Routine double-J stenting for live related donor kidney transplant recipients: It doesn't serve the purpose, but does it serve a better purpose?

Abstract

PurposeDespite meticulous techniques, surgical complications continue to be problematic in kidney transplant recipients. Role of routine stenting to reduce complications is controversial. In this study, we compare incidence of early urological complications, lymphoceles, urinary tract infections (UTI) and graft function; with or without double-J stenting.Materials and MethodsAll patients who underwent live related donor renal transplantation from February 2014 to February 2016 were included. Transplants prior to February 2015 were without routine stenting; subsequent transplants were with routine stenting. Patients with neurogenic bladder, previously operated bladder and delayed or low urinary output were excluded. Follow-up was for at least three months. Descriptive statistics was performed for all parameters. Chi square test and Fisher's Exact test were used for qualitative variables. For quantitative variables, Mann-Whitney test was used to test median difference and independent samples t-test for mean difference. The p-value ≤0.05 was considered significant.ResultsWe analysed 74 patients (34 stented and 40 non-stented). There was no difference in the incidence of urinary leak, anastomotic obstruction, lymphoceles or UTI (p>0.4 for all comparisons). However, mean estimated glomerular filtration rate at sixth day, 14th day, one month and two months were 76.1 vs. 61.5 (p=0.025), 72.1 vs. 56.6 (p=0.005), 79.4 vs. 63.1 (p=0.002) and 82.0 vs. 63.3 (p=0.001) in the stented versus non-stented groups.ConclusionsPlacement of ureteral stent in renal transplant does not significantly affect the incidence of early urinary complications or UTI. However, graft function is significantly better in stented recipients, at least in the short term.

An Update on Early Urological Complications in Kidney Transplantation: A National Cohort Study

“…KTX is associated with lower mortality and improved quality of life compared with long-term dialysis treatment [2]. However, major urological complications (MUCs), defined as urinary leakage and ureteral stenosis, are still common and can lead to increased morbidity, prolonged hospital stay, and need for a second surgical procedure [3,4]. Most MUCs occur within 3 months after transplantation [1].…”

“…The literature on the incidence of MUCs following KTX is limited to numerous, relatively small, single-center studies, mainly performed in recipients from deceased donors. Reported incidences range from 1% to 15% [3,[5][6][7][8][9][10]. Due to various definitions of urological complications, an accurate estimation of the incidence of MUCs following KTX remains difficult.…”

Infekcije mokraćnog sustava povezane s uporabom urinarnih katetera – put do nula infekcija

“…Iako Europsko društvo za urologiju, kao i nacionalne smjernice, preporučuju uklanjanje stenta unutar šest tjedana od transplantacije, optimalan vremenski okvir za ovo nije striktno definiran 8,9 . Stoga su posljednjih godina provedene brojne studije kako bi se definiralo vrijeme za uklanjanje ureteralnog stenta [10][11][12][13] . U 2019. godini objavljeni su rezultati opsežne metaanalize koji su pokazali da ranije uklanjanje stenta, prije trećeg postoperacijskog tjedna, ne dovodi do veće učestalosti nastanka urinarne fistule, a značajno smanjuje učestalost IMS-a u usporedbi s kasnijim uklanjanjem (> tri tjedna) 13 .…”