Abstract / Summary
Abstract Purpose Ureteral complications after kidney transplantation remain technically challenging to manage endoscopically. Retrograde access to the transplant ureter is often difficult because of an unfavourable ureteroneocystostomy angle, oedema, or scarring. We evaluated a dual-endoscope-assisted technique combining a rigid cystoscope with a flexible ureteroscope and benchmarked it against the published performance of conventional retrograde techniques. Methods We conducted a retrospective single-centre case series of kidney transplant recipients undergoing dual-endoscope-assisted retrograde ureteral stent placement for ureteral stenosis, urolithiasis, urinary leakage, or lymphocele-related obstruction. The primary outcome was first-attempt technical success. In parallel, we performed a systematic review and single-arm random-effects meta-analysis (PROSPERO CRD420261328594) of conventional retrograde techniques to derive historical pooled success rates and 95% prediction intervals (PIs). Results First-attempt success was 96.4% (27/28; exact 95% confidence interval [CI] 81.7–99.9%), and overall procedural success was 97.4% (38/39; 95% CI 86.5–99.9%). Pooled historical first-attempt success was 68.4% across 17 studies (95% CI 55.1–79.2%; 95% PI 21.1–94.6%; I²=80.5%). All-procedure success was 71.3% across 18 studies (95% CI 57.7–81.8%; 95% PI 19.3–96.3%; I²=86.1%). Three patients had Clavien-Dindo grade Ⅱ urinary tract infections; no higher-grade procedure-related complication was identified. Conclusion Dual-endoscope assistance was technically feasible and achieved high access rates in this small series. Because comparison with the literature was indirect and heterogeneous, the findings should be confirmed in prospective multicentre studies. Clinical trial registration This study was a retrospective case series and did not involve the prospective assignment of participants to an intervention for research purposes. Therefore, it was not considered a clinical trial. Clinical trial number not applicable.