Routine stenting reduces urologic complications as compared with stenting "on demand" in adult kidney transplantation.
OBJECTIVE
To examine the impact of the chosen surgical technique and of systematic versus "on-demand" placement of a primary stent on the incidence of urologic complications in adult kidney transplantation.


METHODS
Data of 497 consecutive patients undergoing kidney transplantation at a single center were retrospectively analyzed with respect to urologic complications. Three different surgical strategies for the ureteroneocystostomy were compared: (1) transvesical anastomosis with stenting "on demand," (2) extravesical anastomosis with stenting "on demand," and (3) extravesical anastomosis with routine stenting. Nine parameters were evaluated by logistic regression for a possible contribution to the development of urologic complications.


RESULTS
Routine placement of a stent significantly reduced the number of urologic complications compared with both transvesical or extravesical anastomoses with stenting "on demand" (20.8% in transvesical "on demand," 17.9% in extravesical "on demand," and 5.8% in extravesical "routine"). Logistic regression analysis revealed that routine stenting versus stenting "on demand" (P = 0.001) and living donor transplantation (P = 0.038) are two independent factors associated with a significantly lower incidence of urologic complications. Although routine stenting was not associated with an increased incidence of urinary tract infections, female gender was the only independent factor associated with this complication (P = 0.001).


CONCLUSIONS
Routine stenting of the ureteroneocystostomy is superior to stenting "on demand" in adult kidney transplantation, suggesting that the intraoperative decision of whether to stent is insufficient to avoid urologic complications.
Georgiev
Panco
P
Department of Visceral and Transplant Surgery, University Hospital of Zurich, Zurich, Switzerland.
Böni
Christian
C
Dahm
Felix
F
Maurus
Christine F
CF
Wildi
Stefan
S
Rousson
Valentin
V
Wüthrich
Rudolf P
RP
Clavien
Pierre-Alain
PA
Weber
Markus
M
D005260:Female; D006801:Humans; D016030:Kidney Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology* / Q000517:prevention & control*; D012189:Retrospective Studies; D015607:Stents; D014570:Urologic Diseases / Q000453:epidemiology* / Q000517:prevention & control*; D013520:Urologic Surgical Procedures / Q000295:instrumentation / Q000379:methods