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Stent-related ureteric obstruction in paediatric renal transplantation

Catherine M Simpson1, Jonathan A C Sterne, Rowan G Walker

  • 1Department of Nephrology, The Royal Children's Hospital, Flemington Road, 3052, Parkville, Melbourne, VIC, Australia. kate.simpson@mcri.edu.au

Pediatric Nephrology (Berlin, Germany)
|October 28, 2005
PubMed

Insights

Internal double-J stents significantly reduce ureteric obstruction in pediatric renal transplant patients compared to external stents. This leads to improved kidney function after stent removal, supporting their prophylactic use.

Area of Science:

  • Urology
  • Nephrology
  • Transplantation Surgery

Background:

  • Ureteric obstruction is a significant complication following pediatric renal transplantation.
  • Both externally draining uretero-vesico-cutaneous stents and internal uretero-vesical double-J stents are used to manage ureteric drainage.
  • Comparing the efficacy and complication rates of these stent types is crucial for optimizing patient outcomes.

Purpose of the Study:

  • To compare the rates of ureteric obstruction and complications between external stents and double-J stents in pediatric renal transplant recipients.
  • To evaluate the impact of different stent types on serum creatinine levels and glomerular filtration rate (GFR).

Main Methods:

  • A retrospective comparison of 55 pediatric renal transplant recipients (January 1996 - December 2003).
  • Group 1 (n=39) received external stents; Group 2 (n=16) received double-J stents.
  • Ureteric obstruction diagnosed by serum creatinine increase (>20%) and ultrasound evidence of hydronephrosis/hydroureter, excluding other causes.

Main Results:

  • Ureteric obstruction occurred in 33.3% of patients with external stents versus 6.25% with double-J stents (OR=7.5, P=0.038).
  • No significant difference in urinary tract infections or mean hospital stay between groups.
  • Glomerular filtration rate improved post-stent removal in the double-J stent group, but deteriorated in the external stent group (P=0.07).

Conclusions:

  • The use of prophylactic double-J stents in pediatric renal transplantation is supported due to decreased ureteric complications.
  • Double-J stents appear to improve renal function post-stent removal compared to external stents.
  • This non-randomized study highlights the benefit of internal stents for ureteric management in this population.

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