Forgotten ureteric stents in renal transplant recipients: Three case reports

Abstract

Ureteric stents are widely used in renal transplantation to minimize the early urological complications. Ureteric stents are removed between two and 12 weeks following trans-plantation, once the vesico-ureteric anastomosis is healed. Ureteric stents are associated with considerable morbidity due to complications such as infection, hematuria, encrustations and migration. Despite the patient having a regular follow-up in the renal transplant clinic, ureteric stents may be overlooked and forgotten. The retained or forgotten ureteric stents may adversely affect renal allograft function and could be potentially life-threatening in immunocompromised transplant recipients with a single transplant kidney. Retrieving these retained ureteric stents could be challenging and may necessitate multimodal urological treatments. We report three cases of forgotten stents in renal transplant recipients for more than four years. These cases emphasize the importance of patient education about the indwelling ureteric stent and possibly providing with a stent card to the patient. Maintaining a stent register, with a possible computer tracking system, is highly recommended to prevent such complications.

Urologic Considerations and Complications in Kidney Transplant Recipients

“…Retained ureteral stents calcify as they act as a nidus for stone formation and can require ureteroscopy, percutaneous pyeloscopy, and laser lithotripsy for removal. 44,45 Transplant ureteroscopy can be extremely technically difficult secondary to the location of the transplanted ureteral orifice near the dome of the bladder. 44,45 Hydroureteronephrosis in the graft kidney occurs in 3% to 6.5% of transplant recipients and has many possible etiologies.…”

“…44,45 Transplant ureteroscopy can be extremely technically difficult secondary to the location of the transplanted ureteral orifice near the dome of the bladder. 44,45 Hydroureteronephrosis in the graft kidney occurs in 3% to 6.5% of transplant recipients and has many possible etiologies. 1,6 Urinary retention, calculus disease, ureteral obstruction, VUR, infection, and rejection are pathologic causes, whereas anatomic variation is also a possibility.…”

Early Versus Delayed Double J Stent Removal in Deceased Donor Renal Transplant Recipients: A Prospective Comparative Study

“…Several meta-analyses in the past have proved the fact that ureteric stents reduce the risk of urologic complications [ 8 - 9 ]. However, the presence of stents is associated with a high risk of stent-related symptoms like dysuria, frequency, and hematuria [ 10 - 11 ]. It also promotes urinary tract infection (asymptomatic pyelonephritis, cystitis, and pyelonephritis) by the formation of a biofilm.…”

How to stent the ureter after kidney transplantation in children?—A comparison of two methods of urinary drainage

“…Compared to splints, JJ catheters have some drawbacks. First, some case reports describe indwelling JJ catheters left in situ, causing considerable morbidity due to infection, hematuria, encrustations, or migration . Second, the JJ catheter must be removed through another invasive cystoscopic procedure, requiring general anesthesia, whereas an external splint is easily pulled out.…”

“…First, some case reports describe indwelling JJ catheters left in situ, causing considerable morbidity due to infection, hematuria, encrustations, or migration. 30 Second, the JJ catheter must be removed through another invasive cystoscopic procedure, requiring general anesthesia, whereas an external splint is easily pulled out. Every invasive procedure is a potentially stressful experience for a child and should be avoided as Unexpectedly, six children in the JJ catheter group developed a lymphocele, but none in the splint group.…”