Factors affecting the difficulty of transurethral double J stent removal in patients with renal transplants

This study aimed to identify factors affecting the difficulty of transurethral double J (JJ) stent removal in patients with renal transplants, using fluoroscopy time as a surrogate for procedural difficulty.

Between January 2016 and November 2023, transurethral stent removal was attempted in 996 procedures (342 women, mean age 53.1 years). The following potential predictors of fluoroscopy time were investigated using bivariate analysis: patient age, sex, performance of the procedure by an attending physician alone, time from stent placement to removal, configuration and location of stent loop in the bladder, and device used for removal. For each stent retrieval device type, a multivariable model was created, including covariates of interest.

Stent removal was technically successful in 99.2% of procedures. The mean fluoroscopy time for successful removals was 4.9 minutes (range 0.1-39.6 minutes). There were 5 adverse events (5/996, 0.5%), consisting of 3 moderate and 2 mild severity events. A complex snare was used in 72.5% of procedures, a simple snare in 6.0%, a looped guidewire in 31.6%, and forceps in 2.5%; multiple devices were used in 11.9% of procedures. Patient sex, number of intravesicular stent loops, and use of a simple snare, looped guidewire, and forceps predicted fluoroscopy time in bivariate analyses. In multivariable models, mean fluoroscopy time was estimated to be 0.78 minutes less when a complex snare was used (P = 0.018), 1.87 minutes greater when a simple snare was used (P = 0.002), and 0.86 minutes greater when a looped guidewire was used (P = 0.014); the use of forceps was not significant. When procedures using multiple devices were excluded, only the use of a complex snare and looped guidewire remained significant.

Transurethral JJ stent removal has a high success rate and can be performed with a single device in most cases. Use of complex snares and looped guidewires is associated with decreased and increased fluoroscopy time, respectively, suggesting that use of these devices may impact procedural difficulty.

These results demonstrate that fluoroscopically guided transurethral JJ stent retrieval is an efficient technique that may be offered instead of cystoscopic stent removal. Careful choice of removal device may improve speed and ease of transurethral stent retrieval.