BERKELEY, CA (UroToday.com) - Certain modalities of treatment might improve outcomes in certain situations, but we must resist the temptation to employ a blanket policy of using that method for all patients. Application of such policies must only happen after clear demonstration of evidence of benefit. Ureteric stenting at renal transplantation has become the standard practice in many centres, but in light of the incidence of urinary tract infections, we felt a review of the results and complication rates at our centre would be useful as some surgeons were practising selective stenting while others used stents in all cases.
An increase in the infection rate was expected, but we found that there was no significant difference in the perceived benefits of stenting, i.e., leak rates and ureteric stenosis rates. In fact the only patient with ureteric necrosis had also been stented.
More significantly, all the cases with a major urological infection (MUI, including complicated UTI, pyelonephritis and urosepsis with or without bacteraemia) occurred in the stented group. This implies a higher risk to patients themselves in addition to their grafts.
Finally there was a significant decrease in patients' eGFR at 12 months if they had suffered from a urinary tract infection; this could mean poorer long-term function, but a much longer follow up would be required for this purpose.
Points to note:
Due to selective stenting, some of the patients with complications after stenting might be explained by the higher-risk profile in their cases (e.g., thin walled ureter, stripped ureter, and multiple arteries, especially with small lower polar arteries or arterial injury, or recipient bladder anomalies). Overall, this report should cause routine stenters to rethink their practice. We believe that such measures as use of an optimum length of well-vascularised ureter, a wider anastomotic ostium (reflux has not been an issue), and careful anastomotic technique should eliminate the need for routine stenting.
Jacob A. Akoh and Tahawar Rana as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.
South West Transplant Centre, Plymouth Hospitals NHS Trust, Derriford Hospital, Plymouth PL6 8DH, United Kingdom