[Endoscopic therapy combined antegrade percutaneous approach and retrograde transurethral approach for ureteral obstruction after kidney transplantation].

Objective: To evaluate the method and efficacy of endoscopic therapy combined with antegrade percutaneous approach and retrograde transurethral approach for ureteral obstruction after kidney transplantation.

Methods: Eight cases were analyzed retrospectively who received endoscopic therapy combined with antegrade percutaneous approach and retrograde transurethral approach when they had been diagnosed with ureteral obstruction in the transplant kidney from February 2007 to March 2013 in Department of Urology, Peking University Third Hospital. The cases included three males and five females, with the average age being 44 years (30-64 years). The interval between ureteral obstruction and kidney transplantation ranged from one month to 12 months. Four cases presented with increased serum creatine, two with anuria and two with urinary leakage. The stricture site was located in ureter terminal part in seven cases, and middle part in 1 case. In three cases, percutaneous nephrostomy were carried out immediately while endoscopic therapy combined with antegrade percutaneous approach and retrograde transurethral approach were carried out later. The remaining five cases were treated simultaneously.

Results: The average serum creatine decreased from (237±43) μmol/L to (121±29) μmol/L (P<0.05) after the therapy. No perioperative complications occurred. Two urinary fistula healed. Six cases were treated successfully with two cases that failed followed by percutaneous nephrostomy. The ureteral obstruction recurred in one case after six months with recurrence rate of 17% (1/6).

Conclusion: Endoscopic therapy combined with antegrade percutaneous approach and retrograde transurethral approach is an effective therapeutic approach to treat ureteral obstruction in transplant kidney which shows good clinical results.