title: The role of ureteral stents for all ureteroneocystostomies in kidney transplants.
abstract: BACKGROUND
  Despite significant advancements in renal transplantation, certain basic surgical practices such as the routine use of ureteral stents (US) remain controversial. A recent met-analysis of ureteral stenting concluded that the routine use of US resulted in improved outcomes. In contrast, the indiscriminate use of US can lead to adverse complications.
  
  
  OBJECTIVE
  To better define this question, we reviewed our single center experience in which US were placed selectively.
  
  
  METHODS
  301 patients were eligible to be enrolled. 55 living donor and 246 deceased-donor charts were analyzed for donor and recipient clinical characteristics, immunosuppressive therapy and outcomes.
  
  
  RESULTS
  28 US were placed for either small bladder capacity (n=7), unhealthy appearing bladder tissue (n=8) or for an uncertain vascular supply to the ureter (n=13). Patients with US did not develop urinary leaks, 8 (28%) developed complications including obstruction, encrustation, and urinary tract infections. 12 (4.3%) non-stented patients developed a clinically significant urinary leak. Risk factors for urinary leaks included dual and en-bloc pediatric donor kidney transplants, extended criteria donors and the use of single U stitch technique for ureteral anastomoses.
  
  
  CONCLUSIONS
  Our results demonstrate that the majority of patients can be successfully transplanted without the routine use of US. Selective use of US should be reserved for high-risk situations.
authors.affiliation: Department of Surgery, Division of Transplantation.
authors.forename: M R
authors.initials: MR
authors.lastname: Laftavi
authors.affiliation: Department of Surgery, Division of Transplantation.
authors.forename: Q
authors.initials: Q
authors.lastname: Chaudhry
authors.affiliation: Department of Medicine, State University of New York (SUNY) at Buffalo, Buffalo, NY, USA.
authors.forename: R
authors.initials: R
authors.lastname: Kohli
authors.affiliation: Department of Surgery, Division of Transplantation.
authors.forename: L
authors.initials: L
authors.lastname: Feng
authors.affiliation: Department of Surgery, Division of Transplantation.
authors.forename: M
authors.initials: M
authors.lastname: Said
authors.affiliation: Division of Transplantation, Kaleida Health, Buffalo, NY, USA.
authors.forename: K
authors.initials: K
authors.lastname: Paolini
authors.affiliation: Department of Surgery, Division of Transplantation.
authors.forename: M
authors.initials: M
authors.lastname: Dayton
authors.affiliation: Department of Surgery, Division of Transplantation.
authors.forename: O
authors.initials: O
authors.lastname: Pankewycz
keywords: Renal transplantation; Ureter; Ureteral anastomosis; Ureteral stents