Routine Stenting of Extravesical Ureteroneocystostomy in Kidney Transplantation: A Systematic Review and...

Area of Science:

• Nephrology
• Urology
• Transplantation Surgery

Background:

• Major urologic complications (MUC) in kidney transplantation can lead to severe morbidity and graft loss.
• Ureteric stents are commonly employed to prevent MUC, but their use is associated with potential complications.
• Extravesical ureteric implantation is a common surgical technique in kidney transplantation.

Purpose of the Study:

• To systematically review and meta-analyze the role of routine ureteric stenting in preventing MUC after kidney transplantation with extravesical ureteric implantation.
• To evaluate the impact of routine stenting on specific complications such as urinary leak, obstruction, and urinary tract infections.

Main Methods:

• Systematic review and meta-analysis of 6 randomized controlled trials.
• Literature search conducted on PubMed for relevant studies.
• Statistical analysis performed using RevMan 5 with the Cochran-Mantel-Haenszel test and random effect model.

Main Results:

• Routine ureteric stenting did not significantly decrease the incidence of urinary leak (OR, 0.39; P = .08).
• Stent use also did not significantly reduce the incidence of ureteric obstruction (OR, 0.41; P = .11).
• A significantly higher incidence of urinary tract infections was observed in patients who received ureteric stents (OR, 3.59; P = .01).

Conclusions:

• Routine ureteric stenting has a limited role in preventing major urologic complications in kidney transplantation using extravesical ureteric anastomosis.
• The practice may be associated with an increased risk of urinary tract infections.
• Current evidence suggests reconsidering the routine use of ureteric stents in this patient population.