EFFECTS OF USING A DOUBLE J STENT AFTER RENAL TRANSPLANTATION

Abstract

Abstract

Introduction: In modern urology, ureteral stents are playing significant role in avoiding complications

after endoscopic or open surgery. In this study, the association between double J stent and ureteral

complications, urinary tract infections and creatinine levels in renal transplant recipients after renal

transplantation was prospectively assessed.

Materials and Methods: Between January 2002 and March 2005, 60 recipients after renal transplantation

from relative living donors in Cukurova University were observed prospectively. Lich-Gregoir reimplantation

was used as ureteroneocystostomy technique. 4.8 French 12 cm double J stent was placed in 30 recipients

(Group I). No double J stent was placed in 30 recipients (Group II). Double J stents were removed 14 days

after renal transplantation. More than 105 colonies of bacteria in urine culture were considered as urinary

tract infection. The creatinine levels and urine volumes of recipients were documented for 7 days

postoperatively.

Results: There was no difference between two groups according to age, sex, donor’s age, operation time

and cold ischemia time. Ureteral complications were seen in 6 recipients in group II (no double J) while no

complication was seen in group I (p=0.024). Urinary tract infection occurred in 6 recipients in group I and in 3

recipients in group II (p=0.72). The average creatinine level in group I was lower than group II in

postoperative 1st, 2nd and 3rd days (p=0.024, p=0.029 and p=0.041) while there was no significant difference

preoperatively (p=0.688). There was no significant difference between two groups in after postoperative 4th,

5th, 6th and 7th days (all p>0.05). The average urine volume in group I was more than group II in postoperative

1st day (p=0.017).

Conclusion: Ureteral complications after renal transplantation may cause graft loss and mortality. The

ureteral stents were used successfully to avoid and reduce the complications. Some centers have suggested that

brief stenting could stop minor leakage due to partial disruption of the ureterovesical anastomosis and prevent

early obstruction secondary to anastomotic edema or small tunnel hematoma. However, using double J stent

routinely was not suggested in some centers because of the stent complications like urinary tract infection,

hematuria, stent migration, stone formation, frequency, flank pain, suprapubic pain, dysuria, reflux, stent

fracture. As a result, we believe that the double J stents have a significant role in avoiding the ureteral

complication and in forming the ureterovesical anastomosis. However, double J stents have to be removed as

soon as possible in the recipients who are under serious immunosupressive treatment. Further studies with

larger series are necessary to confirm these results.