No evidence for the need of a routine renal transplant ultrasound after elective transplant ureteric stent removal—A retrospective cohort study

Abstract

Transplant ureteric stent insertion reduces the incidence of MUCs, but it is not known whether routine PSRGU is needed to detect unmasked MUCs. This study evaluated whether routine PSRGU in the pRTR is a useful tool to identify MUCs before they become clinically apparent. A retrospective analysis was undertaken of the clinical outcomes following elective stent removal from pediatric kidney‐only transplant recipients at two London centers between 2012 and 2016. Our policy was to perform PSRGU either routinely or urgently if there were concerning symptoms or biochemical evidence of renal allograft dysfunction. Elective stent removal was performed in 86% (97 of 113 pRTR), and 75 (77%) of whom had routine PSRGU at a median (IQR) of 6 (2‐8) days after stent removal. There were changes to management in 3 (4%) of pRTR with PSRGU identifying no MUC. Nineteen patients (25%) had urgent PSRGU, most commonly due to renal allograft dysfunction, at a median (IQR) of 5.5 (2.7‐12.3) days after stent removal. Of these, two pRTR required ureteric intervention. For our current practice of removing transplant stents at 4‐6 weeks post‐transplantation, our study has found no evidence to support routine PSRGU after elective stent removal.

Outcomes and surgical complications following living‐donor renal transplantation using kidneys retrieved with trans‐peritoneal or retro‐peritoneal hand‐assisted laparoscopic nephrectomy

“…Apart from a single episode of urinary leak, all urological complications were recorded after stent removal. Such observation is not surprising as ureteric stenosis usually remains silent while the stent is in place 41 . We believe that the small difference in urological complications between TP‐HALDN (2.6%) and RP‐HALDN (4.9%) is probably due to some cases when efficient pneumo‐retro‐peritoneum was particularly difficult to establish, leading to more laborious ureteric dissection and unintentional skeletonization of the ureter.…”