative complications and ureteral stricture after ureteroscopy with laser lithotripsy for upper urinary tract stones in multicenter collaborative study.

This study aimed to investigate perioperative complications and the details of postoperative ureteral stricture after ureteroscopy with laser lithotripsy (URS-L) for upper urinary tract stones in Japan. Patient data on intra- and postoperative complications after ureteroscopy using URS-L were retrospectively collected from multiple centers in Japan between April 2017 and March 2020 with the cooperation of the Japanese Society of Endourology and Robotics. Data included the number of patients undergoing URS-L, number and type of intra- and postoperative complications, and detailed characteristics of postoperative ureteral stricture. In total, 14 125 patients underwent URS-L over 3 years at 82 institutions. Annual URS-L numbers gradually increased from 4419 in 2017, to 4760 in 2018, and 4946 in 2019. The total complication rate was 10.5%, which was divided into intra-operative complications in 1.40% and postoperative complications in 9.18%. The annual incidences of intra- and postoperative complications were not significantly different from year to year (p = 0.314 and p = 0.112). Ureteral perforation, ureteral avulsion, and the intra-operative conversion rate were 1.35%, 0.03%, and 0.02%, respectively. Fever >38°C, septic shock, blood transfusion, and postoperative mortality were 7.44%, 0.81%, 0.07%, and 0.04%, respectively. Ureteral stricture occurred in 0.8% of cases. The median length of stricture site was 10.0 mm and the success rate of stricture treatment was 54.6%. Although URS-L utilization has increased in Japan, the annual complication rate has remained steady. Although URS-L is a useful and less invasive procedure, devastating complications can still occur.

Ureteral stricture rate after endoscopic treatments for urolithiasis and related risk factors: systematic review and meta-analysis.

We aimed to accurately determine ureteral stricture (US) rates following urolithiasis treatments and their related risk factors. We conducted a systematic review and meta-analysis following the PRISMA guidelines using databases from inception to November 2023. Studies were deemed eligible for analysis if they included ≥ 18 years old patients with urinary lithiasis (Patients) who were subjected to endoscopic treatment (Intervention) with ureteroscopy (URS), percutaneous nephrolithotomy (PCNL), or shock wave lithotripsy (SWL) (Comparator) to assess the incidence of US (Outcome) in prospective and retrospective studies (Study design). A total of 43 studies were included. The pooled US rate was 1.3% post-SWL and 2.1% post-PCNL. The pooled rate of US post-URS was 1.9% but raised to 2.7% considering the last five years' studies and 4.9% if the stone was impacted. Moreover, the pooled US rate differed if follow-ups were under or over six months. Patients with proximal ureteral stone, preoperative hydronephrosis, intraoperative ureteral perforation, and impacted stones showed higher US risk post-endoscopic intervention with odds ratio of 1.6 (P = 0.05), 2.6 (P = 0.009), 7.1 (P < 0.001), and 7.47 (P = 0.003), respectively. The overall US rate ranges from 0.3 to 4.9%, with an increasing trend in the last few years. It is influenced by type of treatment, stone location and impaction, preoperative hydronephrosis and intraoperative perforation. Future standardized reporting and prospective and more extended follow-up studies might contribute to a better understanding of US risks related to calculi treatment.

Robotic Buccal Mucosa Graft Ureteroplasty for Complex Ureteral Stricture Disease: Early Outcomes at a Single Institution

Robotic Buccal Mucosa Graft Ureteroplasty for Complex Ureteral Stricture Disease: Early Outcomes at a Single Institution

Congenital Mid Ureteric Stricture: Case Report and Review of the Literature

Congenital Mid Ureteric Stricture: Case Report and Review of the Literature

Https://jemis.org/efficacy-and-safety-of-laser-endoureterotomy-for-the-treatment-of-ureteral-strictures-with-length-%e2%89%a4-10-mm/

Introduction: Ureteral strictures are severe and difficult to treat disorders and significantly affect the quality of life of patients. Endoscopic laser ureterotomy is a minimally invasive procedure that is increasingly used for the management of ureteral strictures. Objective:The objective of our study is to evaluate the efficacy and safety of Holmium laser endoureterotomy in the treatment of ureteral strictures with length ≤ 10 mm. Material and methods:A retrospectively collected database of 21 patients who unederwent laser endoureterotomy for uretereral strictures with length ≤ 10 mm between January 2018 and January 2021 in the Clinic of Endourology and SWL, Military Medical Academy, Sofia, Bulgaria was reviewed. The endoureterotomy was performed under direct vision using a semirigid or flexible ureteroscope. Confirmation of obstruction and the results of the intervention were obtained by combinations of retrograde ureteropyelography, ultrasonography and CT. Success was defined as symptomatic relief and the absence of obstruction from the radiographic studies. Results: Patients’ mean age was 57.5±12 years and male-to-female ratio – 52.4%/47.6%. Mean length of the ureteral stricture was 7.2±2 mm. Eighteen of the patients (85.7%) were with secondary ureteral structures mainly with anamnesis for previous endoscopic surgery for impacted ureteral stones. There were no intraoperative complications. In 20 of the patients (95.2%) stent JJ 7 Fr was put postoperatively. The stent JJ was removed mean 84.2±51.6 days after the procedure. The success rate after the endoureterotomy was 85,7% (18/21), while 3 cases(14.3%) presented with a recurrent stricture. The mean follow-up period was 30.5±14.9 months. Conclusions: Ureteroscopicholmium:YAG laser endoureterotomyfor the treatment of ureteral strictures is a minimally invasive, short-stay out-patient procedure associated with a good success rate and less morbidity.

Naringin Alleviates Intestinal Fibrosis by Inhibiting ER Stress-Induced PAR2 Activation.

Fibrosis characterized by intestinal strictures is a common complication of Crohn's disease (CD), without specific antifibrotic drugs, which usually relies on surgical intervention. The transcription factor XBP1, a key component of endoplasmic reticulum (ER) stress, is required for degranulation of mast cells and linked to PAR2 activation and fibrosis. Many studies have confirmed that naringin (NAR) can inhibit ER stress and reduce organ fibrosis. We hypothesized that ER stress activated the PAR2-induced epithelial-mesenchymal transition process by stimulating mast cell degranulation to release tryptase and led to intestinal fibrosis in CD patients; NAR might play an antifibrotic role by inhibiting ER stress-induced PAR2 activation. We report that the expression levels of XBP1, mast cell tryptase, and PAR2 are upregulated in fibrotic strictures of CD patients. Molecular docking simulates the interaction of NAR and spliced XBP1. ER stress stimulates degranulation of mast cells to secrete tryptase, activates PAR2-induced epithelial-mesenchymal transition process, and promotes intestinal fibrosis in vitro and vivo experiments, which is inhibited by NAR. Moreover, F2rl1 (the coding gene of PAR2) deletion in intestinal epithelial cells decreases the antifibrotic effect of NAR. Hence, the ER stress-mast cell tryptase-PAR2 axis can promote intestinal fibrosis, and NAR administration can alleviate intestinal fibrosis by inhibiting ER stress-induced PAR2 activation.

Correlation Diagnostic Contribution of SPECT/CT Imaging to 99mTc-DTPA Dynamic Scintigraphy in Patients with Different Renal Pathologies

Introduction: Dynamic renal scintigraphy with 99mTechnetium diethylenetriaminepentaacetic acid (99mTc-DTPA) is a widely performed imaging method to evaluate kidney function of patients with various renal pathologies. However the one-stop-shop combination with subsequent SPECT/CT imaging is a rarely discussed topic. Objective: The aim of the study was to evaluate the diagnostic benefits of SPECT/CT imaging to 99mTc-DTPA dynamic renal scintigraphy. Materials and Methods: A group of 32 patients (21 females and 11 males) who underwent dy- namic nephroscintigraphy with subsequent SPECT/CT was retrospectively studied. A dose of 185MBq (5mCi) 99mTc-DTPA was intravenously applied. A low-dose non-contrast CT protocol was used for attenuation correction and anatomical correlation. Results: Impaired relative renal function in various degrees of left kidney was detected in 18 patients (56%) and of right kidney in 14 patients (44%). SPECT/CT imaging identified the particular cause for the renal dysfunction in the analyzed subjects. The hybrid imaging demonstrated urolithiasis in 11 patients, postoperative ureteral strictures in 5 patients, diagnosed urological cancer in 4 patients and external compression of ureter in 2 patients as a possible obstructive cause. Congenital renal anomalies were the identified causes of impaired renal function in 10 patients – hypoplastic kidney in 4 patients, duplex kidney in 2 patients, multiple cortical cysts in 2 patients, aberrant vessel obstructing the pyeloureteral segment in 1 patient and horseshoe kidney in 1 patient. Conclusion: Dynamic renal scintigraphy combined with SPECT/CT is a very useful clinical tool, by providing not only functional but also anatomical information of the urinary tract, especially in the evaluation of obstructive uropathies and congenital renal abnormalities, that has the potential to change clinical management.

Single Port Bilateral Ureteral Stricture Repair with Buccal Graft

Single Port Bilateral Ureteral Stricture Repair with Buccal Graft

Long-term Renal Preservation and Complication Profile With Ileal Ureter Creation

ObjectivesTo examine long-term ileal ureter replacement results at over 32 years at our institution. Long segment or proximal ureteral strictures pose a challenging reconstructive problem. Ureteroureterostomy, psoas hitch, boari flap, buccal ureteroplasty and autotransplantation are common reconstructive techniques. We show that ileal ureter remains a lasting option. MethodsWe performed a retrospective review of patients undergoing open ileal ureter creation from 1989-2021. Patient demographics, operative history, and complications were examined. All patients were followed for change in renal function. Demographic data was analyzed and cox proportional hazard models performed. Results158 patients were identified with median follow-up time of 40 months. 81% had a unilateral ileal ureter creation. 50% were female, median age was 53.3. 27% of patients had radiation-induced strictures. Pre-operatively, 56.3% of patients were CKD stage 1-2 and 43.7% were stage 3-5. Post-operatively, 54% were stage 1-2 and 46% were stage 3-5. Cox proportional hazard models demonstrated no significant correlation between worsening renal function and stricture cause, bilateral repair, complications, or sex. 77% had no 30-day complications. Clavien complications included grade 1(18), grade 2(4), grade 3(9), grade 4(5). Long-term complications included worsening renal function(3%), incisional hernia(8.2%), and small bowel obstruction(6.9%). 5(3.1%) patients ultimately required dialysis and 5(3.1%) patients developed metabolic acidosis. ConclusionIleal ureteral reconstruction is often a last resort for patients with complex ureteral injuries. Clinicians can be reassured by our long-term data that ileal ureteral creation is a safe treatment with good preservation of renal function and low risk of hemodialysis and metabolic acidosis.

Antegrade and retrograde laser excision and ureterotomy laser for ureteral polyp causing total ureteral stenosis following left ureteral stones removal: a case report and literature review

Background: Ureteral polyps are rare, and the clinical manifestations are typically nonspecific. Obstruction from ureteral polyps can lead to ureteral stone formation. Excision using a less invasive approach is the most commonly performed procedure. Here, the authors report a patient with left proximal and distal ureteral polyps treated with laser excision after removal of the right kidney and left ureteral stone using a combined antegrade and retrograde route. This case is interesting because there was complete ureteral blockage, and polyps were found on the proximal and distal sides of the stenotic area. Case Presentation: A 55-year-old female patient came to our center with bilateral flank pain. Initially, the diagnosis was bilateral hydronephrosis, but after ureteroscopy (URS) was performed, proximal and distal ureteral polyps were identified. The polyp was excised using a Thulium laser, followed by DJ-stent placement. Discussion: Imaging with intravenous pyelography, CT, or retrograde urography can help diagnose ureteral polyps. Removal of the polyp’s base using ureteroscopy with laser coagulation allows for identification and histologic diagnosis. Endoscopic treatment has become the most commonly used treatment for ureteral polyps. Conclusion: Ureteral polyps are rare, and preoperative diagnosis may be difficult. Laser excision with stent placement after primary polyp removal has been reported in many studies to have good outcomes.

Contemporary Imaging Assessment of Strictures and Fibrosis in Crohn Disease, With Focus on Quantitative Biomarkers: From the AJR Special Series on Imaging of Fibrosis.

Patients with Crohn disease commonly have bowel strictures develop, which exhibit varying degrees of inflammation and fibrosis. Differentiation of the distinct inflammatory and fibrotic components of strictures is key for the optimization of therapeutic management and for the development of antifibrotic drugs. Cross-sectional imaging techniques, including ultrasound, CT, and MRI, allow evaluation of the full thickness of the bowel wall as well as extramural complications and associated mesenteric abnormalities. Although promising data have been reported for a range of novel imaging biomarkers for detection of fibrosis and quantification of the degree of fibrosis, these biomarkers lack sufficient validation and standardization for clinical use. Additional methods, including PET with emerging radiotracers, artificial intelligence, and radiomics, are also under investigation for stricture characterization. In this review, we highlight the clinical relevance of identifying fibrosis in Crohn disease, review the histopathologic aspects of strictures in Crohn disease, summarize the morphologic imaging findings of strictures, and explore contemporary developments in the use of cross-sectional imaging techniques for detecting and characterizing intestinal strictures, with attention given to emerging quantitative biomarkers.

Pediatric en bloc kidney transplant from donors

Most kidneys from small pediatric donors are transplanted to adult recipients because of the perceived risk of surgical complications and graft thrombosis. In this study, we aim to demonstrate our favorable outcomes in transplanting pediatric kidneys from donors <15 k into pediatric recipients. This study retrospectively analyzes the outcomes of seven pediatric recipients of en block kidney transplants from pediatric donors weighing <15 kg performed at King Fahad Specialist Hospital-Dammam from December 2014 to January 2018. Baseline characteristics of donors and recipients were collected. The incidences of surgical complication, immediate, and intermediate graft function were the primary outcomes. The study included seven recipients monitored for a mean duration of 6.86 ± 1.35. Donors' and recipients' mean weights were 7.4 ± 3.2 kg and 20.7 ± 9.2 kg, respectively. Ureteric stricture occurred in one patient. There was a substantial improvement of 1-year estimated glomerular filtration rate (eGFR) compared to the 1-week mark (106.7 ± 26.38 mL/min. 1.73 m2 vs. 63.7 ± 22.92 mL/min/1.73 m2, p = .0069). The observed improvement in renal function persisted at the 5-year mark and during the last follow-up, with eGFR of 70.3 ± 40.7 mL/min/1.73 m2, and 79.8 ± 30.8 mL/min/1.73 m2, respectively. There was also increase of 27.9% in the size of the en bloc kidney observed at the 6 months. In a specialized transplant center with highly skilled surgeons, the utilization of en bloc kidney transplant from donors weighing less than 15 kg is an effective strategy for expanding the donor pool and ensuring favorable graft outcomes.