RESUMO
OBJECTIVE: ⢠To describe our experience with surgical management of transplant ureteral strictures over a 6-year period. PATIENTS AND METHODS: ⢠The present study identified patients who underwent open reconstruction for transplant ureteral strictures between March 2002 and May 2008 after kidney or kidney-pancreas transplantation. ⢠Baseline clinical characteristics were documented, including age at transplantation and reconstruction, serum creatinine levels, immunosuppressive drug regimen, and comorbidities. ⢠Postoperative complications were noted, including urinary tract infections, stricture recurrence and graft failure. ⢠Successful reconstructions were defined as stable allograft function with unobstructed outflow not requiring repeat dilation, ureterotomy or stent placement. RESULTS: ⢠Median age at the time of reconstruction was 51 years and the mean time from transplantation was 62 months. ⢠Seven of the 13 patients had failed previous balloon dilation. ⢠The patients were followed for a median of 41 months and a successful repair was achieved in 10 of 13 patients. ⢠Ureteral strictures recurred in two patients who received ureteroneocystostomies, which were subsequently managed with chronic stent exchanges. ⢠Another recurrence involved a 1.5-cm anastomotic stricture 6 months postoperatively, which was balloon-dilated and has remained recurrence-free for 16 months. CONCLUSIONS: ⢠Patients who present > 6 months after renal transplantation with ureteral strictures that are recalcitrant to endoscopic management can safely undergo open surgical ureteral reconstruction without subsequent renal or graft failure. ⢠Further investigation involving a larger patient cohort is required to confirm these initial results.