Is routine ureteric stenting needed in kidney transplantation? A randomized trial. Renal transplantation using ureteral stents. Urologic complications after renal transplantation: a prospective randomized trial comparing different techniques of ureteric anastomosis and the use of prophylactic ureteric stents. Significance of routine JJ stenting in living related renal transplantation: a prospective randomised study. Insertion of a double pigtail ureteral stent for the prevention of urological complications in renal transplantation: a prospective randomized study. Routine insertion of ureteral stent in live-donor renal transplantation: is it worthwhile?
Whether routine ureteric stenting in low-urological-risk patients reduces the risk of urological complications in kidney transplantation is not established.
                Eligible patients were recipients of single-organ renal transplants with normal lower urinary tracts. Patients were randomized intraoperatively to receive either routine stenting or stenting only in the event of technical difficulties with the anastomosis. All patients underwent Lich-Gregoire ureteroneocystostomy.
                Between June 1994 and December 1997, 331 kidney transplants were performed at a single center, 305 patients were eligible, and 280 patients were enrolled and randomized. Donor and recipient age, sex, donor source, whether first or subsequent grafts, ureteric length, native renal disease, and immunosuppression were similar in each group. In the no-routine-stenting group 6 of 137 patients (4.4%) received stents after randomization for intraoperative events that in the surgeon's opinion required use of a stent. In an intention-to-treat analysis there was no difference between groups in the primary outcome cluster of obstruction or leak [routine stenting 5 of 143 (3.5%) vs. no routine stenting 9 of 137 (6.6%); P=0.23], or in either of these complications analyzed separately. All urological complications were successfully managed without major morbidity. Living donor organs and shorter ureteric length (after trimming) were univariate risk factors for leaks, although increasing donor age was associated with obstruction.
                Routine ureteric stenting is unnecessary in kidney transplantation in patients at low risk for urological complications. Careful surgical technique with selective stenting of problematic anastomoses yields similar results. nan nan nan Urologists successfully use ureteral stents to protect the ureterovesical anastomosis in nontransplant patients.
                We determined the value of ureteral stents in transplant patients. The frequency of urological complications (leaks, obstructions and urinary tract infections) was compared in a prospective randomized series of 194 kidney transplantations (97 with and 97 without a double pigtail ureteral stent).
                In the stent group 1 patient had a urinary leak and 35 had urinary tract infections (including 2 cases of Corynebacterium cystitis). In the no stent group 6 patients had urinary leaks, 4 had obstructions and 32 had urinary tract infections. The 1-year patient and graft survival rates were similar in both groups, and renal function at 1 year was also similar (229 versus 208 mumol./l. creatinine in the stent and no stent groups, respectively). A small number of stent related complications occurred (2 stent breakages and 1 stent migration). No stones formed in any case.
                Ureteral stent insertion significantly decreases the rate of vesicoureteral leakage and obstruction in renal transplantation. To evaluate the impact of the routine use of double-J stents in live-donor renal transplantation at a single institute from a prospective randomized study.
                A total of 100 patients were prospectively randomized into two groups of 50 patients each. Group 1 received a routine double-J silicone ureteral stent and group 2 did not. A standard Lich-Gregoir ureteroneocystostomy was performed in both groups. In group 1, the patients were scheduled for stent removal after 2 weeks.
                Both groups were comparable in terms of age, sex, ischemia time, number of renal arteries, and time to diuresis. In group 1, two grafts were lost in the early postoperative period and those patients were excluded from the final analysis. None of our patients in either group had developed a ureteral stricture at a mean follow-up of 10.8 +/- 3.6 months. In the stented group, 2 patients developed a urinary leak, but no leakage was reported in the nonstented group (P = 0.14). Although 19 patients in group 1 (39.6%) had a urinary tract infection, only 9 in group 2 (18%) showed evidence of a positive urine culture (P = 0.02). The presence of a ureteral stent and female sex were the independent predictors of postoperative urinary tract infection on multivariate analysis. The mean serum creatinine at discharge was 1.2 +/- 0.3 mg% and 1.2 +/- 0.4 mg% in groups 1 and 2, respectively (P = 0.2).
                The results of our study have shown that routine ureteral stent insertion has no impact on the rate of vesicoureteral leakage or obstruction in live-donor renal transplantation, whereas it is significantly associated with an increased incidence of urinary tract infection. Stenting should be limited to patients with a pathologic and/or defunctionalized bladder.
Routine prophylactic stenting reduces the incidence of MUCs. Studies comparing selective stenting and universal prophylactic stenting, whilst difficult to design and analyse, would address the unresolved quality of life and economic issues.