Efficacy and safety of routine intraoperative insertion of double-J stents in kidney transplantation;a systematic review / 中华器官移植杂志

ABSTRACT

Objective To systematically evaluate the effect of routine insertion of double-J stents to prevent major urological complications(MUCs)in kidney transplant recipients.Methods Medline,Embase,Cochrane Library,and Chinese Biomedicine database were searched to locate relevant randomized controlled trials(RCT).Data extraction and assessment of methodologic quality were performed independently by two reviewers.Meta-analysis was performed by Revman 5.0 software.Results Ten RCT(including 1616 patients)were identified.By comparing the routine stent group with the no stent group,the meta-analysis showed(1)incidence of urine leak,urinary obstruction and UTI was 4 times lower,6 times lower,increased by 52 % respectively(P＜0.0001);(2)Patient and graft survival,rate of acute rejection,delayed graft function and hematuria were of no significant difference.In subgroup analysis,it was found(1)Compared with the no stent group,the group in which stent duration was≤ 4 weeks had a lower incidence of MUCs and a higher incidence of UTI;meanwhile,the group in which stent duration was ＞ 4 weeks had a much lower incidence of MUCs and the rate of UTI was increased without significant difference;(2)In the RCT of which urethral catheter duration was ＜ 5 days,there were no significant differences between the two groups in MUCs and UTI.In the RCT of which urethral catheter duration was ≥5 days,the stent group had a lower incidence of MUCs and a higher incidence of UTI.Conclusion Routine stenting reduces the incidence of MUCs.Although the double-J stent increases the risk of UTI,it seems that UTI doesn't affect the outcome of transplantation.The stent duration should be within 4 weeks.For the stent recipients,the longer duration of urethral catheter,the lower incidence of MUCs,the higher incidence of UTI;thus,it is up to clinicians to decide the optimal duration of urethral catheter.Long term prescription of 480 mg cotrimoxazole once daily,from the operation day till after stent removal,effectively reduces the risk of UTI associated with stent placement.