Paclitaxel-coated balloon therapy for refractory ureteral stenosis in a kidney transplant recipient

Ureteral stenosis is a frequent urologic complication after kidney transplantation and a relevant cause of graft dysfunction, often requiring repeated interventions due to high rates of restenosis following conventional balloon dilatation. Strategies targeting the underlying fibrotic remodeling remain limited. We report a novel clinical application of paclitaxel-coated balloon ureteroplasty in a transplanted ureter. A kidney transplant recipient developed recurrent distal ureteral stenosis at the ureterovesical anastomosis, with hydronephrosis and graft dysfunction despite standard endourologic management, including balloon dilatation and ureteral stenting, complicated by recurrent urinary tract infections. Paclitaxel-coated balloon dilatation was performed as a stent-free strategy, combining mechanical expansion with local delivery of an antiproliferative agent. The procedure resulted in restoration of urinary drainage, resolution of hydronephrosis, and improvement of graft function, without the need for further stenting. This case illustrates a novel application of drug-coated balloon technology in the transplanted ureter and suggests a potential role for this minimally invasive approach in reducing restenosis of transplant ureteral strictures. By targeting fibroproliferative pathways, paclitaxel may offer a therapeutic advantage over conventional dilatation alone. Further studies are warranted to assess safety and durability in this setting.