Is early removal of prophylactic ureteric stents beneficial in live donor renal transplantation?

Abstract

Prophylactic ureteric stenting has been shown to reduce ureteric leaks and collecting system obstruction following renal transplantation and is in widespread use. However, the optimal time for removal of ureteric stents after renal transplantation remains unclear. Aim of this study was to compare the result of early versus late removal of ureteric stents after kidney transplantation of the laparoscopically retrieved live related donor grafts. Eligible patients were live donor kidney transplant recipients with normal urinary tracts. All recipients underwent extravesical Lich–Gregoire ureteroneocystostomy over 4F/160 cm polyurethane double J stents by a uniform technique. They were randomized on seventh postoperative day for early removal of stents on postoperative day 7 (Group I), or for late removal on postoperative day 28 (Group II). The incidence of urinary tract infections, asymptomatic bacteriuria, and urological complications were compared. Between 2007 and 2009, 130 kidney transplants were performed at one centre of which 100 were enrolled for the study, and 50 each were randomized into the two groups. Donor and recipient age, sex, native renal disease, immunosupression, number of rejection episodes, and antirejection therapy were similar in the two groups. The occurrence of symptomatic urinary tract infection during the follow-up period of 6 months was significantly less in the early stent removal group [5 out of 50 (10%) in Group I, vs 50 out of 15 (30%) in Group II, P=0.02]. Asymptomatic bacteriuria was documented in 2 out of 50 (4%) in Group I and 4 out of 50 (8%) in Group II (P=0.3). There was no statistically significant difference in the rate of ureteric leak, ureteric obstruction, or hematuria in the two groups (P=1.0). We conclude that, in kidney transplant recipients of laparoscopically retrieved live donor grafts, early stent removal at the end of first week reduces the incidence of urinary tract infection without increasing the rate of urine leak or ureteric obstruction.

Timing of Ureteric Stent Removal and Occurrence of Urological Complications after Kidney Transplantation: A Systematic Review and Meta-Analysis

“…Of the 1043 articles identified from the initial literature search, fourteen articles were within the scope of this systematic review; three randomised controlled trials (RCTs) [20,21,31], nine retrospective cohort studies [8,13,19,22,23,32,33,34,35] and two prospective studies [36,37]. A total of 3216 patients were included, of which 2406 patients (74.8%) underwent living donor KTx (two studies did not record if they used living or deceased donors [34,35]).…”

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

“…Though there are multiple studies comparing live-related renal transplantation with and without stents, studies are very few in DDRT [ 8 , 13 ]. Longer ischemia times, variable vascular anatomy, organ harvest techniques, incidences of rejection, and delayed graft function are the main factors that differentiate DDRT from live-related renal transplantation.…”

The Utility of Routine Ultrasound Imaging after Elective Transplant Ureteric Stent Removal

“…There remain unanswered questions on the optimal monitoring of specific patient groups, such as the paediatric population, double kidney transplant recipients, duplex kidneys, patients undergoing urgent stent removal, and those candidates suitable for early stent removal. With a current trend toward earlier ureteric stent removal in order to minimise stent-related complications [ 16 ], there will likely be further interest in determining how to best monitor for MUCs in this group of patients. Overall, we emphasise the need for close clinical and biochemical monitoring in the postoperative period and a need to standardise practise for all transplant recipients.…”