Evaluation of the urological complications of living related renal transplantation at a single center during the last 10 years: impact of the Double-J* stent.

PURPOSE: We evaluated the impact of the routine use of Double-J stents for decreasing urological complications in living related renal transplantation at a single center during the last 10 years.

MATERIALS AND METHODS: Our 3-phase longitudinal study included 670 consecutive living related renal transplants from 1989 to 1998. In phase 1 from 1989 to 1993 a stent was introduced as and when required in only 15 of 170 patients. In phase 2 from January 1994 to April 1995 we randomized 57 and 43 cases to stenting and no stenting, respectively. The stent was removed after 4 weeks. In phase 3 from May 1995 to December 1998 all patients received a stent, which was removed 10 to 14 days just before discharge home. We reviewed urological complications at various time frames to determine the impact of routine Double-J stenting on decreasing urological complications.

RESULTS: In phase 1 the major ureteral complication rate was 8.8%, which decreased to 3% in phase 2 when half of our cases were stented. In phase 3 there was only 1 ureteral complication (0.04%) in 400 patients, of whom all received a stent. The overall ureteral complication rate in nonstented and stented cases was 8.5% (18 of 213) and 0.22% (1 of 457). There was no difference in urological complications or stent related problems whether the stent was removed at 4 or 2 weeks. However, stent removal at 2 weeks eliminated the possibility of a forgotten stent, avoided repeat hospitalization for stent removal and decreased the cost. Routine stenting was cost-effective and almost eliminated urological complications.

CONCLUSIONS: Routine Double-J stenting prevents ureteral complications. Early removal at 2 weeks is advisable. The short duration of stenting is effective and saves the cost of repeat hospitalization at a later date.