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

Abstract

Implanting a ureteric stent during ureteroneocystostomy reduces the risk of leakage and ureteral stenosis after kidney transplantation (KTx), but it may also predispose to urinary tract infections (UTIs). The aim of this study is to determine the optimal timing for ureteric stent removal after KTx. Searches were performed in EMBASE, MEDLINE Ovid, Cochrane CENTRAL, Web of Science, and Google Scholar (until November 2017). For this systematic review, all aspects of the Cochrane Handbook for Interventional Systematic Reviews were followed and it was written based on the PRISMA-statement. Articles discussing JJ-stents (double-J stents) and their time of removal in relation to outcomes, UTIs, urinary leakage, ureteral stenosis or reintervention were included. One-thousand-and-forty-three articles were identified, of which fourteen articles (three randomised controlled trials, nine retrospective cohort studies, and two prospective cohort studies) were included (describing in total n = 3612 patients). Meta-analysis using random effect models showed a significant reduction of UTIs when stents were removed earlier than three weeks (OR 0.49, CI 95%, 0.33 to 0.75, p = 0.0009). Regarding incidence of urinary leakage, there was no significant difference between early (<3 weeks) and late stent removal (>3 weeks) (OR 0.60, CI 95%, 0.29 to 1.23, p = 0.16). Based on our results, earlier stent removal (<3 weeks) was associated with a decreased incidence of UTIs and did not show a higher incidence of urinary leakage compared to later removal (>3 weeks). We recommend that the routine removal of ureteric stents implanted during KTx should be performed around three weeks post-operatively.

Guidance of antibiotic treatment for urinary tract infections in the early postoperative phase after Kidney Transplantation

“…[16] Our ongoing practice of removing the stent after 21 days or earlier in infection has been backed by a review by Visser et al who also estimate 21 days post transplant to likely be the ideal time based on current knowledge. [25] Twenty-three percent of our patients developed asymptomatic bacteriuria in the rst month which is comparable to other reports. Most transplant centers treat asymptomatic bacteriuria after KT.…”

The Ureter in the Kidney Transplant Setting: Ureteroneocystostomy Surgical Options, Double-J Stent Considerations and Management of Related Complications

“…In general, stent-related complications are especially seen in patients when the stent is left for a longer period in situ [2,3,20]. Patel et al [1••] also demonstrated a better quality of life in patients with early stent removal.…”

“…In most centres, stents are removed between 2 and 6 weeks after transplantation [1••, 20]. Since a later stent removal shows a higher risk for stent-related complications, some authors advocate an early removal of the stent after 3 weeks [20]. Although stentrelated complications may be reduced by an early stent removal, there still is some concern about higher rates of urinary leak and ureteric obstruction when stents are removed too early.…”

Comparison of ureteric stent removal procedures using reusable and single-use flexible cystoscopes following ureteroscopy and lasertripsy: A micro costing analysis

“…The timing of ureteral stent removals is especially important in patients with renal transplant. A shorter stent dwell time of 3 weeks as opposed to 6 weeks decreased the risk of UTIs in these patients [ 23 ]. In a prospective study of 103 renal transplant patients, Isiris could be used with ease and convenience on the ward, ICU and outpatient department and showed a cost saving for the hospital [ 24 ].…”