Early double J stent removal in renal transplant patients to prevent urinary tract infection – systematic review and meta-analysis of randomized controlled trials

Abstract

Ureteral stents are routinely used in renal transplant and are associated with reduced urological complications but increased urinary tract infections (UTIs). There is no agreement on the preferred time to removal of stents after transplantation. We performed a systematic review and meta-analysis of all randomized controlled trials (RCTs) comparing stent duration of <14 days vs > =14 days. Electronic databases were searched to identify RCTs that compared early vs late stent removal. Primary outcome was urinary tract infections. Secondary outcomes included various urological complications. No significant difference in UTI rates was demonstrated between short and long stent duration (relative risk (RR) 0.85, 95% confidence interval (CI) 0.44-1.64), with significant heterogeneity (I = 86%). Sensitivity analysis evaluating studies with low risk of bias for allocation concealment demonstrated statistically significant lower rates of UTI with short stent duration (RR 0.48, 95% CI 0.32-0.71) with no heterogeneity. No significant difference was demonstrated for the outcome of major urological complications (RR 0.72, 95% CI 0.50-1.05), without heterogeneity. Ureteral stenosis rates were significantly lower in the short duration arm (RR 0.42, 95% CI 0.18-0.98). Early removal of ureteral stents after renal transplant may be associated with reduced rates of UTI and ureteral stenosis. Additional RCTs are needed.

A Current Review of the Etiology, Clinical Features, and Diagnosis of Urinary Tract Infection in Renal Transplant Patients

“…Furthermore, the presence of the temporary ureteric stent also favors VUR, abolishing peristalsis and dilating the vesico-ureteric junction [12]. The routine use of a prophylactic transplant ureteric stent is recommended since it reduces major urological complications [13] but is associated with increased UTI risk, which may be lower with stent removal before 14-21 days [14,15]. The use of urethral catheters also increases the risk of bacteriuria by 5% per day in the general population [16] as it perturbs the host's defense mechanisms and provides easier access to the bladder by uropathogens.…”

Effects of Continuous Catheterization on Reducing Postoperative Urinary Tract Infection in Cervical Cancer Patients with Double J Stent Placement

“…Indwelling double J ureteral stents are useful supplement to urinary devices. Placement of self-retaining double J stents has been widely accepted for relieving obstruction, preventing stenosis formation, treating urinary tract leakage, and facilitating debris removal [ 13 , 14 ].…”

The Impact of Timing of Stent Removal on the Incidence of UTI, Recurrence, Symptomatology, Resistance, and Hospitalization in Renal Transplant Recipients

“…Multiple studies have examined the impact of stent removal at different intervals from renal transplantation including at 4 weeks [ 6 ], 3 weeks [ 5 ], 2 weeks [ 4 ], one week [ 22 , 23 ], or 5 days [ 24 ] post renal transplantation. These studies have shown that the early removal of ureteric stents following kidney transplantation may potentially reduce the incidence of UTI without significant increase of major urological complications.…”

“…Ureteric stents are shown to decrease post renal transplant urological complications but are believed to increase the risk of urinary tract infections (UTIs) [1][2][3][4][5][6][7]. Hence, our practice has changed over the years.…”