Early Removal of Ureteric Stent Reduces UTIs in Kidney Transplant Recipients

10 Mar, 22

Introduction

Ureteric stent may help reduce the major urologic complications (MUCs) but increase the risk of urinary tract infections (UTIs) in kidney transplant recipients. There is no consensus on the optimal timing for removal of ureteric stent among the surgeons.

Aim

This systematic review and meta-analysis was conducted to identify the optimal timing of ureteric stent removal after kidney transplant.

Method

Study Design

Systematic review and meta-analysis.

Treatment Strategy

Extensive literature search using the Cochrane Central Register of Controlled Trials, PubMed, and Embase databases was performed.
Randomized clinical trials that evaluated the timing of stent removal after kidney transplant were included.
Patients with early versus late stent removal were compared.

Endpoints

Timing of ureteric stent removal
Incidence of UTIs
Incidence of MUCs

Results

The meta-analysis included 7 RCTs, which included 1277 patients.
There were significant differences between early versus late stent removal groups in the development of UTIs, favoring early stent removal; relative risk (RR) of 0.42; p<0.001.
With consideration of high heterogeneity, a subgroup analysis of incidence of UTIs was conducted using 2 timelines: 2 weeks and 3 weeks.
The results of this subgroup analysis were consistent with the previous conclusion and favored the early stent removal; with RR of 0.36 and 0.35, at 2 and 3 weeks respectively; P < 0.001 for both.
There were no significant differences in the incidence of MUCs between early and late stent removal; odds ratio (OR) at 2 and 3 weeks of 2.79 and 1.97, respectively; p=0.18 and p=0.26, respectively.
With regards to development of urinary leakage, there were also no significant differences between groups (OR at 2 weeks of 3.02, p=0.18; and RR at 3 weeks of 2.00, p=0.27).
Only 3 cases of ureteral stenosis were reported in the late stent removal group.

Conclusion

The meta-analysis concluded that early ureteral stent removal, not later than 3 weeks, could significantly decrease the incidence of urinary tract infections without affecting incidence of major urological complications.
The researchers of this study recommend 14 to 21 days as the optimal timing of ureteric stent removal in kidney transplant recipients.

Exp Clin Transplant. 2022 Jan;20(1):28-34. Doi: 10.6002/ect.2021.0183.