| Objective:The optimal time for stent removal following renal transplantation is still controversial. This article takea randomized, prospective, double blind trial aimed at detection of differences in urological complications at 1-week early removal and at the routine 4-week ureteral stent removal.Though a retrospective clinical trial,we observe the effect ofmagnetic resonance urography in diagnosis of urological complication and compare different surgical methods in the treatment of urological compication.Design and participants:Between October 2010 and November 2014,103 recipients in Chinese people liberation army general hospital were preoperatively randomized to the early ureteral stent removal (1 week) or routine ureteral stent removal (4 weeks) group after living donor renal transplantation. Urinary symptoms, auxiliary examination, and obstruction events were recorded during the three months of follow-up. Cost analysis of postoperative period was discussed.Between February 2002 and August 2012, sixteen cases of urinary fistula and 13 cases of ureteral constructions in 981cases cadaveric renaltransplantation in Chinese people liberation army general hospital were described. Evaluate the role of magnetic resonance urography(MRU)and compare it with the surgical exploration. The surgical methods and postoperative effect have been recorded for anlysis.Results:In total,52 patients in the 1-week stent group and 51 patients in the 4-week stent group were analyzed. No serious adverse events were reported. Three episodes of UTIs occurred in the 1-week stent group, and 18 episodes were recorded in the 4-week stent group 5.8% vs.29.4%, P=0.002, Table 2. After adjusting for age, sex, ischemia time, renal artery number, BMI, multiple arteries, and associated medical illness, regression analysis indicated that only stent duration was associated with UTI, OR 8.791; 95% CI,1.984?38.943; P=0.004, Table 3. There are 3 cases of kidney failure due to chronic renal allograft rejection. The remaining 26 cases keep normal function during the follow-up days.Thirteen recipents have moderate pyelectasis, with interruption of high signals inupper ureter and urine around the lower ureter tissue. Ureterocystostomystoma urinary fistula happened in 9 recipents, with high signal bladder image around the encapsulated exudative urine. Seven cases have normal image of magnetic resonance urography. The surgical explorations show severe adhesion in lower ureter under the kidney and damage ofcontinuity in tranplantation ureteral. Thelocation of ureter nercosis in surgical explorations is same as the image of magnetic resonance urography. The consistent between urine around the necrosis ureter and image around the encapsulated exudative urine was recorded. The ureteral stenosis subjected to ureteroureterostomy was managed using native ureter successfully. Serum creatinine became normal (<133?mol/L) after surgery. B-Ultrasound showed that hydronephrosis completely disappeared.Conclusions:The results of our study demonstrate that ureteral stent removal at 1 week reduce the risk of UTIs compared to the routine 4-week removal. Ureteral stent removal at 1 week probably has similar impact on the rate of ureteralmechanical complications compared to the routine 4-week removal. Magnetic resonance urography has the following advantages:no X-ray radiation, no injection of iodine contrast medium, stable image. Percutaneous nephrostomy, balloon dilatation and ureteric stent insertion is a safe and effective method for the ureteric complications.Re-ureteroureterostomy and reimplantationo f native pelvis and ureter is stable and effective, which is good for the fuction of transplant kidney and long term survival rate. |
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