Risk Factors of Ureteral Stenosis in Kidney Transplant Recipients: A Retrospective Study in National Referral Hospital in Indonesia.

Ureteral stenosis is one of the most common urological complications following kidney transplantations. It is occurred in 2-10% of patients and poses a significant problem to the patients as it may lead to permanent damage to renal damage. Identification of risk factors is important to prevent the incidence of ureteral stenosis. Thus, we aim to determine the risk factors of ureteral stenosis in the Indonesian population. This is a retrospective analysis of 487 kidney transplant patients performed in Cipto Mangunkusumo Hospital between 2014 and 2018. We collected and compared donor and recipient demography data in recipients who developed ureteral stenosis and recipients who did not develop ureteral stenosis. Ureteral stenosis was defined as the presence of hydronephrosis from ultrasound and increased number of serum creatinine. The overall incidence of ureteral stenosis post-kidney transplantation in our center is 6.6% (32 from 487 patients) from January 2014 until June 2018. We found that older donor and recipient age more frequent in developing ureteral stenosis post-kidney transplantation (p < 0.001). We also found that donors with number of arteries more than 2 (p < 0.001) and prolonged warm ischemic time (p < 0.05) are more frequently to develop ureteral stenosis post-kidney transplantation. There is no association between type II diabetes mellitus and hypertension with ureteral stenosis in this study. Donor age, recipient age, donor number of arteries more than 2, and prolonged warm ischemia time are associated with ureteral stenosis after kidney transplantation.

Predictive Model of Ureteral Obstruction of Allograft Kidney Following Living Donor Kidney Transplantation.

BACKGROUND: Ureteral obstruction is one of the most frequent urologic complications of kidney transplantation. This study aimed to analyze independent factors that contribute to ureteral obstruction following kidney transplantation and develop predictive models form those factors. METHODS: As many as 545 kidney transplantations were analyzed. Patients underwent transplantation between January 2014 and December 2018. Logistic regression analysis was used to develop the predictive model. Both donor and recipient demographic characteristics and operative parameters were analyzed and presented. RESULTS: There were 37 (6.8%) subjects who developed ureteral obstruction. The independent risk factors for ureteral obstruction were multiple allograft renal arteries, older donor ages (>38 years), and older recipient age (>60 years). From the receiver operating characteristic (ROC) curve analysis, the area under the ROC curve of the predictive model was 0.843 (P < .001). Subjects with >2 renal allograft arteries, recipient age >60 years, and donor age >38 years had 83.8% probability of developing ureteral stenosis after kidney transplantation. CONCLUSION: Donor age, recipient age, and multiple renal arteries were independent risk factors of graft ureteral obstruction. Probability of developing ureteral obstruction should be considered pre-operatively in our population, using the proposed predictive model.

Case Report: An occurrence of steinstrasse in retrograde intra renal surgery (RIRS) for large staghorn kidney stone: a difficult experience in managing surgical outcomes.

Immediate removal of staghorn stones is compulsory to prevent life-threatening complications. The advancement of endoscopic technology makes retrograde intrarenal surgery (RIRS) a favorable treatment to remove large stones over the standard percutaneous nephrolithotomy (PCNL). Without careful considerations, it can cause the formation of steinstrasse. Here, we present the case of a 68-year-old man with multiple stones along his right urogenital duct after being treated with RIRS to remove a staghorn stone. After 2 years of multiple interventions, the steinstrasse was completely removed. To prevent this complication, detailed assessment of the stone (size, location) and renal anatomy should be performed prior to the procedure.