Endourological Management of Ureteral Stricture in Patients with Renal Transplant: A Systematic Review of Literature

Abstract

Purpose: To analyze the utility and outcomes of available endourological options to treat ureteral stricture following kidney transplantation. Methods: A systematic review was carried out for all English language articles from 2000-2023 according to the PRISMA standards using EMBASE, MEDLINE, SCOPUS, Google scholar and Cochrane library. The search term combination for the string was: [(Ureteral stricture) OR (ureter stenosis) OR (ureteral stenosis) OR (Stricture ureter ) OR ( Narrowing ureter) OR (Ureter restriction) OR (ureteral restriction) OR (ureteral narrowing) OR (ureteral obstruction) OR (ureter obstruction) OR (obstructing ureter) OR (obstructive ureter) OR (narrow ureter) OR (ureteral narrow)] AND [(kidney transplant) OR (transplanted kidney) OR (transplant) OR (transplantation)] AND [(management) OR (Robotic) OR (laser) OR (stent) OR (dilatation) OR (dilation) OR (endoscopic) OR (endourological) OR (Urologic) OR (laparoscopic) OR (surgery) OR (treatment)]. Case reports, review articles, animal and laboratory studies were excluded. Risk of bias assessment was conducted using the RoB 2 and ROBINS – I tools. Results: A total of 1102 relevant articles published from 2000 to 2023 were found. After screening of titles and abstracts, a total of 19 articles were included in our systematic review. Ureteral stent/nephrostomy placement, balloon dilation (ureteroplasty) with or without laser were used as initial approaches whereas follow up and success rate were analyzed among other parameters. Conclusions: The management of ureteral strictures after kidney transplantation is challenging and selecting the most appropriate treatment is crucial for successful outcomes. Our review suggests that, an endourological management is a safe option with good long-term outcomes, especially in short and early strictures. Keywords: Ureteral stricture, stenosis, obstruction, restriction, narrowing, kidney transplant, endourological, endoscopic, laser, stent, dilation, dilatation, surgery.