Efficacy Analysis Of Endoscopic Surgery For Post-kidney-transplantation Ureteral Stenosis

OBJECTIVE: The purpose of our study was to evaluate the safety and efficacy of endoscopic technique for the treatment of ureteral stenosis after renal transplantation,and to further explore the factors that affect the efficacy of endoscopic treatment of ureteral stricture after renal transplantation.METHODS: 1.From April 2009 to April 2022,a total of 2,474 kidney transplant patients were admitted to the hospital,1,067 kidney transplant patients underwent kidney transplant operations in this hospital,and the remaining patients underwent kidney transplantation in other hospitals;a total of 39 patients developed ureteral stenosis,The incidence rate was 1.58%.According to the inclusion and exclusion criteria,the clinical data of 26 patients with ureteral stenosis after renal transplantation were collected,including 16 males and 10 females,with an average age of 44.19±10.57 years and an average follow-up time of42.4±75.3(range,2-132)months,17 patients with stenosis after kidney transplantation underwent kidney transplantation in our hospital,and 9patients underwent kidney transplantation in another hospital.The time interval from kidney transplantation to diagnosis of ureteral stricture after kidney transplantation was 6.35±8.07(range,1-32)months.2.The success rate of endoscopic treatment in the early stenosis group was 92.9%,and the recurrence rate was 46.1%.In the late stenosis group,the success rate of endoscopic surgery was 91.7%,and the recurrence rate was 54.5%.Time was 4.20 ± 3.03(range,1-11)months,with a median of 5.00 months.At the end of follow-up,2 of 26 patients(7.69%)had complete loss of allograft function.Whether the length of stenosis ≥1cm may be a risk factor for short-term renal insufficiency after ureteral stenosis after kidney transplantation,while gender,age,urine culture,stenosis location,first operation method,approach,and type of donor have significant effects on short-term renal function after stenosis.The effect of normal rate was not significantly different.RESULTS: a total of 2474 renal transplant patients were hospitalized and followed up in our hospital during this period.1067 renal transplant patients underwent renal transplantation in our hospital,and the rest were completed in other hospitals;According to the inclusion and exclusion criteria,the clinical data of 26 patients with ureteral stricture after renal transplantation were collected.The average age was44.19 ± 10.57 years.Among them,17 patients with ureteral stricture after renal transplantation underwent renal transplantation in our hospital and 9patients underwent renal transplantation outside the hospital.The average follow-up time was 42.4 ± 75.3(range,2-132)months.The time interval from renal transplantation to the diagnosis of ureteral stricture after renal transplantation was 6.35 ± 8.07(range,1-32)months.In 3 patients with early stricture,the stricture recurred after DJ tube was removed,and repeated endoscopic treatment or renal allograft ureter bladder re anastomosis was performed.Intraluminal therapy was used to treat 18 patients with ureteral stricture after renal transplantation for the first time,including 9 cases with recurrence of ureteral stricture,with a recurrence rate of 50.0%.The success rate of intraluminal therapy in the early stricture group was 92.9%,with a recurrence rate of 42.9%.The success rate of intraluminal therapy in the late stricture group was 91.7%,with a recurrence rate of 54.5%.The average time from treatment to recurrence of stricture was 4.20 ± 3.03(range,1-11)months,with a median of5.00 months.Up to the follow-up,2 patients had complete loss of renal allograft function.Whether the stenosis length is ≥ 1cm may be a risk factor for short-term renal insufficiency after ureteral stricture after renal transplantation,while gender,age,urine culture,stenosis site,first operation method,approach and donor type have no significant difference on the short-term normal rate of renal function after ureteral stricture after renal transplantation.Conclusion: Endoscopic treatment after renal transplantation has few complications and high safety.Whether it is patients with early stenosis or late stenosis after renal transplantation,endoscopic treatment has a good short-term effect on them;whether the length of stenosis ≥1cm may be a Risk factors for short-term graft insufficiency in patients after renal transplantation after endoscopic therapy for ureteral strictures.