內視鏡氣球擴張術對於移植腎術後輸尿管狹窄的成功案例：病例報告

李琇碧、鄒凱亦

衛生福利部雙和醫院 泌尿科

Successful Management of Post-Transplant Ureteral Stricture via Ureteroscopic Balloon Dilation: A Case Report

Siou-bi Li, Kai-Yi Tzou

Department of Urology, Shuang Ho hospital, Taipei Medical University, Taipei, Taiwan

Introduction: Ureteral stricture is a significant post-renal transplant complication (incidence: 0.5-6.8%), potentially leading to graft dysfunction and sepsis. While open reconstruction was historically standard, endourology offers minimally invasive alternatives. We present a living donor transplant recipient with a postoperative ureteral stricture successfully managed via ureteroscopic balloon dilation.

Case description: A 36-year-old female underwent living donor renal transplantation for IgA nephropathy-induced end-stage renal disease (ESRD) two years prior. The graft ureter was preserved at a length of 130 mm and was implanted via Lich-Gregoir ureteroneocystostomy with double-J stenting. Following routine stent removal, she developed recurrent urinary tract infections, sepsis, and acute graft dysfunction. Ultrasound revealed graft hydronephrosis with preserved perfusion. After emergent percutaneous nephrostomy (PCN) for stabilization, ureteroscopy identified a severe stricture segment (less than 5 mm) in the distal graft ureter without urolithiasis. Fluoroscopy-guided balloon dilation (up to 12 French) was performed, followed by one-month double-J stenting. Post-stent withdrawal, follow-up ultrasound confirmed resolved hydronephrosis and stable graft function.

Discussion: Post-transplant ureteral stricture management has evolved and increasingly favors endourology due to minimally invasive nature and lower complication rates. Although open surgery remains the definitive treatment for long or complex strictures, balloon dilation has been established as a safe and effective therapy, particularly for short-segment strictures (less than 2 cm). It offers patency rates comparable to surgical revision in selected cases, sparing patients from re-exploration risks. In our patient, early sonographic diagnosis and prompt balloon dilation successfully salvaged the graft function.

Conclusion: Ureteral stricture is a potentially graft-threatening complication in renal transplant recipients. This case demonstrates that ureteroscopic balloon dilation provides a safe and minimally invasive solution that effectively relieves obstruction and preserves graft function, avoiding the morbidity associated with open reconstructive surgery.