External ureteric stent versus internal double J stent in kidney transplantation: a retrospective analysis on the incidence of urological complications and urinary tract infections

Abstract

IntroductionUrologic complications (UCs) and urinary tract infections (UTIs) are common after kidney transplantation. Intraoperative stent placement at the vesicoureteric anastomosis reduces UC risk, but increases UTI risk.MethodsIn 2014 our stenting protocol changed from external ureteric stent (ES) to internal double J stent (DJ). We retrospectively studied the occurrence of UCs and UTIs in relation to ES or DJ in 697 kidney recipients.MethodsAn ES was used in 403 patients (57.8%), in 294 (42.2%) a DJ. ES was removed 7-12 days and DJ 3-4 weeks post-operative. Induction immunosuppression was the same in both groups. Primary outcomes at 6 months follow-up were UC (urinary leakage/ureter stenosis) and UTI; they were related to stenting procedure and clinical and transplant characteristics. The incidence of UCs was similar for ES (8.4%) and DJ (6.8%), p=0.389. ES use was a significant risk factor for UTI (OR 1.69 (1.15-2.50), p=0.008). Post-transplant hospitalization was significantly shorter in the DJ group. Despite more acute rejection episodes with ES (ES/DJ: 16.4%/6.1%, p<0.001), no clinical relevant differences in graft outcomes existed.DiscussionA DJ is, compared to ES, associated with a lower incidence of UTIs and comparable occurrence of UCs and is therefore the preferred technique for stenting the vesicoureteric anastomosis.

Effect of increasing age and ureteral stent implantation on urinary tract infections after kidney transplantation – update of recent literature

“…A recent retrospective analysis conducted in Netherlands emphasized the substantial influence of choosing between external (graft pyelum is externally drained suprapubically through the bladder wall, thereby utilizing a stent to support the vesicoureteric anastomosis) and internal double J stents (DJ) on UTI risk. The study revealed that the use of external stents in earlier years was a risk factor for UTIs, with odds of developing a UTI 1.69 (CI 95% 1.15–2.50, P = 0.008) times higher among individuals with external stents compared to those with internal DJ [ 37 ▪▪ ]. Another crucial aspect of kidney transplant management involves addressing complications arising from obstruction or leakage of the transplanted ureter.…”

“… Guidance on the recommended scenarios for employing ureteral stents (UrS), outlining both the positive and negative consequences linked to UrS implantations [ 7 ▪ , 31 , 32 , 33 ▪▪ , 34 – 36 , 37 ▪▪ , 38 – 41 ]. …”