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논문분류	춘계학술대회 초록집
제목	UVJ stenosis in KTP:Ballooning
저자	Jin ho LEE, Hee yeon KIM, Dong yeol LEE, Joon seok OH, Seong min KIM, Yong hun SIN, Yong ki PARK, *Joong kyung KIM
출판정보	2017; 2017(1):
키워드	KTP, Ureter stenosis, Ballooning
초록	Case Study : Hydronephrosis is one of the etiology of allograft dysfunction in KTP. Ureter stone, midureter ischemia, surgical technique error, and the other reasons make the hydronephrosis. To eliminate the hydronephrosis due to ureter stenosis, balloon dilatation may be the treatment option. We announced 3 cases of hydronephrosis due to neocystostomy stenosis causing graft dysfunction was treated balloon dilatation by interventional nephrologist. Case 1. 59-year-old man who underwent kidney transplantation(KTP) at Feb, 1989. His serum creatinine level was elevated from 2.4mg/dl to 3.2mg/dl. He checked the abdominal US and CT(Fig.1). Image modalities show hydronephrosis and hydroureter(grade IV), UVJ stenosis. Then, we underwent percutaneous nephrostomy(PCN). We inserted 0.035mm guide wire and 3mm ballooning(MUSTANGTM, 3.0mm X 40mm, 10atm)(Fig.2) was done via PCN site. After that, UVJ stenosis was improved and D-J catheter was inserted(Fig.3). His serum creatinine was declined to 2.2mg/dl. Case 2 38-year-old man who underwent KTP with deceased donor at Jan, 2015 was admitted for elevated serum creatinine, from 1.6mg/dl to 2.2mg/dl. His CT and abdominal US findings show hydronephrosis and ureteral wall thickening, UVJ stenosis(Fig.4). We underwent cystoscopy. 0.035mm guide wire was passed from bladder to ureter via cystoscope. And 4mm ballooning (MUSTANGTM, 4.0mm X 40mm, 20atm)(Fig.5) was done. After that, diameter was increased at stenotic ureter and D-J catheter was inserted(Fig.6). His serum creatinine was declined to 1.8mg/dl Case 3 28-year-old man who underwent KTP with deceased donor at Sep, 2015. At POD 21, graft kidney CT scan shows severe hydronephrosis and hydroureter. His serum creatinine level was 1.6mg/dl, but increased slowly. We performed cystoscopy and ballooning at stenotic lesion. 0.035mm guide wire was passed from bladder to ureter via cystoscope. And 4mm and 8mm ballooning was done(MUSTANGTM, 4.0mm X 40mm, 20atm and 8.0mm X 40mm, 20atm)(Fig. 7, 8, 9). After that, ureter size was normalized(Fig. 10) and D-J catheter was inserted. Conclusion: UVJ stenosis in KTP patient could be treated by balloon dilatation and D-J catheter insertion by interventional nephrologist. Limitation: We don’t have long term follow up data after intervention. And We have questions about the each of the roles of the ballooning and D-J catheter insertion.
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