Stented ureterovesical anastomosis in renal transplantation: does it influence the rate of urinary tract infections?

European Journal of Medical Research

A Paul³  O Witzke¹  S Sauerland²  A Zeiger³  M Heuer³  JW Treckmann³  Z Mathe³ 

[1] Department of Nephrology, University Hospital of Essen, University Duisburg-Essen, Germany;Institute for Research and Operative Medicine, University of Witten/Herdecke, Campus Cologne, Germany;Department of General-, Visceral-and Transplantation Surgery, University Hospital of Essen, University Duisburg-Essen, Germany

关键词: sepsis;    urinary tract infection;    ureterovesical stent;    anastomosis;    kidney transplantation;   

Others  :  834451
DOI  :  10.1186/2047-783X-15-7-297

 received in 2009-11-13, accepted in 2009-12-15,  发布年份 2010

【 摘 要 】

Objective

Our objective was to evaluate the impact of routine use of double-J stents on the incidence of urinary tract infection after renal transplantation.

Methods

We conducted a retrospective-comparative single-centre study in 310 consecutive adult deceased donor kidney recipients transplanted from 2002 to 2006. Patients were divided in two groups, with or without urinary stent implantation. To evaluate the predictive factors for UTI, donor and recipients pre- and post-transplantation data were analysed. Early urological complications and renal function within 12 months of transplantation were included as well.

Results

A total of 157 patients were enrolled to a stent (ST) and 153 patients to a no-stent (NST) group. The rate of urinary tract infection at three months was similar between the two groups (43.3% ST vs. 40.1% NST, p = 0.65). Of the identified pathogens Enterococcus and Escherichia coli were the most common species. In multivariate analysis neither age nor immunosuppressive agents, BMI or diabetes seemed to have influence on the rate of UTI. When compared to males, females had a significantly higher risk for UTI (54.0% vs. 33.5%).

Conclusion

Prophylactic stenting of the ureterovesical anastomosis does not increase the risk of urinary tract infection in the early postoperative period.

【 授权许可】

   
2010 I. Holzapfel Publishers

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Alangaden G: Urinary tract infections in renal transplant recipients. Curr Infect Dis Rep 2007, 9:475-479.
• [2]de Souza RM, Olsburgh J: Urinary tract infection in the renal transplant patient. Nat Clin Pract Nephrol 2008, 4:252-264.
• [3]Veroux M, Giuffrida G, Corona D, et al.: Infective complications in renal allograft recipients: epidemiology and outcome. Transplant Proc 2008, 40:1873-1876.
• [4]Lyerova L, Viklicky O, Nemcova D, Teplan V: The incidence of infectious diseases after renal transplantation: a single-centre experience. Int J Antimicrob Agents 2008, 31(Suppl 1):S58-S62.
• [5]Witzke O, Schmidt C, Kohnle M, Lütkes P, Philipp T, Heemann U: Impact of febrile infections on the long-term function of kidney allografts. J Urol 2001, 166:2048-2052.
• [6]Pelle G, Vimont S, Levy PP, et al.: Acute pyelonephritis represents a risk factor impairing long-term kidney graft function. Am J Transplant 2007, 7:899-907.
• [7]Tavakoli A, Surange RS, Pearson RC, Parrott NR, Augustine T, Riad HN: Impact of stents on urological complications and health care expenditure in renal transplant recipients: results of a prospective, randomized clinical trial. J Urol 2007, 177:2260-2264.
• [8]Giakoustidis D, Diplaris K, Antoniadis N, et al.: Impact of double-j ureteric stent in kidney transplantation: single-center experience. Transplant Proc 2008, 40:3173-3175.
• [9]Hetet JF, Rigaud J, Karam G: Should double J catheter be systematically considered in renal transplantation? Ann Urol (Paris) 2006, 40:241-246.
• [10]Osman Y, li-El-Dein B, Shokeir AA, Kamal M, El-Din AB: Routine insertion of ureteral stent in live-donor renal transplantation: is it worthwhile? Urology 2005, 65:867-871.
• [11]Guleria S, Chahal R, Madaan S, et al.: Ureteric complications of renal transplantation: the impact of the double J stent and the anterior extravesical ureteroneocystostomy. Transplant Proc 2005, 37:1054-1056.
• [12]Heuer M, Zeiger A, Kaiser GM, et al.: Use of marginal organs in kidney transplantation for marginal recipients: Too close to the margins of safety? Eur J Med Res 2009, 14:1-4.
• [13]Ben-Meir D, Golan S, Ehrlich Y, Livne PM: Characteristics and clinical significance of bacterial colonization of ureteral double-J stents in children. J Pediatr Urol 2009, 5:355-358.
• [14]Davari HR, Yarmohammadi H, Malekhosseini SA, Salahi H, Bahador A, Salehipour M: Urological complications in 980 consecutive patients with renal transplantation. Int J Urol 2006, 13:1271-1275.
• [15]Yigit B, Tellioglu G, Berber I, et al.: Surgical treatment of urologic complications after renal transplantation. Transplant Proc 2008, 40:202-204.
• [16]Dinckan A, Tekin A, Turkyilmaz S, et al.: Early and late urological complications corrected surgically following renal transplantation. Transpl Int 2007, 20:702-707.
• [17]DuBay DA, Lynch R, Cohn J, et al.: Is routine ureteral stenting cost-effective in renal transplantation? J Urol 2007, 178:2509-2513.
• [18]Goldfarb DA: Stented versus nonstented extravesical ureteroneocystostomy in renal transplantation: a meta-analysis. J Urol 2005, 173:889.
• [19]Mangus RS, Haag BW, Carter CB: Stented Lich-Gregoir ureteroneocystostomy: case series report and cost-effectiveness analysis. Transplant Proc 2004, 36:2959-2961.
• [20]Wilson CH, Bhatti AA, Rix DA, Manas DM: Routine intraoperative stenting for renal transplant recipients. Transplantation 2005, 80:877-882.
• [21]Praz V, Leisinger HJ, Pascual M, Jichlinski P: Urological complications in renal transplantation from cadaveric donor grafts: a retrospective analysis of 20 years. Urol Int 2005, 75:144-149.
• [22]Nicol DL, P'Ng K, Hardie DR, Wall DR, Hardie IR: Routine use of indwelling ureteral stents in renal transplantation. J Urol 1993, 150:1375-1379.
• [23]Dominguez J, Clase CM, Mahalati K, et al.: Is routine ureteric stenting needed in kidney transplantation? A randomized trial. Transplantation 2000, 70:597-601.
• [24]Tolkoff-Rubin NE, Rubin RH: Urinary tract infection in the immunocompromised host. Lessons from kidney transplantation and the AIDS epidemic. Infect Dis Clin North Am 1997, 11:707-717.
• [25]Schmaldienst S, Dittrich E, Horl WH: Urinary tract infections after renal transplantation. Curr Opin Urol 2002, 12:125-130.
• [26]Renoult E, Aouragh F, Mayeux D, et al.: Factors influencing early urinary tract infections in kidney transplant recipients. Transplant Proc 1994, 26:2056-2058.
• [27]Rice JC, Peng T, Kuo YF, et al.: Renal allograft injury is associated with urinary tract infection caused by Escherichia coli bearing adherence factors. Am J Transplant 2006, 6:2375-2383.