The purpose of our educational exhibit is to: Review the causes of ureteral obstruction in renal transplant recipients; Consider the diagnostic process; Discuss the indications, techniques, complications and outcomes related to percutaneous nephrostomy in transplanted kidneys; Outline extensions of nephrostomy procedures including ureteral dilation and stent placement; Summarise our experience of percutaneous nephrostomy insertion.

Renal transplantation, first performed successfully in the 1950s, is the treatment of choice for most patients with end-stage renal failure. It confers longer-term survival and a better quality of life than both haemodialysis and peritoneal dialysis [1]. The success of renal transplantation is dependent on the preservation of renal graft function and despite the many advances in surgical techniques, immunosuppressive regimens and supportive therapy, many challenges remain including ureteral obstruction, which can arise post-operatively. Causes Ureteral obstruction is reported to occur in 2-10% of all...

Prior to percutaneous nephrostomy insertion, acceptable INR, platelets and coagulation must be achieved and risk stratification undertaken [6]. Urine-analysis to screen for active infection and use of prophylactic antibiotics is necessary. Imaging should be reviewed for anatomical consideration, thereby reducing the risk of injury to organs and vessels [7]. With the transplant kidney, the pelvic bowel loops are especially vulnerable. The transplant kidney is assessed using combined US and fluoroscopy, but sole US or CT guidance can be used. Patients are positioned supine [6]. Conscious...

Obstruction of the renal transplant should be diagnosed and treated promptly. Percutaneous nephrostomy is a safe and effective method to relieve ureteric obstruction, with a good technical and short-term success rate. Further studies are warranted to evaluate the long-term effects on both graft survival and mortality.

Aishah Hakim, Medical School, St George's Hospital, London, UK Shankar Kumar, Medical School, St George's Hospital, London, UK Hwee Jeon, Medical School, St George's Hospital, London, UK Seyed Ameli-Renani, Department of Interventional Radiology, St George's Hospital, London, UK Seema Shrivastava, Department of Renal Medicine, St George's Hospital, London, UK Uday Patel, Department of Interventional Radiology, St George's Hospital, London, UK

Halloran PF. Immunosuppressive drugs for kidney transplantation. N Engl J Med 2004; 351: 2715–29. Berger PM and Diamond JR. Ureteral obstruction as a complication of renal transplantation: a review. Journal of Nephrology 1998; 11(1): 20-23. Sandhu C, Patel U. Renal transplantation dysfunction: the role of interventional radiology. Clin Radiol 2002; 57(9): 772-83. Duty BD, Conlin MJ, Fuchs EF et al. The current role of endourological management of renal transplantation. Advances in Urology 2013; 2013: Article ID 246520. Akbar SA, Jafri SZ, Amendola MA et al....