title: Routine stenting reduces urologic complications as compared with stenting "on demand" in adult kidney transplantation.
abstract: 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.
authors.affiliation: Department of Visceral and Transplant Surgery, University Hospital of Zurich, Zurich, Switzerland.
authors.forename: Panco
authors.initials: P
authors.lastname: Georgiev
authors.forename: Christian
authors.initials: C
authors.lastname: Böni
authors.forename: Felix
authors.initials: F
authors.lastname: Dahm
authors.forename: Christine F
authors.initials: CF
authors.lastname: Maurus
authors.forename: Stefan
authors.initials: S
authors.lastname: Wildi
authors.forename: Valentin
authors.initials: V
authors.lastname: Rousson
authors.forename: Rudolf P
authors.initials: RP
authors.lastname: Wüthrich
authors.forename: Pierre-Alain
authors.initials: PA
authors.lastname: Clavien
authors.forename: Markus
authors.initials: M
authors.lastname: Weber
mesh_terms: 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