Ureteral Stent Removal Research Articles

Cost analysis of removing pediatric ureteral stents with and without a retrieval string

Indwelling ureteral stents are commonly placed in urologic surgeries where optimal urinary drainage is necessary. In the pediatric population, removing a stent without retrieval string (SWOS) requires a secondary operation and additional anesthetic exposure. Although these burdens can be mitigated through the placement of a stentwith retrieval string (SWS), fears of complications may prevent widespread adoption of this practice by pediatric urologists. The authors sought to assess the differential cost of removing SWS and SWOS. It was hypothesized that costs associated with removing SWS are significantly lower than those associated with removing SWOS, without increasing complications. A retrospective chart review was performed on pediatric patients undergoing common urologic surgeries with concurrent stent placement at a single tertiary referral center. Charges and healthcare costs surrounding the removal of ureteral stents were evaluated using the institution-specific ratio of cost to charges, by estimating lost wages, and by exploring differences in poststent healthcare-related events that incur additional cost. A total of 109 patients with a median age of 5 years (range: 6 months-20 years) were reviewed. A total of 29 patients had SWS, and 80 had SWOS. The theoretical cost of SWS removal in clinic was $400.48 compared with $2290.86±$119.30 for operative removal of SWOS, with mean difference of $1890.38 (P<0.01). The mean stent duration of SWOS was 34.0±13.2 days vs. 10.1±4.9 days for SWS (P<0.01). Subgroup analysis of the ureteral reconstruction group showed no difference in any complications (35% vs 27%, respectively), early dislodgment (7% vs 7%, respectively)or costly healthcare utilization (23% vs 20%, respectively) among patients with SWOS compared with those with SWS. In SWS group with early dislodgment, neither required a secondary procedure. With rising healthcare expenditures, physicians must be able to provide cost-effective treatment while not compromising safety or outcomes. Unlike prior analyses of cost related to the type of the stent used, the present study specifically reviewed costs of removing SWS versus SWOS and evaluated rates of costly complications. The study findings provide a preliminary basis for advocating the more economical use of SWS when indicated. Lack of power and heterogeneity of the groups need to be addressed in future analyses with larger, matched cohorts. Removal of SWS is more cost-effective than that of SWOS while maintaining similar safety outcomes and should be considered in certain pediatric urology cases to decrease healthcare cost. SWS should be preferred for uncomplicated ureteroscopy, but benefits are less certain in ureteral reconstruction; further studies are needed.

Est-il nécessaire de faire systématiquement un ECBU avant l’ablation d’une sonde double J ?

To assess the value of systematic urine culture before ureteric double j removal. This prospective audit was performed to assess the validity of our current clinical practice. A cohort of informed patients without clinical signs of urinary tract infection and without predefined risk factors were programmed for ureteral double j stent removal in an outpatient setting. Urine was sampled for culture immediately before the procedure. Patients had to complete a self-questionnaire 15 days following stent removal, inquiring about tolerance and complications which were to be analyzed according to the culture results. The primary endpoint was the occurrence of febrile urinary tract infection. Among the 56 participants, immediate preoperative urine culture revealed colonization in 9 patients (16.1%) and contamination in 6 patients (10.7%). A significant association was found between bacteriuria and double j placement following surgery with urinary tract injury (P<0.02) and diabetes (P<0.009). Two patients had fever including a man with sterile urine and a woman with Staphylococcus Aureus infection. No hospitalization was necessary. Twelve patients reported functional signs with lumbar pain being the most common. There was no significant association between functional signs and patients' clinical characteristics. This evaluation was not in favor of modifying our protocol of care i.e. the lack of performing neither antibiotic prophylaxis nor systematic urine culture before JJ ureteral stent removal in a selected population. 4.

Prospective trial of single-use, flexible cystoscope for ureteric double-J stent removal: Cost and utility analysis

Objective: The objective of this study is to evaluate the costs and benefits of Isiris (Coloplast, Denmark), a mobile, single-use, flexible cystoscope with a built-in stent grasper. Methods: A prospectively collected database was reviewed to define procedural outcomes for Isiris ureteric stent removal. Variables assessed included stent duration and location of removal. A cost assessment was performed evaluating the impact on costs, funding and facility use. Results: Seventy-five procedures were performed using Isiris between April and September 2017. There were no complications. Two procedures failed because of encrustation and poor visibility secondary to haematuria. The mean (SD), median (interquartile range) and range of delay were 2.1 (0–5.3), 0 (0–2) and 0–40 days, respectively. Only one patient was delayed more than two weeks; this occurred because he was placed on a theatre waiting list, which resulted in the 40-day delay. Overall, the cost benefit for our department with the introduction of the Isiris system has been a surplus of $104,434, with an extra 65 elective spaces free for diagnostic flexible cystoscopy cases. Conclusion: Isiris flexible stent removal offers our patients a rapid stent-removal service with low rates of removal delay. Savings have been made in scope repair costs, sterilisation and scope maintenance, as well as optimisation of theatre and procedure room space. Level of evidence: 1c

Extracorporeal shock wave lithotripsy versus ureteroscopy for management of pediatric nephrolithiasis in upper urinary tract stones: multi-institutional outcomes of efficacy and morbidity

As the incidence of pediatric nephrolithiasis rises, understanding the efficacy and morbidity of surgical treatment options is critical. Currently, there are limited comparative data assessing shock wave lithotripsy (SWL) and ureteroscopy (URS) outcomes in children. The objective of this study was to compare stone clearance, 30-day emergency department visits, and the number of general anesthetics required per stone treatment for both modalities. A multi-institutional retrospective review of children presenting for either URS or SWL between 2000 and 2017 was performed. Stone clearance, need for retreatment, the number of anesthetics, as well as the number and reason for emergency room visit were captured and compared between groups. Multivariate statistical analysis accounting for age, stone location, stone diameter, pre-intervention stent, and provider volume was performed for adjusted analysis. A total of 84 SWL and 175 URS procedures were included. Complete stone clearance and rates of residual stone fragments <4mm after final procedure for SWL were 77.0% and 90.8% and for URS were 78.5% and 91.7%, respectively. Retreatment rates for both procedures were not significantly different (17.9% SWL vs. 18.9% URS, P=0.85). Children who underwent SWL had lower rates of emergency room visits for infections (0% vs. 5.1%, P=0.03) and flank pain (3.6% vs. 10.9%, P=0.05)and required fewer general anesthetics per treatment (1.2 vs. 2.0, P<0.01) than those who underwent URS (Figure). Stone clearance after both the initial and final treatmentsand need for repeat interventionswere similar between surgical modalities. However, SWL carries less morbidity than URS. Specifically, patients who underwent SWL experienced lower rates of ED visits for urinary tract infection and for flank pain, parallel to conclusions in current comparative literature. In addition, SWL requires less general anesthetics (2.0 vs. 1.2), secondary to lower rates of ureteral stent placement and removal. Data on the potential risk of general anesthetics to neurodevelopment supportthoughtful utilization of these medications. Limitations of this study include its retrospective natureand the prolonged 20-year time period over which data were collected. When adjusting for confounders, SWL and URS achieve similar stone clearance. In the setting of equivalent efficacy, considerations regarding necessity of repeat interventions, morbidity of anesthesia, and complications should be integrated into clinical practice.

Pyelolithotomy in a Patient with Complete Coraliform Calcification Induced by a Double-J Ureteral Stent

The placement of a double-J ureteral stent enables the treatment of upper urinary tract obstruction. Despite advances, forgetting the stent favors the occurrence of calcification, leading to increased morbidity rates, lawsuits, and a financial burden on the healthcare system. This paper describes a successful pyelolithotomy for the removal of a calcified double-J ureteral stent.

Timing of Ureteric Stent Removal and Occurrence of Urological Complications after Kidney Transplantation: A Systematic Review and Meta-Analysis.

Implanting a ureteric stent during ureteroneocystostomy reduces the risk of leakage and ureteral stenosis after kidney transplantation (KTx), but it may also predispose to urinary tract infections (UTIs). The aim of this study is to determine the optimal timing for ureteric stent removal after KTx. Searches were performed in EMBASE, MEDLINE Ovid, Cochrane CENTRAL, Web of Science, and Google Scholar (until November 2017). For this systematic review, all aspects of the Cochrane Handbook for Interventional Systematic Reviews were followed and it was written based on the PRISMA-statement. Articles discussing JJ-stents (double-J stents) and their time of removal in relation to outcomes, UTIs, urinary leakage, ureteral stenosis or reintervention were included. One-thousand-and-forty-three articles were identified, of which fourteen articles (three randomised controlled trials, nine retrospective cohort studies, and two prospective cohort studies) were included (describing in total n = 3612 patients). Meta-analysis using random effect models showed a significant reduction of UTIs when stents were removed earlier than three weeks (OR 0.49, CI 95%, 0.33 to 0.75, p = 0.0009). Regarding incidence of urinary leakage, there was no significant difference between early (<3 weeks) and late stent removal (>3 weeks) (OR 0.60, CI 95%, 0.29 to 1.23, p = 0.16). Based on our results, earlier stent removal (<3 weeks) was associated with a decreased incidence of UTIs and did not show a higher incidence of urinary leakage compared to later removal (>3 weeks). We recommend that the routine removal of ureteric stents implanted during KTx should be performed around three weeks post-operatively.

Incidence and microbiology of post-operative infections after radical cystectomy and ureteral stent removal; a retrospective cohort study

BackgroundPost-operative infections are frequent after radical cystectomy with urinary diversion surgery (UDS). Reduction of post-operative infections necessitates appropriate peri-operative antimicrobial prophylaxis targeting causative bacteria. We assessed the incidence and microbiology of infections in the 30-day post-operative period after UDS and investigated effectiveness of the currently used peri-operative antibacterial prophylaxis.MethodsRetrospective cohort study of all patients undergoing UDS in a tertiary university medical center from January 2014 until September 2016. Antibiotic prophylaxis consisted of cefazolin plus metronidazol according to the Dutch national guideline. Primary outcome was the incidence of post-operative infections within 30 days. Risk factors for post-operative infections and antimicrobial susceptibility profiles of cultured bacteria were also assessed.Results147 patients were included. 69 patients (46.9%) had 82 post-operative infections, 27 of which were patients with bacteremia (18.4%). Highest incidence of infections was on day 4–5 and on day 8–10 postoperatively. The second peak was associated with ureteral stent removal. 4.8% of 147 study patients developed bacteremia 24 h after stent removal, which counted for 25.9% of all bacteremia episodes found in this study. Enterobacteriaceae were cultured in 67.9% of blood cultures and were only highly susceptible to ciprofloxacine, piperacillin-tazobactam (90%), meropenem and gentamicin (100%). Multivariate logistic regression analysis showed orthotopic Hautmann neobladder to be associated with increased infections complications: odds ratio 4.1 (95% confidence interval 1.6–10.5), p = 0.03.ConclusionsThe incidence of infections after radical cystectomy is high and particularly ureteral stent removal was associated with both bacteremia and complicated urinary tract infections. Based on the results of this study, antibiotic prophylaxis might need to be broadened for patients undergoing radical cystectomy. Further research is required to investigate whether current guidelines need to be altered concerning administration of antibiotic prophylaxis just before stent removal.

PD12-08 STENT DURATION AND INCREASED PAIN IN THE HOURS AFTER URETERAL STENT REMOVAL

INTRODUCTION AND OBJECTIVES:Causes of pain after ureteral stent removal are poorly understood. Stent duration may be a factor. We studied the relationship between pain after ureteral stent removal ...

Impact of Retained Ureteral Stents on Long-Term Renal Function.

The current literature does not provide any data regarding the rate of chronic kidney disease associated with retained ureteral stents. Thus, we determined the rates of major morbidities such as chronic kidney disease and severe urinary tract infection caused by retained stents. We retrospectively reviewed all records of patients at our institution who underwent ureteral stent placement and ureteral stent removal between January 2003 and October 2016. Of these patients 34 were diagnosed with a retained ureteral stent defined as a stent in place for more than 6 months. We selected 120 patients with a nonretained stent during this time frame to serve as a control group. Our primary end point was the rate of chronic kidney disease after ureteral stent removal. Median duration of ureteral stent in situ was 13.7 months (range 6.4 to 146.1) in the retained group vs 32 days (range 2 days to 5.1 months) in the control group. Of the retained group 9 patients (26.47%) with normal renal function before stent placement were diagnosed with chronic kidney disease after stent removal vs 4 (3.33%) in the control group (OR 8.64, 95% CI 2.05-41.9, p = 0.0009). Patient counseling and measures to ensure compliance with followup are of paramount importance after stent placement as patients with a retained ureteral stent are at risk for chronic kidney disease despite removal of the retained stent.

Feasibility research of remifentanil combined with propofol on ureteral stent removal under patient's sober state

Objective To investigate feasibility of remifentanil combined with propofol on ureteral stent removal under outpatient's sober state. Methods From October 2015 to April 2017, 60 outpatients with ureteral stent removal were selected in hospital(considering urethral physiologic characteristics of male patients, the research selected all patients as male), who were randomly divided into two groups, 30 cases in each group. Group A was remifentanil-propofol-lidocaine group. Group B was local infiltration anesthesia group. Changes of vital signs during the operation in two groups were observed, such as heart rate (HR), mean arterial pressure (MAP) , oxygen saturation (SPO2) at different time points of pre-anaesthesia (T1), post injection (T2), cystoscopy (T3), double-J tube (T4), 3 minutes after operation (T5). Operation time, postoperative left ventricular time, anesthesia effect, visual analogue score of pain, postoperative patients' satisfaction were compared between two groups. Results Patients in two groups were able to remove ureteral stent successfully. Hemodynamics in group A were more stable than group B. Anesthesia effect in group A was better than group B. VAS score in group A was lower than group B(P 0.05). There was no significant difference in operation time between two groups(P>0.05). Conclusions Remifentanil-propofol-lidocaine compound solution can be used safely in ureteral stent removal of outpatients, which has great clinical value. Key words: Ureter; Stents; Fentanyl; Propofol

Impact of ureteric stent removal by string on patient's quality of life and on complications at post-ureteroscopy for urolithiasis: a controlled trial.

To evaluate the impact of ureteric stent removal by string vs ureteric stent removal by cystoscope with regard to pain at ureteric stent removal, complications and quality of life, as well as patients' self-rated symptoms, after ureteroscopy (URS) for urolithiasis. Of 328 patients who underwent URS for upper urinary tract stones at our institution, 149 were randomly divided into a ureteric stent removal by string group (string group) and a ureteric stent removal by flexible cystoscope group (cystoscope group), using gender as a stratification factor. We focused on four sites, namely, the upper abdomen, bladder, flank and urethra, to evaluate the most painful site at stent removal. The primary endpoint was total pain scores for four sites at stent removal in the string group vs the cystoscope group. Secondary endpoints included comparison of the psychological well-being scores of patients using the five-item World Health Organization well-being index (WHO-5) preoperatively, pre-stent removal and 2 weeks after stent removal between the string group and cystoscope group. Of 149 patients analysed, 74 were in the string group and 75 were in the cystoscope group. In most patients, the ureteric stent was removed ~10 days after URS. The string group experienced significantly less pain than the cystoscope group (mean visual analogue scale [VAS] scores 2.73 vs 5.67; P < 0.001). Although VAS scores for women were not significantly different between the groups (P = 0.300), those for men were significantly lower in the string group (P < 0.001). In particular, men in the string group experienced significantly less urethral pain than those in the cystoscope group. The WHO-5 scores were not significantly different between the groups preoperatively, pre-stent removal or 2 weeks after stent removal. Stent string-related complications and self-rated symptoms were also not significantly different. Ureteric stent removal by string after URS led to significantly less pain than removal by cystoscope in men. Patients in the string group experienced no more complications in terms of urinary tract infections or accidental dislodgement than those in the cytoscope group.

Ureteral Obstruction in Endometriosis

Aim: Endometriosis is defined as functional endometrial glands and stroma that occur outside the uterine cavity. It is an estrogen dependent, benign, inflammatory disease that affects women during premenarcheal, reproductive and postmenopausal hormonal stages.&#x0D; Methods: This is a retrospective review of six cases with diagnosis of ureteral endometriosis. All the patients were referred to Department of Surgery, Kathmandu Model Hospital and the study period was from September 2015 to August 2018.&#x0D; Results: In our study all the patients had involvement of the ureter. All the patients who had undergone open surgery had extrinsic involvement of the ureter. Two patients who had mild distal ureteric stenosis only were managed by diagnostic URS and retrograde DJ stenting. Another two patients with right distal ureteric stenosis were managed initially with retrograde DJ stenting but after removal of ureteric stent and in subsequent follow up the degree of hydroureteronephrosis increased in both the cases. These two patients were finally undergone right Lich Gregoir ureteroneocystostomy. In the remaining two patients, ureterorenoscopy (URS) guided double J stenting were attempted but failed to insert the stent due to stenosed ureter so they underwent open abdominal hysterectomy with excision endometriotic cyst with ureterolysis and double J stenting.&#x0D; Conclusions: Ureteral endometriosis is a rare disease presenting most commonly with nonspecific symptoms and signs and thus making preoperative diagnosis often difficult for the clinicians. Treatment of ureteral endometriosis is primarily surgical. The surgical procedures which are usually performed are excision of all endometriosis lesion, ureterolysis, ureterectomy with ureteroureteral anastomosis and ureteroneocystomy.

Ureteral stent removal using an extraction string after uncomplicated ureteroscopy: a cost-benefit analysis.

Some urologists used the extraction strings for removal of ureteral stent without cystoscopy. While some urologists may have concern about perceived risks, including accidental dislodgement, infection, renal?colic?and lower urinary tract symptoms. Therefore, we performed a retrospective study to help address this conflict. Patients who had an indwelling ureteral stent with(n=58) or without(n=82) extraction strings inserted after ureteroscopy for unilateral ureteral stones were enrolled. For ureteral stent removal, the strings were pulled by physician, no string-stents were removed by cystoscopic. Postoperative morbidity was assessed. Patients' medicalexpense due to postoperative morbidity was collected. Patients with extraction string had shorter stent dwell time((5.3±1.8 versus 11.2±3.2 day, P= .001) and less cost (8.97±3.07 versus 455±0 CNY, P = .001)) for ureteral stent removal. However, six patients with extraction string had an accidental dislodgement, additional medical expenses were 345±137.9 CNY. There was no difference in the cost due to urinary tract infection, renal?colic?and LUTS between the two groups. The overall cost in patients without an extraction string was significantly more than in patients with an extraction string (86.7±167.7 versus 507.9±147.8 CNY, p =.008). Despite an increase in stent dislodgement related risks to the extraction string, it results in significant cost savings for patients, and most of patients remove with extraction stringsmightbenefit from it.INTRODUCTION Nowadays, most of urologists place an indwelling ureteral stent following uncomplicated ureteroscopy(URS). However, ureteral stent may impact quality of life (QoL) of patients. And the additional suffering due to cystoscopic extraction is even morepainful.Current ureteral stents are manufactured with a string attached to the distal end, allowing for removal without cystoscopy, which may lead to a reduction of the dwell time(usually less than one week)[1-8]. Although stent extraction strings have many advantages, more than two-thirds of urologists remove extraction strings prior to their insertion[9]. Surgeons who do not adopt?this?method?may have concern about perceived risks, including accidental dislodgement, infection, renal?colic?and lower urinary tract symptoms(LUTS). But how about incidence?rate of the risk aforementioned??does this increase the patient's financial burden compared with patients remove without extraction strings? Whether patients remove with extraction stringsmightbenefit from it? Therefore, we performed a retrospective study to help address these questions by comparing patients those who underwent ureteric stent placement with and without extraction strings after URS for stone disease.

Meta-analysis of Early Versus Late Ureteric Stent Removal After Kidney Transplantation

BackgroundUreteral stents have been widely used in kidney transplantation to prevent postoperative ureter-related complications such as ureteral stricture, ureteral obstruction, and ureteral leakage; however, a longer indwelling ureteral stent time corresponds to a greater risk of complications such as urinary tract infections. Currently, transplantation centers have not yet reached an agreement on the time to remove ureteral stents. Several randomized controlled trials (RCTs) have evaluated the optimal removal time for ureteral stents. ObjectiveThis meta-analysis was designed to evaluate and discuss the optimal removal time for ureteral stents after kidney transplantation. MethodWe used key words to search PubMed, Embase, and Cochrane Library and retrieve published articles. A total of 568 kidney transplantation patients from 5 RCTs were included in this meta-analysis. We collected information regarding postoperative complications related to indwelling stents, such as ureteral stricture, ureteral obstruction, ureteral leakage, and urinary tract infection, and evaluated whether early removal of ureteral stents (≤7 days) was superior to late removal (≥14 days). ResultsA significant difference was observed in the incidence of urinary tract infection between the early removal group and the late removal group (risk ratio [RR] = 0.43, 95% confidence interval [CI] [0.32, 0.59], P < .01). No significant between-group difference was observed in the incidence of major urological complications (MUCs) (RR = 1.87, 95% CI [0.45, 7.70], P > .05). ConclusionEarly removal of ureteral stents of transplanted kidneys after kidney transplantation (≤7 days) did not significantly increase the incidence of postoperative MUCs (ureteral stricture, ureteral obstruction, and ureteral leakage) relative to late removal (≥14 days). Early removal may significantly reduce the incidence of postoperative urinary tract infection relative to late removal.

Antibiotic prophylaxis is not associated with reduced urinary tract infection-related complications after cystectomy and ileal conduit.

OBJECTIVESMajority of complications after ileal conduit urinary diversion with cystectomy are related to urinary tract infections (UTIs). Controversy exists regarding use of prophylactic antibiotics after surgery. We determined if prophylactic antibiotic use during ureteral stent placement after ileal conduit urinary diversion decreased incidence of UTI-related complications.METHODSWe retrospectively identified 75 consecutive patients who underwent ileal conduit urinary diversion with cystectomy at our institution from 2010 to 2016. Patients were stratified based on presence or absence of a UTI-related complication in the 90-day postoperative period. Means were compared with independent t-test and proportions with chi-square analysis. Multivariate logistic regression was performed to determine independent predictors of UTI-related complications.RESULTSForty-five patients (60%) were prescribed prophylactic antibiotics after surgery. Mean duration of antibiotic use was 15 d, and mean duration of ureteral stenting was 25 d. Most common antibiotics used included fluoroquinolones (n = 23, 30.7%) followed by sulfamethoxazole-trimethoprim (n = 14, 18.7%). Rate of 90-day UTI-related complications was 36% (n = 27), and 90-day UTI-related readmission rate was 14.7% (n = 11). On bivariate and multivariate analysis, prophylactic antibiotic use was not associated with reduced 90-day UTI-related complications (P > 0.05). Patients prescribed prophylactic antibiotics had increased incidence of Clostridium difficile infections in the 90-day postoperative period compared to controls (20% vs. 3.3%; P = 0.038).CONCLUSIONSProphylactic antibiotic use after ileal conduit urinary diversion with cystectomy was not associated with reduced UTI-related complications, and rate of Clostridium difficile infections was higher in this patient cohort. The effect of early removal of ureteral stents on UTI risk still has to be elucidated.

Early Versus Delayed Double J Stent Removal in Deceased Donor Renal Transplant Recipients: A Prospective Comparative Study.

Introduction: Prophylactic ureteric stents have been commonly employed to reduce the incidence of ureteric obstruction and anastomotic leaks following renal transplantation. There are very few studies on the duration of ureteric stenting in deceased donor renal transplantation (DDRT). We performed a prospective study to compare early and late double J stent removal in DDRT.Aims and methods: The aim of this study was to compare the early and delayed removal of ureteric stents after DDRT. We performed 80 DDRTs at our center from August 2012 to December 2016, which were included in the study. However, we enrolled 48 patients as the remaining had to be excluded based on the high-risk factors. The recipients were allocated on the 14th postoperative day to two groups. Group 1 underwent early stent removal on the fourteenth postoperative day and in group 2, the stent was removed in the sixth postoperative week. The two groups were followed up for six months and the incidence of urological complications and urinary tract infections (UTI) was compared.Results: The incidence of UTI during the follow-up period of six months was significantly lower in the early stent removal group (two out of 24) than in delayed stent removal group (eight out of 24) (p=0.016). Asymptomatic bacteriuria occurred in six out of 24 (25%) in group 1 and 10 out of 24 (41.6%) in group 2 (p=0.120). There was no significant difference in the incidence of urinary leak, hematuria, or ureteric obstruction between the two groups (p=0.900). However, stent-related symptoms were significantly more in the delayed stent removal group (three in group 1 versus 18 in group 2) (p=0.001).Conclusion: Prolonged stenting is associated with an increased risk of UTI and stent-related symptoms in immunosuppressed renal transplant recipients. The early removal of double J stents can be done in carefully selected patients to reduce stent-related complications in DDRT.

Outpatient removal of ureteric stents in renal transplant patients improves patient outcomes

Outpatient removal of ureteric stents in renal transplant patients improves patient outcomes

Robot-assisted laparoscopic transplant-to-native ureteroureterostomy of an intraperitoneal renal allograft

The objective is to describe our experience with robot-assisted laparoscopic transplant-to-native ureteroureterostomy (UU) in a pediatric patient with an intraperitoneal renal allograft. We have previously demonstrated this technique for an extraperitoneal allograft. The patient is a 17-year-old female who had undergone a deceased donor renal transplant at 5 years of age. She developed acute kidney injury and hydronephrosis because of a ureteral stricture that developed after a right ovarian cyst excision. A retrograde pyelogram of her native ureter showed normal morphology. Her options were discussed and she proceeded with a robotic transplant-to-native UU. Robot-assisted laparoscopic transplant-to-native UU was performed via an intraperitoneal approach. The procedure time was 217min with an estimated blood loss of 10mL. Her postoperative course was unremarkable. After ureteral stent removal, her serum creatinine remained stable and follow-up imaging showed an improvement in hydronephrosis. Pediatric robot-assisted laparoscopic transplant-to-native UU for an intraperitoneal allograft is a technically feasible approach for the treatment of transplant ureteral strictures that combines the durability of open revision with the minimal invasiveness of endourologic management.

A survey of Canadian renal transplant surgeons: Use of ureteric stents and technique of the ureteroneocystotomy.

The role of ureteric stenting in renal transplant has been well-demonstrated. The goal of this survey was to determine the utilization of ureteric stents by Canadian transplant surgeons, and how the ureteroneocystotomy and followup is performed. An online survey was sent to the 40 surgeon members of the Canadian Society of Transplantation. The primary outcome was the rate of ureteric stent use at the time of renal transplantation. The secondary outcomes were the ureteric stent dwell time, use and type of prophylactic antibiotics, and the use of routine post-transplant ultrasonography. All respondents (25) used ureteric stent routinely and 92% remove the stent between four and six weeks postoperatively. Prophylactic antibiotics were used 64% of the time for ureteric stent removal. The majority of surgeons do not routinely perform a post-stent removal ultrasound. Fifty-six percent of respondents perform a refluxing anastomosis. Ureteric stents are routinely used in renal transplant in Canada. Areas for improvement and topics of debate identified from this survey are the need for peri-stent removal antibiotics, the role of post-stent removal ultrasound, the duration of stent dwell time, and the need for a non-refluxing ureteroneocystotomy.

Very Early Post-Operative Ureteral Stent Removal in Pediatric Kidney Transplantation

Very Early Post-Operative Ureteral Stent Removal in Pediatric Kidney Transplantation