Reconstructive versus palliative management of ureteral stenosis after kidney transplant: an EAU‑YAU kidney transplantation working group collaboration

Introduction The gold standard for treatment of ureteral stenosis after kidney transplantation is surgical redo of the anastomosis, although some patients may only be candidates for palliative treatment by permanent urinary catheterization. We aimed to compare the functional results of these two approaches. Methods A retrospective comparative analysis was carried out to compare the groups. The outcomes of each procedure and factors associated with success of reconstruction, graft failure and GFR variation were analyzed by means of descriptive statistics. Results 30 (54.5%) and 24 (44.5%) patients underwent surgical and palliative treatment, respectively. Distal/ureterovesical location was most frequently observed (81.1%, p  < 0.0001). Reconstruction consisted of ureterovesical reimplantation, pyeloureterostomy and ureteroureterostomy in 11 (36.6%), 13 (43.3%) and 3 (10.0%) cases, respectively. Intestinal segment interposition was employed in 2 (6.7%) cases. We observed 4 (13.3%) cases of failure after surgery and ureterovesical reimplantation was significantly associated with stricture recurrence ( p  = 0.018). A significant variation of GFR from post treatment baseline to last follow-up was observed in the palliative group (43.5 to 32.0, p  < 0.001), although graft survival was similar (9.1% vs. 10.0%, p  = 0.65). Conclusion Surgical reconstruction can attain definitive treatment of post KT US in almost nine out of ten patients with a satisfactory safety profile. On the other hand, palliative treatment seems to be associated with GFR degradation.