Journal of Peking University (Health Sciences) ›› 2022, Vol. 54 ›› Issue (4): 762-765. doi: 10.19723/j.issn.1671-167X.2022.04.029

Previous Articles     Next Articles

Ureteral stenosis following hematopoietic stem cell transplantation: A case report

Guan-peng HAN1,Yang-yang XU1,Zhi-hua LI1,Chang MENG1,Hong-jian ZHU2,Kun-lin YANG1,Li-qun ZHOU1,Xue-song LI1,*()   

  1. 1. Department of Urology, Peking University First Hospital; Institute of Urology, Peking University; National Urological Cancer Center, Beijing 100034, China
    2. Department of Urology, Beijing Jiangong Hospital, Beijing 100054, China
  • Received:2022-03-25 Online:2022-08-18 Published:2022-08-11
  • Contact: Xue-song LI E-mail:pineneedle@sina.com

Abstract:

Ureteral stenosis is a comparatively rare complication following hematopoietic stem cell transplantation (HSCT). The etiology is still unclear and most believe that this may be due to the reactivation of BK virus in a state of immunodeficiency. In the later stages of ureteral stenosis with scarring, invasive interventions must be taken to relieve the hydronephrosis. Common treatments, such as D-J stent placement and permanent nephrostomy may not only entail the risk of infection, but also seriously affect the quality of life. Few cases of surgical intervention have been reported. In this article, a 25-year-old female was admitted to Peking University First Hospital suffering from recurrent flank pain. Seven years before, she developed hemorrhagic cystitis and bilateral urethritis 40 days after allogeneic HSCT. After continuous bladder irrigation and antiviral therapy, the left-sided hydronephrosis gradually alleviated while the right-sided one did not improve. D-J stents were used for urine drainage for 7 years before percuta-neous nephrostomy. Preoperative antegrade pyelography revealed significant hydronephrosis in the right kidney with long stricture of proximal-middle ureter. After comprehensive decision, she underwent ileal ureter replacement. The operation was successful. The segmental lesion was dissected and the scar tissue was removed. A 25 cm intestinal tube was isolated to connect the pelvis and bladder. An anti-reflux nipple was created at the distal end of ileal ureter to prevent the potential infection. The blood loss was minimal. After surgery, the drainage tube was removed in 2 weeks, the nephrostomy tube and the D-J stent was removed in 3 months. Follow-up mainly included clinical assessment, serologic testing, renal ultrasonography, blood gas analysis and radiological examination. During the follow-up of 6 years, she was symptom-free and no postoperative complications occurred. The serum creatinine level was stable. No hydronephrosis was observed under ultrasonography. Obvious peristaltic waves and ureteral jets of the ileal ureter was confirmed on cine magnetic resonance urography. To sum up, ureteral stenosis after HSCT is relatively rare. Obstruction caused by scarring is usually irreversible and surgical intervention should be designed according to the location and length of the lesion. Ileal ureter replacement can be a safe, feasible and effective method to solve this kind of complex stricture.

Key words: Hematopoietic stem cell transplantation, Ureteral stenosis, Ileal ureter replacement

CLC Number: 

  • R693.2

Figure 1

Preoperative antegrade pyelography There is significant hydronephrosis in the right kidney with long stricture of proximal-middle ureter."

Figure 2

Surgical technique of ileal ureter replacement and postoperative cine magnetic resonance urography A, surgical technique of right-sided ileal ureter replacement; B, postoperative cine MRU showed no hydronephrosis and excellent peristalsis of the ileal ureter."

Figure 3

Scatter diagram of serum creatinine level after surgery"

1 Haab AC , Keller IS , Padevit C , et al. BK virus associated pronounced hemorrhagic cystoureteritis after bone marrow transplantation[J]. Can J Urol, 2015, 22 (5): 8009- 8011.
2 Hirsch HH , Steiger J . Polyomavirus BK[J]. Lancet Infect Dis, 2003, 3 (10): 611- 623.
doi: 10.1016/S1473-3099(03)00770-9
3 Coleman DV , Mackenzie EF , Gardner SD , et al. Human po-lyomavirus (BK) infection and ureteric stenosis in renal allograft recipients[J]. J Clin Pathol, 1978, 31 (4): 338- 347.
doi: 10.1136/jcp.31.4.338
4 Hwang YY , Sim J , Leung AY , et al. BK virus-associated bilateral ureteric stenosis after haematopoietic SCT: Viral kinetics and successful treatment[J]. Bone Marrow Transplant, 2013, 48 (5): 745- 746.
doi: 10.1038/bmt.2012.215
5 Mylonakis E , Goes N , Rubin RH , et al. BK virus in solid organ transplant recipients: An emerging syndrome[J]. Transplantation, 2001, 72 (10): 1587- 1592.
doi: 10.1097/00007890-200111270-00001
6 王明瑞, 胡浩, 王起, 等. Allium覆膜金属输尿管支架长期留置治疗放疗后输尿管狭窄的有效性和安全性[J]. 中华泌尿外科杂志, 2020, 41 (12): 921- 926.
doi: 10.3760/cma.j.cn112330-20200623-00488
7 Jeong IG , Han KS , Joung JY , et al. The outcome with ureteric stents for managing non-urological malignant ureteric obstruction[J]. BJU International, 2007, 100 (6): 1288- 1291.
doi: 10.1111/j.1464-410X.2007.07172.x
8 于路平, 徐涛, 黄晓波, 等. 造血干细胞移植后肾积水的病因及治疗[J]. 北京大学学报(医学版), 2014, 46 (4): 552- 557.
doi: 10.3969/j.issn.1671-167X.2014.04.014
9 Zhong W , Hong P , Ding G , et al. Technical considerations and outcomes for ileal ureter replacement: A retrospective study in China[J]. BMC Surgery, 2019, 19 (1): 9.
doi: 10.1186/s12893-019-0472-1
10 Mori K , Yoshihara T , Nishimura Y , et al. Acute renal failure due to adenovirus-associated obstructive uropathy and necrotizing tubulointerstitial nephritis in a bone marrow transplant recipient[J]. Bone Marrow Transplant, 2003, 31 (12): 1173- 1176.
doi: 10.1038/sj.bmt.1704077
11 Wolff B , Chartier-Kastler E , Mozer P , et al. Long-term functional outcomes after ileal ureter substitution: A single-center experience[J]. Urology, 2011, 78 (3): 692- 695.
doi: 10.1016/j.urology.2011.04.054
12 Chung BI , Hamawy KJ , Zinman LN , et al. The use of bowel for ureteral replacement for complex ureteral reconstruction: Long-term results[J]. J Urol, 2006, 175 (1): 179- 183.
doi: 10.1016/S0022-5347(05)00061-3
13 Lee Z , Lee M , Lee R , et al. Ureteral rest is associated with improved outcomes in patients undergoing robotic ureteral reconstruction of proximal and middle ureteral strictures[J]. Urology, 2021, 152, 160- 166.
doi: 10.1016/j.urology.2021.01.058
14 Drain A , Jun MS , Zhao LC . Robotic ureteral reconstruction[J]. Urol Clin North Am, 2021, 48 (1): 91- 101.
doi: 10.1016/j.ucl.2020.09.001
15 Waldner M , Hertle L , Roth S . Ileal ureteral substitution in reconstructive urological surgery: Is an antireflux procedure necessary?[J]. J Urol, 1999, 162 (2): 323- 326.
doi: 10.1016/S0022-5347(05)68550-3
16 Koff S . The search for the definition and effective diagnosis of upper urinary tract obstruction: The Whitaker test then and now, Whitaker et al. 2018[J]. J Pediatr Urol, 2019, 15 (1): 27- 28.
doi: 10.1016/j.jpurol.2018.10.032
17 Zhu WJ , Ma MM , Zheng MM , et al. Cine magnetic resonance urography for postoperative evaluation of reconstructive urinary tract after ileal ureter substitution: Initial experience[J]. Clin Radiol, 2020, 75 (6): 480- 481.
18 Li X , Wang X , Li T , et al. Cine magnetic resonance urography and Whitaker test: dynamic visualized and quantified tools in ileal ureter replacement[J]. Transl Androl Urol, 2021, 10 (11): 4110- 4119.
doi: 10.21037/tau-21-507
[1] Le-qing CAO,Jing-rui ZHOU,Yu-hong CHEN,Huan CHEN,Wei HAN,Yao CHEN,Yuan-yuan ZHANG,Chen-hua YAN,Yi-fei CHENG,Xiao-dong MO,Hai-xia FU,Ting-ting HAN,Meng LV,Jun KONG,Yu-qian SUN,Yu WANG,Lan-ping XU,Xiao-hui ZHANG,Xiao-jun HUANG. Relationship between treatment and prognosis in patients with late-onset severe pneumonia after allogeneic hematopoietic stem cell transplantation [J]. Journal of Peking University (Health Sciences), 2022, 54(5): 1013-1020.
[2] Yao Chen,Xiao-hui ZHANG,Lan-ping XU,Kai-yan LIU,Jiong QIN,Yan-ling YANG,Xiao-jun HUANG. Haploidentical allogenetic hematopoietic stem cell transplantation for X-linked adrenoleukodystrophy [J]. Journal of Peking University(Health Sciences), 2019, 51(3): 409-413.
[3] ZHU Ming-xia, WAN Wen-li, LI Hai-shen, WANG Jing, WANG Yan-fang, HU Kai, KE Xiao-yan. Early immune reconstitution after hematopoietic stem cell transplantation [J]. Journal of Peking University(Health Sciences), 2016, 48(3): 505-522.
[4] YU Lu-Ping, XU Tao, HUANG Xiao-Bo, WANG Xiao-Feng. Pathogenesis and therapy of hydronephrosis after hematopoietic stem cell transplantation [J]. Journal of Peking University(Health Sciences), 2014, 46(4): 552-557.
[5] XU Lan-ping, CHEN Yao, SHI Hong-xia, HUANG Xiao-jun. 8p11 myeloproliferative syndrome cured by allogeneic hematopoietic stem cell transplantation: two case reports and literature review [J]. Journal of Peking University(Health Sciences), 2013, 45(6): 993-996.
Viewed
Full text


Abstract

Cited

  Shared   
  Discussed   
[1] . [J]. Journal of Peking University(Health Sciences), 2007, 39(4): 434 -436 .
[2] . [J]. Journal of Peking University(Health Sciences), 2001, 33(3): 288 -289 .
[3] . [J]. Journal of Peking University(Health Sciences), 2002, 34(2): 97 -98 .
[4] . [J]. Journal of Peking University(Health Sciences), 2002, 34(2): 112 -116 .
[5] . [J]. Journal of Peking University(Health Sciences), 2011, 43(1): 29 -33 .
[6] . [J]. Journal of Peking University(Health Sciences), 2011, 43(2): 179 -182 .
[7] . [J]. Journal of Peking University(Health Sciences), 2009, 41(6): 635 -639 .
[8] . [J]. Journal of Peking University(Health Sciences), 2003, 35(4): 429 -433 .
[9] . [J]. Journal of Peking University(Health Sciences), 2003, 35(5): 485 -487 .
[10] . [J]. Journal of Peking University(Health Sciences), 2003, 35(z1): 92 -94 .