ROUTINE USE OF INDWELLING URETERAL STENTS IN RENAL-TRANSPLANTATION

An extravesical ureteral implantation with the routine use of an inter nal stent was performed in 358 transplants (351 cadaveric and 7 living related). The 1-year patient and graft survival was 93% and 87%, resp ectively, with a minimum followup of 2 years. Ureteral complications d eveloped in 9 patients (2.6%), with 3 fistulas, 2 of which resolved sp ontaneously, and 6 stenoses following stent removal. Nephrostomy drain age and antegrade stenting were initially attempted in all cases of st enosis, and were successful in 4. Revision of the ureteral anastomosis was required in 1 case of fistula and 2 cases of stenosis (0.9%). Ext rinsic compression resulted in ureteral obstruction in 3 cases (2 lymp hoceles and 1 hematoma), which resolved following drainage. Stent rela ted complications occurred in 8 patients (2.2%), including obstruction due to the stent in 2 cases, breakage during removal in 3 leaving fra gments in the upper urinary tract, proximal migration of 2 stents that were retrieved via percutaneous nephrostomy and calculus formation on 1 stent in a patient with hyperparathyroidism, necessitating extracor poreal shock wave lithotripsy for stent removal. In the cases with ure teral or stent related complications 1-year patient and graft survival was 100%. These results suggest that ureteral stents used routinely i n renal transplantation are associated with a low incidence of urinary leaks, early postoperative obstruction and subsequent surgery for uro logical complications. However, a small number of unique problems rela ted to stent use or malfunction may occur. Minimally invasive strategi es using percutaneous nephrostomy and antegrade stenting are effective in managing the majority of complications that occur following ureter al stenting in renal transplant recipients.