Early Removal of Ureteral Stent After Kidney Transplant Could Decrease Incidence of Urinary Tract Infection: A Systematic Review and Meta-Analysis.

Abstract

In this systematic review and meta-analysis, our aim was to explore the optimal timing of ureteric stent removal after kidney transplant. For our analyses, we searched the Cochrane Central Register of Controlled Trials, PubMed, and Embase databases for all randomized clinical trials that evaluated the timing of stent removal after kidney transplant. Patients with early versus late stent removal were compared. Seven eligible studies published from 2012 to 2018, which included 1277 patients, were found to be within the scope of our study. Significant differences were shown between early versus late stent removal groups with regard to development of urinary tract infections (relative risk of 0.42; 95% CI, 0.26-0.685; P < .001). In a further subgroup analysis of incidence of urinary tract infection with consideration of heterogeneity, early stent removal was also favored (relative risk at 2 and 3 weeks of 0.36 and 0.35, respectively; P < .001 for both). However, with regard to incidence of major urologic complications, there were no significant differences between early and late stent removal (odds ratio at 2 and 3 weeks of 2.79 and 1.97, respectively; P = .18 and P = .26, respectively). There were also no significant differences between groups in risk of development of urinary leakage (odds ratio at 2 weeks of 3.02, P = .18; and relative risk at 3 weeks of 2.00, P = .27). With regard to ureteral stenosis, only 3 cases were reported in the late stent removal group. Our study demonstrated that early ureteral stent removal (that is, not later than 3 weeks) could significantly decrease the incidence of urinary tract infections without affecting incidence of major urological complications. We suggest that the appropriate timing of stent removal should be within 14 to 21 days.