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Introduction <p>Ureteral strictures and urinary fistulas remain the most frequent urological complications after kidney transplantation and may jeopardize graft function when drainage or endourological measures fail. We assessed outcomes of surgical reconstruction, using pyelo-ureteral anastomosis as the reference technique.</p> Methods <p>We conducted a retrospective, single-center study (March 2008–June 2025) including adult kidney transplant recipients who required open surgical reconstruction for ureteral stricture or urinary fistula. Patients treated with endoscopy alone and those managed with simple early ureterovesical reimplantation were excluded. Reconstructions were grouped as pyelo-ureteral anastomosis (<i>n</i> = 21) or other techniques (<i>n</i> = 14): calico-ureteral anastomosis (<i>n</i> = 6), Boari–Küss flap (<i>n</i> = 3), ureterovesical reimplantation with psoas hitch (<i>n</i> = 3) and crossed pyelo-ureteral anastomosis (<i>n</i> = 2). The primary endpoint was functional success defined by recurrence-free status, i.e., no long-term dependence on secondary urinary diversion (JJ stent and/or nephrostomy) and no need for further reconstructive surgery. Secondary endpoints were renal function at last follow-up (creatinine and creatinine clearance) and graft survival.</p> Results <p>Among 1,137 transplantations, 90 patients (7.9%) developed urological complications: ureteral stenosis (<i>n</i> = 42) and urinary fistula (<i>n</i> = 54), with 4 fistulas evolving to stenosis. After a stepwise strategy, 35 patients underwent definitive reconstruction, while the overall institutional pathway achieved ultimate success in 81/90 cases (90%). In the surgical cohort, return to dialysis was observed only in the non-reference group (two calico-ureteral stricture cases), and failures clustered in crossed pyelo-ureteral repairs (2/2). At last follow-up, renal function tended to be better after pyelo-ureteral anastomosis (lower creatinine, similar clearance), with broadly comparable graft survival across techniques.</p> Conclusion <p>Pyelo-ureteral anastomosis is a robust salvage option for post-transplant strictures and fistulas. Alternative reconstructions remain valuable when tailored to anatomy and intraoperative findings, whereas crossed pyelo-ureteral repair showed limited durability in our experience.</p>

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Analysis of techniques for urinary reconstruction following ureteral complications in renal transplant recipients

  • 期刊论文

  • 发表日期：

    2026年2月17日

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  • Clara Duval,
  • Thibaut Waeckel,
  • Eve Calvar,
  • Xavier Tillou

摘要

Introduction

Ureteral strictures and urinary fistulas remain the most frequent urological complications after kidney transplantation and may jeopardize graft function when drainage or endourological measures fail. We assessed outcomes of surgical reconstruction, using pyelo-ureteral anastomosis as the reference technique.

Methods

We conducted a retrospective, single-center study (March 2008–June 2025) including adult kidney transplant recipients who required open surgical reconstruction for ureteral stricture or urinary fistula. Patients treated with endoscopy alone and those managed with simple early ureterovesical reimplantation were excluded. Reconstructions were grouped as pyelo-ureteral anastomosis (n = 21) or other techniques (n = 14): calico-ureteral anastomosis (n = 6), Boari–Küss flap (n = 3), ureterovesical reimplantation with psoas hitch (n = 3) and crossed pyelo-ureteral anastomosis (n = 2). The primary endpoint was functional success defined by recurrence-free status, i.e., no long-term dependence on secondary urinary diversion (JJ stent and/or nephrostomy) and no need for further reconstructive surgery. Secondary endpoints were renal function at last follow-up (creatinine and creatinine clearance) and graft survival.

Results

Among 1,137 transplantations, 90 patients (7.9%) developed urological complications: ureteral stenosis (n = 42) and urinary fistula (n = 54), with 4 fistulas evolving to stenosis. After a stepwise strategy, 35 patients underwent definitive reconstruction, while the overall institutional pathway achieved ultimate success in 81/90 cases (90%). In the surgical cohort, return to dialysis was observed only in the non-reference group (two calico-ureteral stricture cases), and failures clustered in crossed pyelo-ureteral repairs (2/2). At last follow-up, renal function tended to be better after pyelo-ureteral anastomosis (lower creatinine, similar clearance), with broadly comparable graft survival across techniques.

Conclusion

Pyelo-ureteral anastomosis is a robust salvage option for post-transplant strictures and fistulas. Alternative reconstructions remain valuable when tailored to anatomy and intraoperative findings, whereas crossed pyelo-ureteral repair showed limited durability in our experience.