Routine insertion of ureteral stent in live-donor renal transplantation: is it worthwhile?
OBJECTIVE
To evaluate the impact of the routine use of double-J stents in live-donor renal transplantation at a single institute from a prospective randomized study.


METHODS
A total of 100 patients were prospectively randomized into two groups of 50 patients each. Group 1 received a routine double-J silicone ureteral stent and group 2 did not. A standard Lich-Gregoir ureteroneocystostomy was performed in both groups. In group 1, the patients were scheduled for stent removal after 2 weeks.


RESULTS
Both groups were comparable in terms of age, sex, ischemia time, number of renal arteries, and time to diuresis. In group 1, two grafts were lost in the early postoperative period and those patients were excluded from the final analysis. None of our patients in either group had developed a ureteral stricture at a mean follow-up of 10.8 +/- 3.6 months. In the stented group, 2 patients developed a urinary leak, but no leakage was reported in the nonstented group (P = 0.14). Although 19 patients in group 1 (39.6%) had a urinary tract infection, only 9 in group 2 (18%) showed evidence of a positive urine culture (P = 0.02). The presence of a ureteral stent and female sex were the independent predictors of postoperative urinary tract infection on multivariate analysis. The mean serum creatinine at discharge was 1.2 +/- 0.3 mg% and 1.2 +/- 0.4 mg% in groups 1 and 2, respectively (P = 0.2).


CONCLUSIONS
The results of our study have shown that routine ureteral stent insertion has no impact on the rate of vesicoureteral leakage or obstruction in live-donor renal transplantation, whereas it is significantly associated with an increased incidence of urinary tract infection. Stenting should be limited to patients with a pathologic and/or defunctionalized bladder.
Osman
Yasser
Y
Urology and Nephrology Center, Mansoura University, Mansoura, Egypt. y_osman99@yahoo.com
Ali-El-Dein
Bedeir
B
Shokeir
Ahmed A
AA
Kamal
Mohamed
M
El-Din
Ahmed B Shehab
AB
D000328:Adult; D005260:Female; D006801:Humans; D016030:Kidney Transplantation; D019520:Living Donors; D008297:Male; D009392:Nephrectomy; D011183:Postoperative Complications / Q000517:prevention & control*; D015607:Stents / Q000009:adverse effects; D014513:Ureter / Q000601:surgery; D001743:Urinary Bladder / Q000601:surgery; D014552:Urinary Tract Infections / Q000209:etiology / Q000517:prevention & control