Extravesical ureteroneocystostomy with and without internalized ureteric stents in pediatric renal transplantation

Abstract

The use of ureteric double-J stents and the Lich-Gregoir (extravesical) technique of ureteroneocystotomy have both been shown to decrease the rate of urologic complications in adult kidney transplantation (Tx). There are, however, few studies of the systematic use of stents in pediatric renal Tx. Between 1991 and 1997, 32 consecutive pediatric renal transplant recipients routinely received a 6F-12 cm indwelling double-J stent and were studied prospectively. These patients were compared with 32 consecutive pediatric recipients in whom a stent was not used. The latter were transplanted between 1987 and 1991 and formed the control group. All patients had a Lich-Gregoir ureteroneocystotomy. Stents were removed under general-anesthetic cystoscopy 2 3 weeks after Tx. Immunosuppression for stented patients was polyclonal antibody induction, delayed (7-10 days) cyclosporin A, azathioprine, and prednisone. The control group received the same triple drug regimen but with no induction in 29 of the 32 patients. All patients were followed-up with at least one ultrasound evaluation in the first month, and a renal scan and repeat ultrasound were performed if there was any rise in serum creatinine. In the stented group there were two patients with urinary leak and no obstructions. In the non-stented group there were no leaks and one obstruction. There was no graft loss owing to urologic complications in either group. There were three cases of stent expulsion (all in girls) and one case of stent migration in the posterior urethra (a boy). The 1-yr graft survival rate was 90.6% in the stented group and 65.6% in the non-stented group. The prophylactic use of an indwelling ureteral stent in pediatric renal Tx did not reduce the risk of urinary leakage or obstruction. Stent migration is a common phenomenon and, while not a serious complication, is traumatic to children. Furthermore, removal of an internalized double-J stent requires a general anesthetic. We recommend using a stent for selected patients only.

Urological Complications in 1,223 Kidney Transplantations

“…The overall rate of incidences of urological complications in our study was 7.5%, comparable with other major centers [4][5][6][7] . Vascular integrity of the donor ureter, the anastomotic technique employed and avoidance of technical mishaps such as kinks and twisting of the ureter are major factors impacting the success of ureterovesical anastomosis [8] . Most transplant centers prefer U-C as the initial approach for ureteral reimplantation for kidney transplant recipients.…”

“…However, other surgeons have reported that routine ureteral stenting is unnecessary for patients with a low risk of urological complications [6] . It must be kept in mind that refinement of surgical techniques and the introduction of new immunosuppressive protocols have also decreased the incidence of urological complications [8] .…”

The Effect of the Use of Ureteric Stents on Urological Complications in Selected Kidney Transplant Cases

“…(19) French ve ark. pediatrik transplantasyon hastalarında 32 stent kullanılarak yapılan nakillerle, stentsiz 32 hastanın sonuçlarını karşılaştırmıştır (20). Stent kullanılan 2 hastada idrar kaçağı gözlenirken, stent yerleştirilmeden yapılan nakillerde sadece 1 hastada obstrüksüyon saptanmıştır.…”

Stent-related ureteric obstruction in paediatric renal transplantation

“…Although the extra-vesical technique of ureteroneocystostomy is believed to reduce the rate of urological complications in both adult and paediatric patients [21,22,23,24], the use of ureteric stenting devices remains controversial. Some units do not routinely use stent placement at transplantation [14].…”