Urologic Complications After Kidney Transplantation: Involvement of the Double-J Stent and the Urologic Suture

Abstract

Urologic complications in renal transplantation are an important cause of morbidity and hospitalization. This retrospective study of 343 transplants, performed between 1999 and 2009, analyzed the incidence of urinary fistula (4.4%) and ureteral stenosis (3.5%), based upon the type of extravesical anastomosis—Woodruff (W) versus Taguchi (T)—and with versus without the use of a double-J stent. The frequencies of ureteral stenosis with a W anastomosis (without a double J), W + double J, or T + double J were 3.7%, 1.5%, and 9%, respectively ( P = .031). There were differences between W + double J versus T + double J ( P = .015), with a hazard ratio (HR) = 6.3. In relation to a double-J stent, the incidences of fistulae among patients with a double-J stent were: W (12%) versus W + double J (0.8%) versus T + double J (0%; P < .0001; HR = 15.8) versus patients without a double-J stent. Logistic regression showed the predictors of ureteral stenosis to be a urologic anastomosis (odds ratio 0.06, 95% confidence interval [CI]: 0.01–0.49) and delayed renal function (odds ratio 10.1, 95% CI: 1.4–72.4). Concerning fistulae, the best covariates were double-J stent (odds ratio 0.027, 95% CI: 0.003–0.227) and donor age (odds ratio 1.052, 95% CI: 1.01–1.096). A double-J stent protected against the development of a urologic fistula. Donor age was a risk factor. The W suture with a double-J stent was the best way to prevent ureteral stenosis, with delayed graft function being an important risk factor.