Optimal management of distal ureteric strictures following renal transplantation: a systematic review.
Kwong J, Schiefer D, et al.Transplant International 2016; 29(5): 579-588.
Aims
To define the optimal management of distal ureteric strictures following renal transplantation.
Interventions
A systematic review was conducted which included english language clinical studies from 1984 to 2014 referencing treatment of transplant distal ureteric strictures. The database PubMed was searched and no date or publication type restrictions were applied.
Participants
385 patients from 34 articles were included.
Outcomes
The primary outcomes measured were treatment success rates and procedural complications of specific primary and secondary treatments.
Follow-up
Not described
CET Conclusions
This systematic review gives a narrative description of studies describing the management of distal ureteric strictures following renal transplantation. Initially it is unclear what comparison was intended as the authors had an open approach and ultimately make most comparisons between open surgery and endourologic management. The search was conducted in pubmed only and a large number of studies were excluded for not having sufficient information. There was only 1 RCT included, and this randomised between two types of ureterocystotomy at the time of transplant, not between stricture management strategies. It is a shame that more patient information was not included to assess confounders as the majority of studies were retrospective, case series/studies. All of the severe complications recorded were associated with endourologic management rather than open surgery but there is not enough evidence to associate this with the treatment type alone. Given the large number of specific treatments available there were only a small number of cases managed by certain techniques, transurethral cold knife for example, so the comparative efficacy of these cannot be assessed.
Quality notes
Quality Assessment not appropriate
Trial registration
None