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Comparison of Removing Double-J Stent With and Without Cystoscopy in Kidney Transplant Patients: A Randomized Clinical Trial

Mohammad Nadjafi-Semnani, Nasser Simforoosh, Abbas Basiri, Ali Tabibi, Ali Nadjafi-Semnani
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Abstract

Purpose:  The ureteric stent can be attached to the Foley catheter in kidney transplantation to exclude the cystoscopy for its removal. It is rarely practiced in renal transplantation. There has been no randomized trial to evaluate the outcome of this procedure on the major urologic complications.

Materials and Methods: One hundred sixty-three kidney transplant patients were randomized into an intervention group in which the stent attached to the Foley catheter and removed together and a control group in which stent removed by cystoscopy. In both groups, stents removed around the 8th post-op day.

Results:  From March 2016 to June 2017, out of 234 kidney transplants performed in our center, a hundred Sixty-three (69.6%) patients met the study inclusion criteria.  91patients (55.8%) were allocated to the intervention group. Mean days before JJ removal for intervention and control groups (“per-protocol” group) were 8.08±1.52 and 8.57±1.58, respectively (P = .09). There was no difference between groups regarding major urologic complications (P=.679). Visual analog scale pain scores were significantly higher in the control group (p=.001). The procedure reduced USD 63-120 from the cost of operation in the intervention group.

Conclusion: In selected kidney transplant patients, attaching the Foley catheter to the stent and removing both of them early may be a safe maneuver regarding the major urological complications, reduces pain, and eliminates the cost of cystoscopy.


Keywords

Stent, kidney transplantation, cystoscopy

References

References:

Phelan PJ, O’Kelly P, Tarazi M, et al. Renal allograft loss in the first post‐operative month: causes and consequences. Clinical transplantation. 2012;26(4):544-549.

Hau H, Tautenhahn H-M, Schmelzle M, et al. Management of urologic complications in renal transplantation: a single-center experience. Paper presented at: Transplantation proceedings2014.

Bessede T, Hammoudi Y, Bedretdinova D, et al. Preoperative Risk Factors Associated With Urinary Complications After Kidney Transplantation. Paper presented at: Transplantation proceedings2017.

Davari HR, Yarmohammadi H, Malekhosseini SA, Salahi H, Bahador A, Salehipour M. Urological complications in 980 consecutive patients with renal transplantation. International journal of urology. 2006;13(10):1271-1275.

Alberts VP, Idu MM, Legemate DA, Laguna Pes MP, Minnee RC. Ureterovesical anastomotic techniques for kidney transplantation: a systematic review and meta-analysis. Transpl Int. 2014;27(6):593-605.

Wilson CH, Rix DA, Manas DM. Routine intraoperative ureteric stenting for kidney transplant recipients. Cochrane Database Syst Rev. 2013;6(6):CD004925.

Thompson ER, Hosgood SA, Nicholson ML, Wilson CH. Early versus late ureteric stent removal after kidney transplantation. Cochrane Database Syst Rev. 2018;1:CD011455.

DuBay DA, Lynch R, Cohn J, et al. Is routine ureteral stenting cost-effective in renal transplantation? The Journal of urology. 2007;178(6):2509-2513.

Tavakoli A, Surange RS, Pearson RC, Parrott NR, Augustine T, Riad HN. Impact of stents on urological complications and health care expenditure in renal transplant recipients: results of a prospective, randomized clinical trial. The Journal of urology. 2007;177(6):2260-2264; discussion 2264.

Waters SL, Heaton K, Siggers JH, et al. Ureteric stents: investigating flow and encrustation. Proc Inst Mech Eng H. 2008;222(4):551-561.

Simpson CM, Sterne JA, Walker RG, Francis DM, Robertson AJ, Jones CLJPN. Stent-related ureteric obstruction in paediatric renal transplantation. 2006;21(1):79-85.

Simforoosh N, Obeid K, Javanmard B, Rezaeetalab GH, Razmjoo S, Soltani MH. Stent Removal in 200 Kidney Transplant Recipients: Nonoperative Versus Endoscopic Removal. Experimental and clinical transplantation: official journal of the Middle East Society for Organ Transplantation. 2016;14(4):385-388.

Kim DJ, Son JH, Jang SH, Lee JW, Cho DS, Lim CH. Rethinking of ureteral stent removal using an extraction string; what patients feel and what is patients' preference? : a randomized controlled study. Bmc Urol. 2015;15(1):121.

Rassweiler MC, Michel MS, Ritter M, Honeck P. Magnetic Ureteral Stent Removal Without Cystoscopy: A Randomized Controlled Trial. Journal of Endourology. 2017;31(8):762-766.

Kajbafzadeh AM, Zeinoddini A, Ebadi M, Heidari R, Tajalli A. External extension of double-J ureteral stent during pyeloplasty: inexpensive stent and non-cystoscopic removal. Int Urol Nephrol. 2014;46(4):671-676.

Dong J, Lu J, Zu Q, et al. Routine short-term ureteral stent in living donor renal transplantation: introduction of a simple stent removal technique without using anesthesia and cystoscope. Paper presented at: Transplantation proceedings2011.

Morris-Stiff G, Balaji V, Lord RH. Simple technique for non-operative removal of ureteric stents after renal transplantation. Annals of the Royal College of Surgeons of England. 1998;80(5):370.

Kayler L, Kang D, Molmenti E, Howard R. Kidney transplant ureteroneocystostomy techniques and complications: review of the literature. Paper presented at: Transplantation Proceedings2010.

Patel P, Rebollo-Mesa I, Ryan E, et al. Prophylactic Ureteric Stents in Renal Transplant Recipients: A Multicenter Randomized Controlled Trial of Early Versus Late Removal. Am J Transplant. 2017;17(8):2129-2138.

Thiyagarajan UM, Thiyagarajan P, Bagul A, Nicholson MJIJoS. Early removal of ureteric stents and its impact on reducing the urinary infection in renal transplantation–A single centre experience. International Journal of Surgery. 2012;10(8):S84.

Sansalone CV, Maione G, Aseni P, et al. Advantages of short-time ureteric stenting for prevention of urological complications in kidney transplantation: an 18-year experience. Transplant Proc. 2005;37(6):2511-2515.

Morris-Stiff G, Balaji V, Lord RH. Simple technique for non-operative removal of ureteric stents after renal transplantation. Ann R Coll Surg Engl. 1998;80(5):370-371.

Baxby K. Simple technique for non-operative removal of ureteric stents after renal transplantation. Ann R Coll Surg Engl. 1999;81(2):142-143.

Parapiboon W, Wiengpon K, Kitiyakara C, et al. Early ureteric stent removal reduces urinary tract infection in kidney transplant recipients: A randomized controlled trial. 2017;2:0.

Taghizadeh-Afshari A, Alizadeh M, Farshid S. Comparison of Complications and Short Term Results of Conventional Technique Versus New Technique During Graft Ureteral Stent Insertion in Bari Technique at Emam Khomeini Hospital, Urmia. Global Journal of Health Science. 2014;6(7).

Macaluso JN, Deutsch JS, Goodman JR, Appell RA, Prats LJ, Wahl P. The Use of the Magnetip Double-J Ureteral Stent in Urological Practice. Journal of Urology. 1989;142(3):701-703.

Robertson IR, Edwards RD, Harden P. Radiological retrieval of transplant ureteric stents. Nephrol Dial Transplant. 1993;8(9):877-878.

Mosayyebi A, Manes C, Carugo D, Somani BK. Advances in Ureteral Stent Design and Materials. Current urology reports. 2018;19(5):35.

Barnes KT, Bing MT, Tracy CR. Do ureteric stent extraction strings affect stent-related quality of life or complications after ureteroscopy for urolithiasis: a prospective randomised control trial. Bju International. 2014;113(4):605-609.




DOI: http://dx.doi.org/10.22037/uj.v0i0.5448

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