Di Gregorio M, Giudice C, Gueglio G, Daels F, Tejerizo J C, Damia O, Schiappapietra J
Servicio de Urología, Hospital Italiano de Bs., Buenos Aires, Argentina.
Actas Urol Esp. 1999 Feb;23(2):105-10.
Evaluate the incidence of ureterovesical stenosis in the renal transplant and its outcomes in the evolution of the allograft.
Seventy three renal transplants were made between August 1988 and December 1995 in Italian Hospital in Buenos Aires. The mean follow up period was 35 months. The incidence of ureterovesical stenosis and its outcomes in the renal allograft were evaluated. Seven cases of ureterovesical stenosis were found. Clinic diagnosis was made in all cases (decreased filtration, diuresis rythm diminished, pain over the implant) confirmed with ecography that showed hydronefrosis and pielography percutaneous anterograde to check the cause of obstruction. Time elapsed between transplant and diagnosis of stenosis varied from 2 to 23 months. Inicial treatment was percutaneous derivation and then in all cases where renal function was recovered ureterovesical reimplant was made out, but ureterotomy in one of them.
Incidence of ureterovesical stenosis was 9.58% (seven patients). Two of the patients keep an adequate renal function, one has altered renal function, the forth lost the implant due to pyelonephritis, and the other three lost the implant due to cronic rejection between 6 and 18 months after diagnosis and treatment of stenosis.
Ureterovesical stenosis is an important cause for lost of renal allograft. Imaging is outstanding for diagnosis. Definitive treatment can be made by open reconstructive operation or endoscopy.
评估肾移植中输尿管膀胱狭窄的发生率及其在移植肾演变过程中的结局。
1988年8月至1995年12月期间，在布宜诺斯艾利斯的意大利医院进行了73例肾移植手术。平均随访期为35个月。评估输尿管膀胱狭窄的发生率及其在肾移植中的结局。发现7例输尿管膀胱狭窄病例。所有病例均作出临床诊断（滤过减少、利尿节律减弱、移植部位疼痛），超声检查证实有肾积水，并行经皮顺行肾盂造影以检查梗阻原因。从移植到狭窄诊断的时间间隔为2至23个月。初始治疗为经皮引流，然后在所有肾功能恢复的病例中进行输尿管膀胱再植，但其中1例进行了输尿管切开术。
输尿管膀胱狭窄的发生率为9.58%（7例患者）。2例患者肾功能正常，1例肾功能改变，第4例因肾盂肾炎失去移植肾，另外3例在狭窄诊断和治疗后6至18个月因慢性排斥反应失去移植肾。
输尿管膀胱狭窄是肾移植丢失的重要原因。影像学检查对诊断很重要。最终治疗可通过开放重建手术或内镜进行。
