Hazenberg Ietje T, Middelkoop Stephanie J M, de Joode Anoek A E, Rabbeljee Juliette D, Pol Robert A, Doornweerd Benjamin H J, Sanders Jan-Stephan F, Stegeman Coen A
Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands.
Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, Netherlands.
Front Nephrol. 2023 May 16;3:1130672. doi: 10.3389/fneph.2023.1130672. eCollection 2023.
Urologic complications (UCs) and urinary tract infections (UTIs) are common after kidney transplantation. Intraoperative stent placement at the vesicoureteric anastomosis reduces UC risk, but increases UTI risk.
In 2014 our stenting protocol changed from external ureteric stent (ES) to internal double J stent (DJ). We retrospectively studied the occurrence of UCs and UTIs in relation to ES or DJ in 697 kidney recipients.
An ES was used in 403 patients (57.8%), in 294 (42.2%) a DJ. ES was removed 7-12 days and DJ 3-4 weeks post-operative. Induction immunosuppression was the same in both groups. Primary outcomes at 6 months follow-up were UC (urinary leakage/ureter stenosis) and UTI; they were related to stenting procedure and clinical and transplant characteristics. The incidence of UCs was similar for ES (8.4%) and DJ (6.8%), p=0.389. ES use was a significant risk factor for UTI (OR 1.69 (1.15-2.50), p=0.008). Post-transplant hospitalization was significantly shorter in the DJ group. Despite more acute rejection episodes with ES (ES/DJ: 16.4%/6.1%, p<0.001), no clinical relevant differences in graft outcomes existed.
A DJ is, compared to ES, associated with a lower incidence of UTIs and comparable occurrence of UCs and is therefore the preferred technique for stenting the vesicoureteric anastomosis.
肾移植术后泌尿系统并发症（UCs）和尿路感染（UTIs）很常见。在膀胱输尿管吻合术中放置术中支架可降低UC风险，但会增加UTI风险。
2014年，我们的支架置入方案从外置输尿管支架（ES）改为内置双J支架（DJ）。我们回顾性研究了697例肾移植受者中与ES或DJ相关的UCs和UTIs的发生情况。
403例患者（57.8%）使用ES，294例（42.2%）使用DJ。ES在术后7 - 12天取出，DJ在术后3 - 4周取出。两组的诱导免疫抑制相同。6个月随访时的主要结局是UC（尿漏/输尿管狭窄）和UTI；它们与支架置入程序以及临床和移植特征相关。ES组（8.4%）和DJ组（6.8%）的UC发生率相似，p = 0.389。使用ES是UTI的一个显著危险因素（OR 1.69（1.15 - 2.50），p = 0.008）。DJ组的移植后住院时间明显更短。尽管ES组的急性排斥反应发作更多（ES/DJ：16.4%/6.1%，p < 0.001），但移植结局无临床相关差异。
与ES相比，DJ与较低的UTI发生率以及相当的UC发生率相关，因此是膀胱输尿管吻合术支架置入的首选技术。
