A Rationale to Use Bladder Boari Flap Reconstruction for Late Kidney Transplant Ureteral Strictures - 12/03/16

Doi : 10.1016/j.urology.2015.10.028

Aaron Boonjindasup ^a,^* , Alison Smith ^b, Anil Paramesh ^c, Daniel Rittenberg ^b, Joseph Buell ^c, Mary Killackey ^c, Raju Thomas ^a
^a Department of Urology, Tulane University School of Medicine, New Orleans, LA
^b Tulane University School of Medicine, New Orleans, LA
^c Tulane Abdominal Transplant Institute, New Orleans, LA

^*Address correspondence to: Aaron Boonjindasup, M.D., M.P.H., Department of Urology, Tulane University Health Sciences Center, 1430 Tulane Ave. SL-42, New Orleans, LA 70112.Department of UrologyTulane University Health Sciences Center1430 Tulane Ave. SL-42New OrleansLA70112

Abstract

Objective

To evaluate the efficacy of Boari flap reconstruction (BFR) in the management of late-onset transplant ureteral strictures (TUS).

Methods

Between March 2007 and March 2014, there were 730 patients who underwent kidney transplant (KTx) at our institution. We identified 16 patients with TUS, occurring more than 60 days after KTx. Baseline clinical and posttransplant characteristics were reviewed and stratified upon treatment modality. Outcomes for each treatment modality were determined.

Results

Median time from transplant to the treatment of TUS was 703 days (range, 65-2617 days). BFR was the most common treatment modality and was used in 87.5% of patients (n = 14/16). This procedure was performed as both a primary treatment and as a salvage procedure in recurrent TUS refractory to balloon dilation and neoureterocystotomy. Incidence of BFR failure was 6.3% (n = 1/14). BFR as a primary treatment was more successful compared to other methods (P < .01).

Conclusion

Late TUS after KTx is a difficult complication to treat. Our study suggests that BFR can provide a higher success rate of primary treatment compared to other common treatment options. BFR can be used as a primary treatment of TUS or as a salvage procedure with similar success. Additional follow-up is necessary to evaluate the long-term efficacy of BFR for the treatment of late-onset TUS.

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