Prophylactic ureteric stents in renal transplant recipients: a multicentre randomised controlled trial of early versus late removal.
Patel P, Rebollo-Mesa I, et al.American Journal of Transplantation 2017; 11: 11.
Aims
To determine the optimal duration for stent removal post renal transplantation.
Interventions
Participants were randomised to either early stent removal (on day 5 without cystoscopy) versus late stent removal (6 weeks with cystoscopy).
Participants
227 patients aged 2-75 years scheduled for renal transplantation.
Outcomes
The primary outcome measured was a composite of transplant ureteric stent complications defined as pain, urinary tract infection, haematuria, fragmentation and migration. Secondary outcomes measured included major urological complications, health status and patient acceptability.
Follow-up
6 months
CET Conclusions
This interesting study investigated the impact of early (day 5) versus late (week 6) ureteric stent removal in adult and paediatric renal transplant recipients. The authors report increased incidence of stent-related complications with late removal, mainly due to increased incidence of urinary tract infection, supporting the early removal of stents. It should be noted that there was a numerical (but not significant) increase in major and intermediate ureteric complications (stenosis, leak, temporary obstruction) in the early removal group. Whilst the results appear to support the early removal of stents, there are some limitations to note. Firstly, a number of randomised patients did not undergo early removal due to technical difficulties connecting the stent to the catheter. When analysed as intent-to-treat, the difference in stent-related complications did not quite reach significance. This may represent a technical learning curve and be improved with more experience. Secondly, whilst there was a protocol for urine sampling for infection and a clear definition provided, the number of samples analysed in each group is not reported. As the study is unblinded, it is possible that some measurement bias exists. Finally, longer-term follow-up for late ureteric stenoses will be important to ensure that there are no long-term effects of early removal.
Data analysis
Available case analysis
Trial registration
ISRCTN09184595