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

1
Imperial College Renal and Transplant Centre, Imperial College NHS Healthcare Trust, Hammersmith Hospital, London W12 0HS, UK
2
Department of Surgery and Cancer, Imperial College, London W12 0HS, UK
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2019, 8(5), 689; https://doi.org/10.3390/jcm8050689
Received: 23 April 2019 / Revised: 10 May 2019 / Accepted: 13 May 2019 / Published: 16 May 2019
(This article belongs to the Special Issue Recent Advances and Clinical Outcomes of Kidney Transplantation)
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Abstract

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. View Full-Text
Keywords: kidney transplantation; urological complications; ureteric stent; urinary tract infection; timing of removal kidney transplantation; urological complications; ureteric stent; urinary tract infection; timing of removal
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Visser, I.J.; van der Staaij, J.P.T.; Muthusamy, A.; Willicombe, M.; Lafranca, J.A.; Dor, F.J.M.F. Timing of Ureteric Stent Removal and Occurrence of Urological Complications after Kidney Transplantation: A Systematic Review and Meta-Analysis. J. Clin. Med. 2019, 8, 689.

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