Stenting the ureteroneocystostomy reduces urological complications in kidney transplantation: a noninferiority randomized controlled trial, SPLINT trial

Abstract

The role of ureteral stents in living-donor kidney transplantation remains uncertain. In this randomized controlled trial (SPLINT), we compared urological complications in living-donor kidney transplantations performed with or without stents. We included 200 consecutive patients that received living-donor kidney transplantations at the Erasmus MC, University Medical Center, Rotterdam. Patients (124 males, 76 females, mean age 54 AE 13) were randomized for suprapubic externalized single J stents (N = 100) or no stent (N = 100). The primary outcome was the probability of a percutaneous nephrostomy insertion (PCN) during a 12-month follow-up. To assess whether no stenting is noninferior to stenting, we allowed the probability of a PCN to increase by at most 5% (this is the noninferiority margin). Baseline characteristics were comparable between groups. In the no-stent group, there were more PCN insertions, 14% (95% CI 4.3-23.7%); urinary leakages, 12% (95% CI 5.4-21.3%); and surgical re-interventions because of urological complications, 8% (95% CI 1.5-14.5%). The stent group had more hematuria, 26% (95% CI 13.1-38.9%); and graft rejections, 15% (95% CI 2.7-27.3%). Patients in both groups had similar mean GFRs at several time points. Besides a better Euro-Qol-5D in the no-stent group at 2 and 6 weeks postoperative, similar quality of life was reported based on SF-36 and Euro-Qol-5D scores. In this trial, noninferiority has not been demonstrated for no-stent placement in relation to the number urological complications.

Surgical outcomes of ureteral reconstruction during cytoreductive surgery for ovarian cancer: a retrospective cohort study

“…The use of ureteral stents could reduce urologic complications, including postoperative stenosis and leakage at the anastomotic site, as demonstrated by several case–control studies and randomized controlled trials [ 20 – 22 ]. However, prolonged stent retention might predispose to urinary tract infections, encrustations and blockade of stents [ 23 , 24 ].…”

Results of a previously unreported extravesical ureteroneocystostomy technique without ureteral stenting in 500 consecutive kidney transplant recipients

“…In addition to including the overall meta-analysis results of Mangus and Haag [1], we included all studies (with complete data) published since that report which were included in the more recent meta-analysis of Alberts et al [6] or more recent review by Wilson et al [24]. A recently reported randomized trial [25] was also included as well.…”

“…Percentages of urologic complications that developed post-transplant, as reported by other kidney transplant studies of extravesical ureteroneocystostomies, stratified by routine stent placement (yes/no), appear in Table 4 [1,[25][26][27][28][29][30][31][32][33][34][35][36][37][38]. Our overall urologic complication incidence of 1.4% (7/500) is at least as good as every report (and better than most of the reports) shown in the table, including the 1.5% (6/407) incidence among Lich-Gregoir ureteroneocystostomies with routine stenting in 5 randomized trials combined as reported by Mangus and Haag [1].…”

Time to reflect, time to move on

“…Stenting the ureter during renal transplantation was a source of controversy for decades, and Ooms et al . [1] have grappled with this topic again in this issue of Transplant International. The team in Rotterdam have designed and implemented a research trial, after the first iteration of the Cochrane review on ureteric stents [2], published back in 2005.…”