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Quintana Álvarez R, Herranz Amo F, Esteban Labrador L, Bueno Chomón G, Subirá Ríos D, Hernández Fernández C. Influence of double J stent in the complications of ureterovesical anastomosis during kidney transplantation. Actas Urol Esp 2022; 46:252-258. [PMID: 35525705 DOI: 10.1016/j.acuroe.2021.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 11/25/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Complications arising from ureterovesical anastomosis in kidney transplantation have an important influence on the success of the procedure. The most serious and frequent complications are fistula and stenosis of the ureterovesical junction. The placement of double J stents in anastomosis is currently recommended to reduce these complications. OBJECTIVE The aim of the study is to evaluate whether the placement of a DJ stent affects complications of anastomosis. MATERIAL AND METHODS Retrospective analysis of 697 patients treated with cadaveric donor renal transplant in our center from 1999 to 2018 was performed. Results were compared according to double J stent placement and the surgical technique employed for anastomosis. RESULTS Transplantation was performed without DJ placement in 51.7% of the patients, compared to 48.3% who were treated with DJ stent placement. The most commonly used technique was Lich-Gregoir. Ureterovesical fistula occurred in 5% of cases, and ureterovesical stenosis in 4.2%. DJ stent behaved as a protective factor for ureterovesical fistula but did not significantly influence the development of stenosis. The Taguchi technique greatly increased the risk of developing both ureterovesical fistula and stenosis. The incidence of stenosis and fistula was significantly higher when the Taguchi technique was combined with no DJ stent placement. CONCLUSION DJ stent placement acts as a protective factor for ureterovesical stenosis complications. The results of our study seem to agree with current literature.
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Affiliation(s)
- R Quintana Álvarez
- Servicio de Urología, Hospital General Universitario Gregorio Maranon, Madrid, Spain.
| | - F Herranz Amo
- Servicio de Urología, Hospital General Universitario Gregorio Maranon, Madrid, Spain
| | - L Esteban Labrador
- Servicio de Urología, Hospital General Universitario Gregorio Maranon, Madrid, Spain
| | - G Bueno Chomón
- Servicio de Urología, Hospital General Universitario Gregorio Maranon, Madrid, Spain
| | - D Subirá Ríos
- Servicio de Urología, Hospital General Universitario Gregorio Maranon, Madrid, Spain
| | - C Hernández Fernández
- Servicio de Urología, Hospital General Universitario Gregorio Maranon, Madrid, Spain
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Quintana Álvarez R, Herranz Amo F, Esteban Labrador L, Bueno Chomón G, Subirá Ríos D, Hernández Fernández C. Influencia del catéter doble J en las complicaciones de la anastomosis vesicoureteral realizada durante el trasplante renal. Actas Urol Esp 2022. [DOI: 10.1016/j.acuro.2021.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Ciancio G, Farag A, Gonzalez J, Vincenzi P, Gaynor JJ. Results of a previously unreported extravesical ureteroneocystostomy technique without ureteral stenting in 500 consecutive kidney transplant recipients. PLoS One 2021; 16:e0244248. [PMID: 33428659 PMCID: PMC7799771 DOI: 10.1371/journal.pone.0244248] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 12/07/2020] [Indexed: 12/22/2022] Open
Abstract
Urologic complications can still occur following kidney transplantation, sometimes requiring multiple radiological and/or surgical procedures to fully correct the problem. Previously proposed extravesical ureteral reimplantation techniques still carry non-negligible risks of the patient developing urologic complications. About 10 years ago, a new set of modifications to the Lich-Gregoir technique was developed at our center, with the goal of further minimizing the occurrence of urologic complications, and without the need for initial ureteral stent placement. It was believed that an improvement in the surgical technique to minimize the risk of developing urologic complications was possible without the need for stent placement at the time of transplant. In this report, we describe the advantages of this technique (i.e., mobilized bladder, longer spatulation of the ureter, inclusion of bladder mucosa with detrusor muscle layer in the ureteral anastomosis, and use of a right angle clamp in the ureteral orifice to ensure that it does not become stenosed). We also retrospectively report our experience in using this technique among 500 consecutive (prospectively followed) kidney transplant recipients transplanted at our center since 2014. During the first 12mo post-transplant, only 1.4%(7/500) of patients developed a urologic complication; additionally, only 1.0%(5/500) required surgical repair of their original ureteroneocystostomy. Five patients(1.0%) developed a urinary leak, with 3/5 having distal ureteral necrosis, and 1/5 subsequently developing a ureteral stricture. Two other patients developed ureteral stenosis, one due to stricture and one due to ureteral stones. These overall results are excellent when compared with other reports in the literature, especially those in which routine stenting was performed. In summary, we believe that the advantages in using this modified extravesical ureteroneocystostomy technique clearly help in lowering the early post-transplant risk of developing urologic complications. Importantly, these results were achieved without the need for ureteral stent placement at the time of transplant.
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Affiliation(s)
- Gaetano Ciancio
- Department of Surgery, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, Florida, United States of America
- Department of Urology, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, Florida, United States of America
- Miami Transplant Institute, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, Florida, United States of America
- * E-mail:
| | - Ahmed Farag
- Department of Surgery, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, Florida, United States of America
- Miami Transplant Institute, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, Florida, United States of America
- Department of Surgery, Zagazig University School of Medicine, Zagazig, Egypt
| | - Javier Gonzalez
- Department of Urology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Paolo Vincenzi
- Department of Surgery, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, Florida, United States of America
- Miami Transplant Institute, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, Florida, United States of America
| | - Jeffrey J. Gaynor
- Department of Surgery, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, Florida, United States of America
- Miami Transplant Institute, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, Florida, United States of America
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Hussein A, Sran K, Ali I, Woellner J, Wilcox H, Marks SD, Jones H, Callaghan C. No evidence for the need of a routine renal transplant ultrasound after elective transplant ureteric stent removal-A retrospective cohort study. Pediatr Transplant 2020; 24:e13704. [PMID: 32255548 DOI: 10.1111/petr.13704] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 12/19/2019] [Accepted: 03/06/2020] [Indexed: 11/29/2022]
Abstract
Transplant ureteric stent insertion reduces the incidence of MUCs, but it is not known whether routine PSRGU is needed to detect unmasked MUCs. This study evaluated whether routine PSRGU in the pRTR is a useful tool to identify MUCs before they become clinically apparent. A retrospective analysis was undertaken of the clinical outcomes following elective stent removal from pediatric kidney-only transplant recipients at two London centers between 2012 and 2016. Our policy was to perform PSRGU either routinely or urgently if there were concerning symptoms or biochemical evidence of renal allograft dysfunction. Elective stent removal was performed in 86% (97 of 113 pRTR), and 75 (77%) of whom had routine PSRGU at a median (IQR) of 6 (2-8) days after stent removal. There were changes to management in 3 (4%) of pRTR with PSRGU identifying no MUC. Nineteen patients (25%) had urgent PSRGU, most commonly due to renal allograft dysfunction, at a median (IQR) of 5.5 (2.7-12.3) days after stent removal. Of these, two pRTR required ureteric intervention. For our current practice of removing transplant stents at 4-6 weeks post-transplantation, our study has found no evidence to support routine PSRGU after elective stent removal.
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Affiliation(s)
- Aliyah Hussein
- Department of Nephrology and Transplantation, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Kiran Sran
- Department of Nephrology and Transplantation, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Imran Ali
- Department of Nephrology and Transplantation, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Janine Woellner
- Department of Paediatric Nephrology, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Helen Wilcox
- Department of Paediatric Nephrology, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Stephen D Marks
- Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,NIHR Great Ormond Street Hospital Biomedical Research Centre, University College London Great Ormond Street Institute of Child Health, London, UK
| | - Helen Jones
- Department of Paediatric Nephrology, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Chris Callaghan
- Department of Nephrology and Transplantation, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
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Implementing a Ureteric Magnetic Stent in the Kidney Transplant Setting: Report of 100 Consecutive Cases. Transplantation 2019; 103:2654-2656. [PMID: 31335781 DOI: 10.1097/tp.0000000000002855] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Kidney transplantation (KT) is the treatment of choice for end-stage kidney disease. The double-J-stent has been used to prevent urological complications (UCs), but it requires cystoscopy extraction. The novel magnetic black star (MBS) stent provided with a customized retrieval device (9 or 15 Fr) has been developed to spare cystoscopy. Scope of the paper is to analyze MBS in 100 consecutive KTs. METHODS We report a retrospective analysis of 100 consecutive KT performed between April 2015 and September 2018 using MBS (4.8 Fr, 15 cm) to protect Lich-Gregoir ureteroneocystotomy. MBS was removed 4 weeks after KT by either the 9 Fr (61 cases) or the 15 Fr (39 cases) retrieval device. RESULTS Intraoperative MBS insertion was straightforward in all cases, and its extraction was carried out in the outpatient setting in 93 patients. Extraction time was <30 seconds in 45 out of 61 patients (73.8%) and in 38 out of 39 patients (97.4%) using the 9 Fr and the 15 Fr retrieval device, respectively. In 15 patients, MBS removal took between 30 seconds and 3 minutes. Only 2 cases required extraction by cystoscopy. We observed 2 UC (ureteric leak and stenosis), 8 urinary tract infections, and 9 stent-related symptoms. 7 patients experienced distressing pain according to Visual Analog Scale for Pain. CONCLUSIONS In our cohort, MBS appeared to be safe and cost-effective. We advocate its routine implementation in KT because of an easy and comfortable extraction in the outpatient setting even by nondedicated staff, without detrimental impact on UC and urinary tract infection rates.
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Ter Haar AS, Parekh RS, Leunissen RWJ, van den J, Lorenzo AJ, Hebert D, Keijzer-Veen MG, Cransberg K. How to stent the ureter after kidney transplantation in children?-A comparison of two methods of urinary drainage. Pediatr Transplant 2018; 22. [PMID: 29080255 DOI: 10.1111/petr.13065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/25/2017] [Indexed: 12/15/2022]
Abstract
Ureteral stenting after pediatric renal transplantation serves to prevent obstruction and urinary leakage, but can also cause complications. This study compares the complication rates of both methods. Data were retrospectively collected at Erasmus MC, Rotterdam, the Netherlands (splint group, n = 61) and Hospital for Sick Children, Toronto, Canada (JJ catheter group, n = 50). Outcome measures included urological interventions and incidence of UTIs during the first 3 months post-transplantation. The splint was removed after a median of 9 (IQR 8-12), the JJ catheter after 42 (IQR 36-50) days. Seven (11.5%) children in the splint group needed at least one urological re-intervention versus two in the JJ catheter group (P-value .20). UTIs developed in 19 children (31.1%) in the splint group and in twenty-five (50.0%) children in the JJ catheter group (P-value .04), with a total number of 27 vs. 57 UTIs (P-value .02). Nine (33.3%) vs. 35 (61.4%) of these, respectively, occurred during the presence of the splint (P-value <.001). Children with a JJ catheter developed more UTIs than children with a splint; the latter, however, tended to require more re-interventions. Modification of either method is needed to find the best way to stent the ureter.
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Affiliation(s)
- Anuradha S Ter Haar
- Department of Pediatric Nephrology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Rulan S Parekh
- Department of Pediatric Nephrology, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Ralph W J Leunissen
- Department of Pediatric Nephrology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Joop van den
- Department of Pediatric Urology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Armando J Lorenzo
- Division of Urology, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Diane Hebert
- Department of Pediatric Nephrology, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Mandy G Keijzer-Veen
- Department of Pediatric Nephrology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Karlien Cransberg
- Department of Pediatric Nephrology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
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Argyrou C, Moris D, Vernadakis S. Steering between Scylla and Charybdis: Picking out the optimum time of double-J stent removal following renal transplantation. Transplant Rev (Orlando) 2016; 31:96-99. [PMID: 27884503 DOI: 10.1016/j.trre.2016.10.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 10/30/2016] [Indexed: 10/20/2022]
Affiliation(s)
| | - Demetrios Moris
- Department of Immunology, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
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Complications chirurgicales de la transplantation rénale. Prog Urol 2016; 26:1066-1082. [DOI: 10.1016/j.purol.2016.09.052] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 08/29/2016] [Accepted: 09/01/2016] [Indexed: 12/13/2022]
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Complications urologiques après transplantation de reins issus de donneurs à critères étendus : anastomoses urétéro-vésicales versus anastomoses pyélo-urétérales. Prog Urol 2016; 26:375-82. [DOI: 10.1016/j.purol.2016.03.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 02/22/2016] [Accepted: 03/22/2016] [Indexed: 11/23/2022]
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Vogel T, Utech M, Schmidt F, Holscher Keplin W, Diller R, Brockmann J, Wolters H. Double-J Versus External Ureteral Stents in Kidney Transplantation: A Retrospective Analysis. Nephrourol Mon 2015; 7:e27820. [PMID: 26539415 PMCID: PMC4628208 DOI: 10.5812/numonthly.27820] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Accepted: 03/12/2015] [Indexed: 01/28/2023] Open
Abstract
Background: Kidney transplantation has long been recognized as the best available therapy for end stage kidney disease. Objectives: This study aimed to compare outcomes of double-J versus percutaneous ureteral stent placement in renal transplantation. Patients and Methods: A retrospective analysis was performed on data of renal transplantations performed at our institution in a 12-month period. In this period, external and double-J stents were used in parallel. Length of hospital stay and stent-associated complications were evaluated. Results: In 76 kidney transplants, 43 external (group 1) and 33 double-J (group 2) urinary stents were used. No significant difference was observed in the number of urinary tract infections, ureteric stenosis or necrosis. The mean overall length of hospital stay was comparable in both groups (20.7 days in group 1 vs 19.3 days in group 2, P = 0.533). For patients without immunological complications, the hospital stay was significantly reduced using double-J stents (12.9 days in group 1, 10.8 days in group 2, P = 0.018). Leakage of the ureteroneocystostomy occurred in 6 out of 43 patients in group 1 (13.9%). No case of anastomotic insufficiency was observed in group 2 (P = 0.035). Macrohematuria was detected in 13 out of the 43 patients in group 1 (30.2%), compared to 3 out of 33 patients in group 2 (9.1%; P = 0.045). Conclusions: This nonrandomized comparison of stent types in kidney transplantation supports the use of prophylactic double-J stents in terms of decreased ureteric complications and reduced length of hospital stay.
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Affiliation(s)
- Thomas Vogel
- Department of General and Visceral Surgery, University Hospital Munster, Munster, Germany
| | - Markus Utech
- Department of General and Visceral Surgery, Knappschafts Hospital, Recklinghausen, Germany
| | - Fabian Schmidt
- Department of General and Visceral Surgery, University Hospital Munster, Munster, Germany
| | - Wiebke Holscher Keplin
- Department of General and Visceral Surgery, University Hospital Munster, Munster, Germany
| | - Ricarda Diller
- Department of General Surgery, Bruderkrankenhaus St. Josef, Paderborn, Germany
| | - Jens Brockmann
- Organ Transplant Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Heiner Wolters
- Department of General and Visceral Surgery, University Hospital Munster, Munster, Germany
- Corresponding author: Heiner Wolters, Department of General and Visceral Surgery, University Hospital Munster, Münster, Germany. Tel: +49-2518356301, Fax: +49-2518356402, E-mail:
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Di Carlo HN, Darras FS. Urologic considerations and complications in kidney transplant recipients. Adv Chronic Kidney Dis 2015; 22:306-11. [PMID: 26088075 DOI: 10.1053/j.ackd.2015.04.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 04/03/2015] [Accepted: 04/08/2015] [Indexed: 01/05/2023]
Abstract
Urologic considerations during the kidney transplantation process, starting with initial recipient evaluation and continuing through the post-transplant, long-term follow-up, are critical for minimizing urologic complications and improving graft survival. Appropriate, targeted, preoperative urologic evaluation of the recipient allows for an optimized urinary tract to accept the graft, whereas post-transplant urologic follow-up and monitoring decrease the risk of graft lost secondary to a urologic cause, particularly in patients with a urologic reason for their kidney failure and in those patients with concomitant urologic diagnoses. Urologic complications comprise the second most common adverse post-transplant event, occurring in 2.5% to 14% of patients and are associated with high morbidity, graft loss, and mortality. Early and late urologic complications, including hematuria, hematoma, lymphocele, urine leak, ureteral stricture, nephrolithiasis, and vesicoureteral reflux, and their causes and treatment options are explored. A multidisciplinary team approach to kidney transplantation, including transplant surgery, urology, and nephrology, optimizes outcomes and graft survival. Although the current role of the urologist in kidney transplantation varies greatly by institution, appropriate consultation, participation, and monitoring in select patients is essential.
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Berli JU, Montgomery JR, Segev DL, Ratner LE, Maley WR, Cooper M, Melancon JK, Burdick J, Desai NM, Dagher NN, Lonze BE, Nazarian SM, Montgomery RA. Surgical management of early and late ureteral complications after renal transplantation: techniques and outcomes. Clin Transplant 2014; 29:26-33. [PMID: 25312804 DOI: 10.1111/ctr.12478] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND In this study, we present our experience with ureteral complications requiring revision surgery after renal transplantation and compare our results to a matched control population. METHODS We performed a retrospective analysis of our database between 1997 and 2012. We divided the cases into early (<60 d) and late repairs. Kaplan-Meier and Cox proportional hazards models were used to compare graft survival between the intervention cohort and controls generated from the Scientific Registry of Transplant Recipients data set. RESULTS Of 2671 kidney transplantations, 51 patients were identified as to having undergone 53 ureteral revision procedures; 43.4% of cases were performed within 60 d of the transplant and were all associated with urinary leaks, and 49% demonstrated ureteral stenosis. Reflux allograft pyelonephritis and ureterolithiasis were each the indication for intervention in 3.8%; 15.1% of the lesions were located at the anastomotic site, 37.7% in the distal segment, 7.5% in the middle segment, 5.7% proximal ureter, and 15.1% had a long segmental stenosis. In 18.9%, the location was not specified. Techniques used included ureterocystostomy (30.2%), ureteroureterostomy (34%), ureteropyelostomy (30.1%), pyeloileostomy (1.9%), and ureteroileostomy (3.8%). No difference in overall graft survival (HR 1.24 95% CI 0.33-4.64, p = 0.7) was detected when compared to the matched control group. CONCLUSION Using a variety of techniques designed to re-establish effective urinary flow, we have been able to salvage a high percentage of these allografts. When performed by an experienced team, a ureteric complication does not significantly impact graft survival or function as compared to a matched control group.
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Affiliation(s)
- Jens U Berli
- Department of Surgery, Johns Hopkins Hospital, Baltimore, MA, USA
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Ordon M, Ghiculete D, Stewart R, Pace KT, Honey RJD. The Role of Prophylactic versus Selective Ureteric Stenting in Kidney Transplant Patients: A Retrospective Review. Prog Transplant 2014; 24:322-7. [DOI: 10.7182/pit2014422] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Objective To evaluate the role of prophylactic versus selective ureteric stenting in the development of postoperative ureterovesical complications in kidney transplant recipients. Methods Records of 614 transplant patients seen from January 2006 to May 2011 were retrospectively reviewed. The primary outcome was the rate of ureterovesical complications, defined as the development of ureteric obstruction or a ureterovesical anastomotic leak. The secondary outcomes were the rate of urinary tract infections and forgotten stents. Using a χ2 test, we compared the primary and secondary outcomes across the selective and prophylactic cohorts. Logistic regression was used to compare the 2 cohorts while adjusting for potential confounders. Results The selective and prophylactic cohorts consisted of 258 and 330 patients, respectively. Unadjusted analysis showed that the prophylactic group had a significantly lower rate of ureterovesical complications than did the selective group (2.12% vs 6.20%; odds ratio, 0.33; P = .01). After adjustment for differences in sex and donor type, the prophylactic group still had a lower risk for ureterovesical complications (odds ratio, 0.30; P = .009). Rates of urinary tract infections and forgotten stents did not differ significantly between the 2 groups. Conclusions Prophylactic stenting is associated with a significantly lower rate of ureterovesical complications than is selective stenting.
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Affiliation(s)
- Michael Ordon
- St Michael's Hospital, University of Toronto, Canada
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Ureteral Stent Placement Increases the Risk for Developing BK Viremia after Kidney Transplantation. J Transplant 2014; 2014:459747. [PMID: 25295178 PMCID: PMC4177822 DOI: 10.1155/2014/459747] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Revised: 08/05/2014] [Accepted: 08/21/2014] [Indexed: 12/16/2022] Open
Abstract
The placement of ureteral stent (UrSt) at kidney transplantation reduces major urological complications but increases the risk for developing nephropathy from the BK virus. It is unclear whether UrSt placement increases nephropathy risk by increasing risk of precursor viral replication or by other mechanisms. We retrospectively investigated whether UrSt placement increased the risk for developing BK Viremia (BKVM) in adult and pediatric kidney transplants performed at the University of Florida between July 1, 2007, and December 31, 2010. In this period all recipients underwent prospective BKV PCR monitoring and were maintained on similar immunosuppression. Stent placement or not was based on surgeon preference. In 621 transplants, UrSt were placed in 295 (47.5%). BKVM was seen in 22% versus 16% without UrSt (P = 0.05). In multivariate analyses, adjusting for multiple transplant covariates, only UrSt placement remained significantly associated with BKVM (P = 0.04). UrSt placement significantly increased the risk for BKVM. Routine UrSt placement needs to be revaluated, since benefits may be negated by the need for more BK PCR testing and potential for graft survival-affecting nephritis.
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Treatment of urological complications in more than 1,000 kidney transplantations: the role of interventional radiology. Radiol Med 2014; 120:206-12. [DOI: 10.1007/s11547-014-0407-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Accepted: 02/11/2013] [Indexed: 10/25/2022]
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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; 27:593-605. [PMID: 24606191 DOI: 10.1111/tri.12301] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Revised: 12/28/2013] [Accepted: 03/03/2014] [Indexed: 01/24/2023]
Abstract
No consensus exists about which ureterovesical anastomosis technique to use for kidney transplantation. The aim of this systematic review was to compare the existing techniques in relation to the risk of urological complications. All studies that compared ureterovesical anastomotic techniques in kidney transplantation were included. Study endpoints were urinary leakage, ureteral stricture, vesicoureteral reflux and hematuria. Subanalyses of stented and nonstented techniques were performed. Two randomized clinical trials and 24 observational studies were included. Meta-analyses were performed on the Lich-Gregoir (LG) versus Politano-Leadbetter (PL) techniques and LG versus U-stitch (U) techniques. Compared with the PL technique, the LG technique had a significantly lower prevalence of urinary leakage (risk ratio (RR): 0.47, 95% confidence interval (CI): 0.30 to 0.75) and a significantly lower prevalence of hematuria when compared with both PL and U techniques (RR: 0.28, 95% CI: 0.16 to 0.49 and RR: 0.23, 95% CI: 0.11 to 0.50, respectively), regardless of ureteral stenting. There was no difference in the prevalence of ureteral strictures or vesicoureteral reflux between the various techniques. Of the three most frequently used ureterovesical anastomotic techniques, the LG technique results in fewer urological complications than the PL and U techniques.
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Affiliation(s)
- Victor P Alberts
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
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17
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Gomes G, Nunes P, Castelo D, Parada B, Patrão R, Bastos C, Roseiro A, Mota A. Ureteric Stent in Renal Transplantation. Transplant Proc 2013; 45:1099-101. [DOI: 10.1016/j.transproceed.2013.02.086] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Intravesical versus extravesical ureteroneocystostomy in kidney transplantation: a systematic review and meta-analysis. Transplantation 2013; 94:1179-84. [PMID: 23269446 DOI: 10.1097/tp.0b013e3182643544] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Urological complications are still a major problem postoperatively with a reported incidence of up to 30%, associated with significant morbidity, mortality, prolonged hospital stay and high medical costs. To date, there is no evidence favouring either an extravesical or an intravesical approach. The purpose of this systematic review and meta-analysis is to determine if an intravesical or extravesical anastomosis in kidney transplantation is to be preferred. Comprehensive searches were conducted in PubMed, Embase and the Cochrane Library. Reference lists were searched manually. The methodology was in accordance with the PRISMA statement. Two randomized controlled trials and seventeen cohort studies were identified. Based on the meta-analysis, outcome was in favour of the extravesical anastomosis. A relative risk (RR) for stenosis of 0.67 (confidence interval (CI), 0.48-0.93; p = 0.02), for leakage 0.55 (CI 0.39-0.80; p = 0.001) for the total number of urological complications 0.56 (CI 0.41-0.76; p < 0.001) and for haematuria of 0.41 (CI 0.22-0.76; p = 0.005) was demonstrated. Based on our results, we conclude that there is evidence in favour of the extravesical ureteroneocystostomy for having a smaller amount of urological complications in kidney transplantation.
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Lehmann K, Müller MK, Schiesser M, Wildi S, Fehr T, Wüthrich RP, Clavien PA, Weber M. Treatment of ureteral complications after kidney transplantation with native ureteropyelostomy reduces the risk of pyelonephritis. Clin Transplant 2011; 25:201-6. [DOI: 10.1111/j.1399-0012.2010.01234.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Luján S, García-Fadrique G, Budía A, Broseta E, Jiménez-Cruz F. [Should ureteral catheterization be systematically used in kidney transplants?]. Actas Urol Esp 2011; 35:213-7. [PMID: 21397987 DOI: 10.1016/j.acuro.2010.10.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2010] [Accepted: 10/08/2010] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To assess if the systematic use of double J ureteral catheters in ureteroneocystostomies of kidney transplants reduces the rate of complications. MATERIALS AND METHODS Non-randomized prospective, comparative study of parallel groups in 194 kidney transplants. We established two equal groups, 111 patients with double J catheter and another of 83 catheter-free patients. We studied the incidence of complications between both groups by means of a univariate comparative study (X2 test)and a multivariate analysis (logistic regression). RESULTS In the catheter group, the overall complications appeared in 22.2% as opposed to 43.3% of the catheter-free group (p=0.04). Depending on the ureteral transplant, complications appeared in 38.12% of the Paquin type reimplantation as opposed to the 20.3% in Lich-Gregoir (p=0.09). There was evidence of 1 (0.9%) urinary fistula in the catheter group as opposed to 5 (6%) in the catheter-free group (p=0.08), and 3 (2.7%) ureterovesical anastomosis stricture in the group with catheter against 7 (8.4%) of the catheter-free group (p=0.13). The multivariate analysis showed that not using the catheter increases the risk of suffering complications related to reimplantation (OR: 2.55; IC 95%, 1.37-4.75). The risk of fistula increased significantly when a catheter was not placed (OR 9.19, IC 95%, 1.01-84.7). There were no differences between the two groups as regards urinary tract infections; there were 3 (2.7%) in the catheter group and 1 (1.2%) in the catheter-free group (p=0,63). CONCLUSIONS The placement of a double J catheter reduces complications related to ureteral reimplantation without increasing the morbidity associated with their use.
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Affiliation(s)
- S Luján
- Servicio de Urología, Hospital Universitario La Fe, Valencia, España.
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Timsit MO, Lalloué F, Bayramov A, Taylor M, Billaut C, Legendre C, Kreis H, Badet L, Méjean A. Should Routine Pyeloureterostomy be Advocated in Adult Kidney Transplantation? A Prospective Study of 283 Recipients. J Urol 2010; 184:2043-8. [DOI: 10.1016/j.juro.2010.06.144] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2010] [Indexed: 11/27/2022]
Affiliation(s)
- Marc-Olivier Timsit
- Universite Paris Descartes, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris
- Division of Urology and Renal Surgery, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Fanny Lalloué
- Department of Urology and Transplant Surgery, Edouard Herriot Hospital, Lyon I University, Lyon, France
| | - Araz Bayramov
- Department of Urology and Transplant Surgery, Edouard Herriot Hospital, Lyon I University, Lyon, France
| | - Melissa Taylor
- Universite Paris Descartes, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris
| | - Claire Billaut
- Division of Urology and Renal Surgery, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Christophe Legendre
- Universite Paris Descartes, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris
- Department of Nephrology and Transplantation, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Henri Kreis
- Universite Paris Descartes, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris
- Department of Nephrology and Transplantation, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Lionel Badet
- Department of Urology and Transplant Surgery, Edouard Herriot Hospital, Lyon I University, Lyon, France
| | - Arnaud Méjean
- Universite Paris Descartes, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris
- Division of Urology and Renal Surgery, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
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Effectiveness of a 5-day external stenting protocol on urological complications after renal transplantation. World J Surg 2010; 33:2722-6. [PMID: 19774409 PMCID: PMC2840662 DOI: 10.1007/s00268-009-0224-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background Ureteral stents are successful in reducing urological complications after renal transplantation. However, the optimal duration and method of stenting have not yet been clarified. The objective of the present study was to investigate the frequency of urological complications when a 5-day external stented ureterocystostomy protocol was followed. Methods A single-center nonrandomized analysis of 392 kidney transplantations between June 2003 and June 2007 was conducted. From July 2005 all 196 renal transplant recipients received a 5-day external stented ureterocystostomy. A urological complication was defined as any cause leading to the placement of a percutaneous nephrostomy catheter and/or surgical revision of the ureterocystostomy. Results In the non-stented group, 21 of the 196 patients (10.7%) developed a urological complication compared to 13 patients (6.6%) in the stented group (p = 0.151). In the stented group, 2 of the 66 recipients of a living donor transplant (3.0%) developed a urological complication compared to 8 of the 59 recipients (13.6%) in the non-stented group (P = 0.030). Eleven of 130 recipients of a deceased donor transplant (8.5%) in the stented group developed a urological complication, compared to 13 of the 137 recipients (9.5%) in the non-stented group (P = 0.769). The surgical revision rate of the stented and the non-stented group was 5/13 39% and 6/21 29%, respectively. Conclusions A 5-day routine external stent protocol is efficacious in living donor renal transplantation in preventing early postoperative ureter obstruction, but this stenting period seems inadequate for deceased donor renal transplantation.
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Veltman Y, Shields JM, Ciancio G, Bird VG. Percutaneous nephrolithotomy and cystolithalapaxy for a “forgotten” stent in a transplant kidney: case report and literature review. Clin Transplant 2010; 24:112-7. [DOI: 10.1111/j.1399-0012.2009.01133.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Ranganathan M, Akbar M, Ilham MA, Chavez R, Kumar N, Asderakis A. Infective complications associated with ureteral stents in renal transplant recipients. Transplant Proc 2009; 41:162-4. [PMID: 19249503 DOI: 10.1016/j.transproceed.2008.10.022] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2008] [Revised: 10/12/2008] [Accepted: 10/29/2008] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Stenting of the ureter is commonly performed during renal transplantation to avoid early complications. However, it predisposes to infections that may pose a significant threat to the graft and patient. Our study sought to investigate the incidence of infections associated with stents in renal transplant recipients. PATIENTS AND METHODS A retrospective analysis of 100 consecutive renal transplant recipients performed over 1 year with 6 months follow-up. RESULTS The median recipient age was 46 years (range, 19-71 years). Among the study group, 75 patients received an organ from deceased donor and 25 from live donor. In our study, there were 79 patients with a stent (ST) and 18 without a stent (WOST); 3 patients who required nephrectomy were excluded from the study. There were 2 ureteric stenoses that occurred following stent removal: 1 required surgical correction and 1 was treated radiologically. There were no cases of urinary leak. The incidence of urinary tract infection (UTI) was significantly greater among ST compared with WOST subjects (71% vs 39%; P = .02). New episodes of UTI following removal of the stent were more common among patients who had experienced infections while having a stent compared with infection-free stented patients (54% vs 30%; P = .04). CONCLUSIONS A ureteric stent may help to reduce early postoperative complications (leak and stricture), but increased the likelihood of UTI. Infection while having a ureteric stent was associated with a high recurrence rate of UTI even after stent removal.
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Affiliation(s)
- M Ranganathan
- Transplant Unit, University Hospital of Wales, Cardiff, Wales, UK.
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Assessing the value of ureteral stent placement in pediatric kidney transplant recipients. Transplantation 2008; 85:986-91. [PMID: 18408579 DOI: 10.1097/tp.0b013e318169bf11] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Ureteral stent placement at kidney transplantation may reduce stenosis or leakage (S/L) complication rates. However, stent placement may also increase risk for early urinary tract infection (early UTI; <3 months after transplant) and BK virus allograft nephropathy (BKVAN). In children, the usefulness of stent placement is not well defined. METHODS We analyzed retrospective data from children transplanted at our center for the three above outcomes in relation to stents. At our center, stent placement decision is driven by surgeon preference. RESULTS Among 129 transplants from 1996 to 2006, early UTI was seen in 9.3% and S/L in 4.6%. By univariate analyses, stent placement was a significant risk factor for early UTI (P=0.0399) but not protective for S/L (P=0.23). In multivariate analyses, stent placement, human leukocyte antigen match, and bladder augmentation increased the odds ratio for early UTI. Only deceased donor source increased the odds ratio for S/L. In a truncated data set from 1999 to 2006, BKVAN occurred in 9 of 93 (9.6%). Per minute increase in warm ischemia time was the only significant risk factor for BKVAN by both univariate and Cox regression analyses. Stent placement did not improve graft survival (P=0.5726) but required general anesthesia for removal in the operating room, leading to additional cost and potential risk. CONCLUSION Routine stent placement in children in this era of low urological complication rates and BKVAN needs reevaluation.
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Gonzalo Rodríguez V, Rivero Martínez M, Trueba Arguiñarena F, Martín Martín S, De Castro Olmedo C, Fernández Del Busto E. Empleo del catéter doble J para la prevención de las complicaciones urológicas en el trasplante renal. Actas Urol Esp 2008; 32:225-9. [DOI: 10.1016/s0210-4806(08)73817-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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