657 Transplant Ureteric Stent Removal Using Isiris® in an Outpatient Setting

Abstract

Abstract Aim The risk of urological complications following kidney transplantation is reduced by the intraoperative insertion of ureteric stents. Transplant ureteric stent removal (TUSR) has traditionally been performed in theatre using flexible cystoscopy. Isiris® is a single-use flexible cystoscope. The aim is to analyse the acceptability, efficacy, and cost-effectiveness of Isiris®, for TUSR in a ward/outpatient setting. Method A retrospective analysis of a contemporaneously maintained database at a high-volume kidney transplant centre from January 2021 to June 2022. Data collected included clinico-demographic, operative and stent removal details including time to removal (gold-standard within 6 weeks) and refusal rates. A cost analysis was also performed based on equipment costs and NHS tariffs. TUSR was performed using Isiris® in outpatient ANP-led clinics or on wards by surgical middle grades or ANPs. Results 345 patients were included in analysis with a median age of 54 (19-81). 99.13% were single ureteric anastamoses with 348 stents removed in total. The M:F ratio was 1.32:1. 98.85% of stents were removed using Isiris®, with a 1.15% refusal rate. 86.34% (n=297) were removed in clinic. Median dwell-time was 34 days, IQR 17.25 (25.75-43). 73.84% of stent removal was within 6 weeks. There were savings of £545.00 per stent removal, including expenses for failed Isiris TUSR, with overall savings of £154,021.20 and 86 theatre sessions freed for other activity. Conclusions Isiris® was acceptable and effective for TUSR. Savings were demonstrated compared to TUSR in theatre. Outpatient/ward TUSR reduces demand for theatre time, freeing theatres for other elective activities.