Indu K N, Lakshminarayana G, Anil M, Rajesh R, George K, Ginil K, Georgy M, Nair B, Sudhindran S, Appu T, Unni V N, Sanjeevan K V
Department of Nephrology, Amrita Institute of Medical Sciences and Research Centre, Kochi, India.
Indian J Nephrol. 2012 Jul;22(4):275-9. doi: 10.4103/0971-4065.101247.
Prophylactic ureteric stenting has been shown to reduce ureteric leaks and collecting system obstruction following renal transplantation and is in widespread use. However, the optimal time for removal of ureteric stents after renal transplantation remains unclear. Aim of this study was to compare the result of early versus late removal of ureteric stents after kidney transplantation of the laparoscopically retrieved live related donor grafts. Eligible patients were live donor kidney transplant recipients with normal urinary tracts. All recipients underwent extravesical Lich-Gregoire ureteroneocystostomy over 4F/160 cm polyurethane double J stents by a uniform technique. They were randomized on seventh postoperative day for early removal of stents on postoperative day 7 (Group I), or for late removal on postoperative day 28 (Group II). The incidence of urinary tract infections, asymptomatic bacteriuria, and urological complications were compared. Between 2007 and 2009, 130 kidney transplants were performed at one centre of which 100 were enrolled for the study, and 50 each were randomized into the two groups. Donor and recipient age, sex, native renal disease, immunosupression, number of rejection episodes, and antirejection therapy were similar in the two groups. The occurrence of symptomatic urinary tract infection during the follow-up period of 6 months was significantly less in the early stent removal group [5 out of 50 (10%) in Group I, vs 50 out of 15 (30%) in Group II, P=0.02]. Asymptomatic bacteriuria was documented in 2 out of 50 (4%) in Group I and 4 out of 50 (8%) in Group II (P=0.3). There was no statistically significant difference in the rate of ureteric leak, ureteric obstruction, or hematuria in the two groups (P=1.0). We conclude that, in kidney transplant recipients of laparoscopically retrieved live donor grafts, early stent removal at the end of first week reduces the incidence of urinary tract infection without increasing the rate of urine leak or ureteric obstruction.
预防性输尿管支架置入已被证明可减少肾移植后输尿管漏和集合系统梗阻，且应用广泛。然而，肾移植后输尿管支架的最佳拔除时间仍不明确。本研究的目的是比较腹腔镜获取的活体亲属供肾移植术后早期与晚期拔除输尿管支架的结果。符合条件的患者为尿路正常的活体供肾移植受者。所有受者均通过统一技术在4F/160 cm聚氨酯双J支架上进行膀胱外Lich-Gregoire输尿管膀胱吻合术。他们在术后第7天被随机分组，一组在术后第7天早期拔除支架（第一组），另一组在术后第28天晚期拔除支架（第二组）。比较两组的尿路感染、无症状菌尿和泌尿系统并发症的发生率。2007年至2009年期间，一个中心进行了130例肾移植手术，其中100例纳入研究，每组随机分配50例。两组的供体和受体年龄、性别、原发病肾病、免疫抑制、排斥反应次数和抗排斥治疗情况相似。在6个月的随访期内，早期拔除支架组有症状的尿路感染发生率显著低于晚期拔除支架组[第一组50例中有5例（10%），第二组50例中有15例（30%），P=0.02]。第一组50例中有2例（4%）记录到无症状菌尿，第二组50例中有4例（8%）（P=0.3）。两组的输尿管漏、输尿管梗阻或血尿发生率无统计学显著差异（P=1.0）。我们得出结论，在腹腔镜获取的活体亲属供肾移植受者中，第一周结束时早期拔除支架可降低尿路感染的发生率，而不会增加尿漏或输尿管梗阻的发生率。
