Timing of Ureteric Stent Removal and Occurrence of Urological Complications after Kidney Transplantation: A Systematic Review and Meta-Analysis

Implanting a ureteric stent during ureteroneocystostomy reduces the risk of leakage and ureteral stenosis after kidney transplantation (KTx), but it may also predispose to urinary tract infections (UTIs). The aim of this study is to determine the optimal timing for ureteric stent removal after KTx. Searches were performed in EMBASE, MEDLINE Ovid, Cochrane CENTRAL, Web of Science, and Google Scholar (until November 2017). For this systematic review, all aspects of the Cochrane Handbook for Interventional Systematic Reviews were followed and it was written based on the PRISMA-statement. Articles discussing JJ-stents (double-J stents) and their time of removal in relation to outcomes, UTIs, urinary leakage, ureteral stenosis or reintervention were included. One-thousand-and-forty-three articles were identified, of which fourteen articles (three randomised controlled trials, nine retrospective cohort studies, and two prospective cohort studies) were included (describing in total n = 3612 patients). Meta-analysis using random effect models showed a significant reduction of UTIs when stents were removed earlier than three weeks (OR 0.49, CI 95%, 0.33 to 0.75, p = 0.0009). Regarding incidence of urinary leakage, there was no significant difference between early (<3 weeks) and late stent removal (>3 weeks) (OR 0.60, CI 95%, 0.29 to 1.23, p = 0.16). Based on our results, earlier stent removal (<3 weeks) was associated with a decreased incidence of UTIs and did not show a higher incidence of urinary leakage compared to later removal (>3 weeks). We recommend that the routine removal of ureteric stents implanted during KTx should be performed around three weeks post-operatively.

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Respiratory tract infections and gut microbiome modifications: A systematic review

PLoS ONE ◽

10.1371/journal.pone.0262057 ◽

2022 ◽

Vol 17 (1) ◽

pp. e0262057

Author(s):

Claire A. Woodall ◽

Luke J. McGeoch ◽

Alastair D. Hay ◽

Ashley Hammond

Keyword(s):

Systematic Review ◽

Respiratory Tract ◽

Cohort Studies ◽

Gut Microbiome ◽

Respiratory Tract Infections ◽

Respiratory Health ◽

Meta Analysis ◽

Bacterial Pathogen ◽

Healthy Controls ◽

Tract Infections

Respiratory tract infections (RTIs) are extremely common and can cause gastrointestinal tract symptoms and changes to the gut microbiota, yet these effects are poorly understood. We conducted a systematic review to evaluate the reported evidence of gut microbiome alterations in patients with a RTI compared to healthy controls (PROSPERO: CRD42019138853). We systematically searched Medline, Embase, Web of Science, Cochrane and the Clinical Trial Database for studies published between January 2015 and June 2021. Studies were eligible for inclusion if they were human cohorts describing the gut microbiome in patients with an RTI compared to healthy controls and the infection was caused by a viral or bacterial pathogen. Dual data screening and extraction with narrative synthesis was performed. We identified 1,593 articles and assessed 11 full texts for inclusion. Included studies (some nested) reported gut microbiome changes in the context of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) (n = 5), influenza (H1N1 and H7N9) (n = 2), Tuberculosis (TB) (n = 4), Community-Acquired Pneumonia CAP (n = 2) and recurrent RTIs (rRTI) (n = 1) infections. We found studies of patients with an RTI compared to controls reported a decrease in gut microbiome diversity (Shannon) of 1.45 units (95% CI, 0.15–2.50 [p, <0.0001]) and a lower abundance of taxa (p, 0.0086). Meta-analysis of the Shannon value showed considerable heterogeneity between studies (I2, 94.42). Unbiased analysis displayed as a funnel plot revealed a depletion of Lachnospiraceae, Ruminococcaceae and Ruminococcus and enrichment of Enterococcus. There was an important absence in the lack of cohort studies reporting gut microbiome changes and high heterogeneity between studies may be explained by variations in microbiome methods and confounder effects. Further human cohort studies are needed to understand RTI-induced gut microbiome changes to better understand interplay between microbes and respiratory health.

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The Impact of Timing of Stent Removal on the Incidence of UTI, Recurrence, Symptomatology, Resistance, and Hospitalization in Renal Transplant Recipients

Journal of Transplantation ◽

10.1155/2021/3428260 ◽

2021 ◽

Vol 2021 ◽

pp. 1-8

Author(s):

Ziad Arabi ◽

Khalefa Al Thiab ◽

Abdulrahman Altheaby ◽

Mohammed Tawhari ◽

Ghaleb Aboalsamh ◽

...

Keyword(s):

Renal Transplantation ◽

Group Versus ◽

Renal Transplant Recipients ◽

Ureteric Stent ◽

Stent Removal ◽

Urological Complications ◽

Tract Infections ◽

The Impact ◽

Removal Group

Purpose. To evaluate the impact of early (<3 weeks) versus late (>3 weeks) urinary stent removal on urinary tract infections (UTIs) post renal transplantation. Methods. A retrospective study was performed including all adult renal transplants who were transplanted between January 2017 and May 2020 with a minimum of 6-month follow-up at King Abdulaziz Medical City, Riyadh, Saudi Arabia. Results. A total of 279 kidney recipients included in the study were stratified into 114 in the early stent removal group (ESR) and 165 in the late stent removal group (LSR). Mean age was 43.4 ± 15.8; women: n: 114, 40.90%; and deceased donor transplant: n: 55, 19.70%. Mean stent removal time was 35.3 ± 28.0 days posttransplant (14.1 ± 4.6 days in the ESR versus 49.9 ± 28.1 days in LSR, p < 0.001 ). Seventy-four UTIs were diagnosed while the stents were in vivo or up to two weeks after the stent removal “UTIs related to the stent” (n = 20, 17.5% in ESR versus n = 54, 32.7% in LSR; p = 0.006 ). By six months after transplantation, there were 97 UTIs (n = 36, 31.6% UTIs in ESR versus n = 61, 37% in LSR; p = 0.373 ). Compared with UTIs diagnosed after stent removal, UTIs diagnosed while the stent was still in vivo tended to be complicated (17.9% versus 4.9%, p : 0.019), recurrent (66.1% versus 46.3%; p : 0.063), associated with bacteremia (10.7% versus 0%; p : 0.019), and requiring hospitalization (61% versus 24%, p : 0.024). Early stent removal decreased the need for expedited stent removal due to UTI reasons (rate of UTIs before stent removal) (n = 11, 9% in the early group versus n = 45, 27% in the late group; p = 0.001 ). The effect on the rate of multidrug-resistant organisms (MDRO) was less clear (33% versus 47%, p : 0.205). Early stent removal was associated with a statistically significant reduction in the incidence of UTIs related to the stent (HR = 0.505, 95% CI: 0.302-0.844, p = 0.009 ) without increasing the incidence of urological complications. Removing the stent before 21 days posttransplantation decreased UTIs related to stent (aOR: 0.403, CI: 0.218-0.744). Removing the stent before 14 days may even further decrease the risk of UTIs (aOR: 0.311, CI: 0.035- 2.726). Conclusion. Early ureteric stent removal defined as less than 21 days post renal transplantation reduced the incidence of UTIs related to stent without increasing the incidence of urological complications. UTIs occurring while the ureteric stent still in vivo were notably associated with bacteremia and hospitalization. A randomized trial will be required to further determine the best timing for stent removal.

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The Utility of Routine Ultrasound Imaging after Elective Transplant Ureteric Stent Removal

Journal of Transplantation ◽

10.1155/2016/1231567 ◽

2016 ◽

Vol 2016 ◽

pp. 1-6 ◽

Cited By ~ 2

Author(s):

Bibek Das ◽

Dorian Hobday ◽

Jonathon Olsburgh ◽

Chris Callaghan

Keyword(s):

Kidney Transplantation ◽

Added Value ◽

Stent Insertion ◽

Renal Transplant Recipients ◽

Transplant Recipients ◽

Renal Imaging ◽

Ureteric Stent ◽

Stent Removal ◽

Urological Complications ◽

Repeat Imaging

Background. Ureteric stent insertion during kidney transplantation reduces the incidence of major urological complications (MUCs). We evaluated whether routine poststent removal graft ultrasonography (PSRGU) was useful in detecting MUCs before they became clinically or biochemically apparent.Methods. A retrospective analysis was undertaken of clinical outcomes following elective stent removals from adult single renal transplant recipients (sRTRs) at our centre between 1 January 2011 and 31 December 2013.Results. Elective stent removal was performed for 338 sRTRs. Of these patients, 222 had routine PSRGU (median (IQR) days after stent removal = 18 (11–31)), 79 had urgent PSRGU due to clinical or biochemical indications, 12 had CT imaging, and 25 had no further renal imaging. Of the 222 sRTRs who underwent routine PSRGU, 210 (94.6%) had no change of management, three (1.4%) required repeat imaging only, and eight patients (3.6%) had incidental (nonureteric) findings. One patient (0.5%) had nephrostomy insertion as a result of routine PSRGU findings, but no ureteric stenosis was identified. Of 79 patients having urgent PSRGU after elective stent removal, three patients required transplant ureteric reimplantation.Conclusions. This analysis found no evidence that routine PSRGU at two to three weeks after elective stent removal provides any added value beyond standard clinical and biochemical monitoring.

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Meta-analysis of Early Versus Late Ureteric Stent Removal After Kidney Transplantation

Transplantation Proceedings ◽

10.1016/j.transproceed.2018.08.033 ◽

2018 ◽

Vol 50 (10) ◽

pp. 3411-3415 ◽

Cited By ~ 1

Author(s):

J.-F. Cai ◽

W. Wang ◽

W. Hao ◽

Z.-J. Sun ◽

L.-L. Su ◽

...

Keyword(s):

Kidney Transplantation ◽

Meta Analysis ◽

Ureteric Stent ◽

Stent Removal

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Uretero-vesical anastomotic techniques for kidney transplantation and urological complications: A systematic review and meta-analysis

Transplant Immunology ◽

10.1016/j.trim.2014.11.111 ◽

2014 ◽

Vol 31 (4) ◽

pp. 219

Author(s):

V.P. Alberts ◽

M.M. Idu ◽

D.A. Legemate ◽

M.P. Laguna Pes ◽

R.C. Minnee

Keyword(s):

Systematic Review ◽

Kidney Transplantation ◽

Meta Analysis ◽

Urological Complications ◽

Anastomotic Techniques

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Use of double J stent in kidney transplantation: a single-center cohort report

Ukrainian Journal of Nephrology and Dialysis ◽

10.31450/ukrjnd.3(63).2019.02 ◽

2019 ◽

pp. 17-21

Author(s):

Gokhan Ertugrul ◽

Tumay Yanaral

Keyword(s):

Kidney Transplantation ◽

Urinary Leakage ◽

Removal Time ◽

Urologic Complications ◽

Urinary Infections ◽

Double J Stent ◽

Urological Complications ◽

Tract Infections ◽

End Stage

Kidney transplantation is the treatment of choice for end-stage kidney disease.The double J stent is commonly used in kidney transplantation.The incidence of urologic complications varies between 0.22 % and 30 %. Ureteral strictures and urinary leakage are the most common urological complications after kidney transplantation. Use of the double J stent can decrease urological complications after kidney transplantation. However, the double J stent can increase urinary tract infections, suprapubic pain and urinary incontinence. This study aimed to evaluate the outcomes of the use of double J stent in kidney transplantation. Methods. Between April 2014 and April 2019 130 patients with the use of double J stent were studied retrospectively at Medipol University Medical Faculty Hospital Organ Transplantation Department, Istanbul, Turkey. In these patients, demographic features, clinical features and urologic complications were evaluated. Results. The mean age of the patients was 38.3 ± 15.6 years. 84 (67 %) patients were males and 46 (33 %) were females. Mean follow-up was 29.1 ± 15 months. Mean double J stent removal time was 31.3 ± 2.2 days. During follow-up, there were no ureteral strictures and urinary leakage. Urinary infections were diagnosed in 5 (3.8 %) patients. Conclusions. Use of double J stent appears to be successful to prevent the urological complications in kidney transplantation.

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