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Retrograde Endoscopic Access for the Management of Ureteral Complications After Renal Transplantation
Jennifer Yates, MD1, Ravi Munver, M.D.2.
1University of Massachusetts, Worcester, MA, USA, 2Hackensack University Medical Center, Hackensack, NJ, USA.

Introduction
Ureteral complications after renal transplantation are often managed via percutaneous renal access. Retrograde endoscopic access, while technically challenging, can offer a less morbid treatment option.
We describe a contemporary series of patients undergoing retrograde management of ureteral complications after renal transplantation.
Materials and Methods
The records of patients presenting with ureteral complications after renal transplantation were reviewed. Those patients who underwent attempted retrograde management of the complication were included in the analysis. All patients had undergone Lich-Gregoir ureteral reimplantation at the bladder dome.
Results
A total of 10 patients underwent 23 retrograde endoscopic procedures to manage ureteral pathology, including hydronephrosis, ureteral stricture, and migrated ureteral stent.
The success rate of the 23 procedures was 74%. In 2 cases, the stent would not pass over an appropriately positioned wire, and in 3 cases the wire would not pass beyond the distal ureter. In 8 of the successful procedures, a Berenstein angiocatheter was utilized. The success rate appeared to increase over time.
Conclusions
Retrograde endoscopic management of ureteral complications after renal transplantation is feasible and offers a less morbid treatment option. In our experience, the Berenstein angiocatheter was a valuable tool for accessing the transplant ureteral orifice. The success rate of attempted retrograde ureteral access improved with experience.


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