Ureteral anastomosis with a polyimide stent in rat kidney transplantation

Abstract

Background: Complications associated with ureteral anastomosis in kidney transplantation are highly prevalent, despite the development of various types of stents. The current stent materials and placement methods have several limitations. This study attempts to provide an alternative by investigating ureteral anastomosis with a polyimide stent and a modified placement method in a rat model of kidney transplantation. Methods: Sprague-Dawley rats were randomly divided into Group I: sham operation, Group II: autologous ureteral anastomosis, and Group III: isogenic kidney transplantation with ureteral anastomosis. For the anastomosis, a polyimide stent with a previously placed 11-0 silk was inserted into the ureter. The stent and ureter were fixed with 11-0 silk sutures. The kidney weight and serum creatinine were recorded. The ureteral and renal sections were taken for histological analysis. Results: None of the stents had migrated. Urethral patency was achieved. Further, there were no evident histological changes in the anastomosed ureters. The serum creatinine level in group III was significantly higher than the other two groups, but there was no significant difference in kidney weight among the groups at postoperative week 12. Finally, the histological structure of kidneys in groups II and III only showed minor changes. Conclusions: The current anastomosis method with polyimide stent causes minimal damage to the ureteral walls and minimizes the possibility of stent migration. Therefore, this method of ureteral anastomosis with the polyimide stent should be explored for its potential benefits in more animal kidney transplantation models, thus providing an alternative for the clinical setting.

Effect of ureteral stricture in transplant kidney and choice of treatment on long-term graft survival

“…We recommend the placement of a ureteral stent regardless of the surgical procedure, which is beneficial to the recovery of the ureteral anastomosis. Some studies have shown that the placement of a stent through the ureteral-vesical anastomosis is an independent protective factor against ureteral complications after kidney transplantation [ 24 , 25 ]. Open surgery mainly has the problems of unclear anatomical layers, severe tissue adhesion, large trauma, much bleeding, and long operation time, especially for patients with a long time after transplantation and a history of infection, which may result in the failure of the operation due to the fact that the transplant kidney and ureter cannot be accurately located and separated, or the ureter is damaged or the length of the ureter is insufficient.…”

Preclinical models versus clinical renal ischemia reperfusion injury: A systematic review based on metabolic signatures

“… 39 , 55 Microdialysis is a potential alternative to arteriovenous sampling, but has not yet been validated for this purpose. Ureterostomy 56 allows for selective functional monitoring of the injured kidney. The model critically relies on optimized ischemia times in order to achieve actual IR injury and avoid excess incidences of IR damage or non‐function.…”

Methodology for the Development and Validation of New Stent Designs: In Vitro and In Vivo Models

“…These animals are often chosen for the validation of both urethral and ureteral stents. Ureteral stents are inserted through a cystotomy in either the bladder or the ureter [51,55,56]. Besides the evaluation of the device's performance, when placed in the ureter, ureteroureteral anastomosis may also be performed for the histological analysis of ureteral healing and scarring processes [13,55,56].…”

“…Ureteral stents are inserted through a cystotomy in either the bladder or the ureter [51,55,56]. Besides the evaluation of the device's performance, when placed in the ureter, ureteroureteral anastomosis may also be performed for the histological analysis of ureteral healing and scarring processes [13,55,56]. Urethral stents are tested in the bladder and the urethra, and depending on stent size and characteristics, transurethral placement may be feasible [57][58][59].…”