Isiris™ for Ureteric Stent Removal in Renal Transplantation: An Initial Single-Centre Experience of 150 Cases

Abstract

Background. Ureteric stent insertion is performed at the time of renal transplant to minimise the risk of post-operative urological complications, including anastomotic leak and ureteric stenosis or obstruction. Transplant ureteric stent removal (TUSR) has historically been performed via flexible cystoscopy, predominantly in a theatre setting. Isiris™ is a single-use cystoscope with integrated grasper designed for removal of ureteric stents. We report our initial experience. Methods. A retrospective analysis of a contemporaneously maintained database was performed with review of case notes from October 2017 to September 2018. TUSR was performed by surgical middle grades with a single nurse assistant. Results. One hundred and fifty ureteric stents were removed in transplant recipients (mean age 50.2 years, SD ± 15.2; 61.3% male). 91.3% ( n = 137) of cases were performed in the outpatient clinic. Median time to TUSR was 42 days (IQR 30-42). 147 attempts at removal were successful. One urinary tract infection (UTI) was reported following TUSR. Use of the Isiris™ for TUSR corresponds to a £63,480 saving in this cohort compared to conventional practice. This value is conservative and does not include income that has been gained from the reallocation of operating theatre capacity. Conclusion. Isiris™ can safely be employed for the timely performance of non-complicated TUSR. Isiris™ releases this procedure from the confines of the operating theatre to the outpatient clinic. This reduces the resource burden for healthcare providers and may result in improved patient satisfaction. The environmental implications of disposable healthcare equipment require consideration. Evaluation of Isiris™ TUSR for encrustation is required.

Disposable grasper‐integrated flexible cystoscope for ureteral stent removal in transplanted patients; focus on feasibility, safety, and patient experience. Results and micro‐cost analysis from a tertiary referral center

“…Limited data are currently available concerning the use of giFC in transplanted patients: two studies showed promising results regarding removal feasibility, safety and cost‐effectiveness 10,11 . However, current literature is limited by the retrospective nature of data collection.…”

“…Doherty et al. retrospectively reported their experience with giFC involving 147 transplanted patients: median dwell time was 42 days, 2% (3/147) of the procedures were unsuccessful (due to urethral false passage or patient's anxiety), and one patient (0.7%) subsequently developed UTI 10 . Georgiades et.…”

“…[7][8][9] Limited data are currently available regarding giFC for SR in KT patients, exclusively based on retrospective series. 10,11 Hence, we performed an observational prospective cohort study on SR through giFC involving transplanted patients, focusing on feasibility, technical aspects, safety, patient experience, and costeffectiveness.…”

“…This device offers a sterile and disposable solution for stent removal (SR), eliminating the need for reprocessing and thus providing clinical, logistical, and economical advantages 7–9 . Limited data are currently available regarding giFC for SR in KT patients, exclusively based on retrospective series 10,11 …”

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“…After 704 stent pulls, the cost-benefit favored the reusable cystoscope. A study of 150 ureteral stent removals in renal transplant patients, showed significant cost-benefit favoring the single-use system [6]. While the single-use system cost was largely compared to reusable cystoscopy in an operating theater, the success and possible financial benefit of disposable cystoscopy is presented.…”