MP79-18 DOES ROUTINE URETERAL STENTING IN KIDNEY TRANSPLANTATION REALLY REDUCE URETERAL COMPLICATION RATES?

Abstract

You have accessJournal of UrologyTransplantation & Vascular Surgery: Renal Transplantation & Vascular Surgery I1 Apr 2015MP79-18 DOES ROUTINE URETERAL STENTING IN KIDNEY TRANSPLANTATION REALLY REDUCE URETERAL COMPLICATION RATES? Samuel C. Haywood, Chad A. Reichard, and Daniel A. Shoskes Samuel C. HaywoodSamuel C. Haywood More articles by this author , Chad A. ReichardChad A. Reichard More articles by this author , and Daniel A. ShoskesDaniel A. Shoskes More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2875AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The use of routine ureteral stenting with ureteroneocystotomy in renal transplantation is debated, although meta-analyses and Cochrane reviews have demonstrated advantage for routine prophylactic stenting. We compared the rate of ureteral complications in stented versus un-stented patients in a large cohort of recipients. METHODS We retrospectively analyzed transplant recipients from 2004-2014. Standard practice for ureteral stenting differs among surgeons at our institution, thus patients were grouped into stent, no stent, and “stent for cause” (SFC). This unique group includes patients who received a stent based solely on intraoperative findings. This study represents a large, single center experience of kidney transplant recipients sharing common post-operative management pathways. RESULTS A total of 1745 recipients were included in the analysis. Ureteral stenting was employed in 1246/1745 cases (71%), which included 1155 patients routinely stented (66% of overall cohort) and 91 SFC recipients (5% of overall cohort). 499 patients (29%) who did not receive a ureteral stent. Mean age was similar among groups – 49.4±12.5 yrs no stent, 48.5±14.5 stent, 49.7±13.1 yrs SFC (p=0.3). There were 35 ureteral complications in this cohort (2.0%) within 1 yr post op. There were 5/499 ureteral complications in the no stent group (1.0%), 28/1155 in the routine stent group (2.4%), and 2/91 in the SFC group (2.1%) (p=0.16). Complications were ureteral stricture in 21/35 (60%), anastomosis leak in 7 (20%), ureteral necrosis in 5 (14%), and other in 3 (6%). All cases involving urine leak (anastamotic leak, ureteral necrosis) in the no stent group required re-operation for revision of ureteroneocystotomy (3/3, 100%). In the groups with ureteral stent in place (stent, SFC), there were 9 total cases involving urine leak or ureteral necrosis. 4/9 (44%) were managed with initial reoperation. The remaining 5 received initial conservative management (indwelling urethral catheter, prolonged stent), of which 2 required eventual re-operation. As such, 3/9 (33%) complications with ureteral stents in place were able to be managed successfully without surgery compared to none in the non stent group; however, this did not reach statistical significance (p=0.24) CONCLUSIONS The overall ureteral complication rate in this cohort is low. Ureteral stenting in renal transplant recipients is not associated with differing rates of ureteral complications, however the presence of ureteral stent may allow for non-surgical management of urine leaks. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e1017 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Samuel C. Haywood More articles by this author Chad A. Reichard More articles by this author Daniel A. Shoskes More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...