Uterine artery embolization for fibroid-induced hydronephrosis in a renal transplant recipient

Obstructive uropathy from uterine fibroids is recognized in the general population but is rare in renal transplant recipients. We report the first case, to our knowledge, of uterine artery embolization successfully treating fibroid-induced hydronephrosis of a transplanted kidney. A woman with a prior renal transplant presented with urinary symptoms and anemia due to menorrhagia from uterine fibroids. Imaging revealed a markedly leiomyomatous uterus causing transplant ureteral compression with hydronephrosis. Uterine artery embolization was performed without traversing the transplant arterial anastomosis. At 4 weeks postintervention, hemoglobin levels improved from 7.1 to 11.4 g/dL. Subsequent magnetic resonance imaging performed 6 months after therapy confirmed a 34% reduction in uterine volume and resolution of hydronephrosis. Renal function remained stable. Uterine artery embolization may be a feasible treatment option for fibroid-induced hydronephrosis in selected renal transplant patients, with symptom resolution and preservation of allograft function.