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Sandberg M, Cohen A, Escott M, Temple D, Marie-Costa C, Rodriguez R, Gordon A, Rong A, Andres-Robusto B, Roebuck EH, Whitman W, Webb CJ, Stratta RJ, Assimos D, Wood K, Mirzazadeh M. Bladder Stones in Renal Transplant Patients: Presentation, Management, and Follow-up. Urol Int 2024:1-7. [PMID: 38684150 DOI: 10.1159/000539091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 04/24/2024] [Indexed: 05/02/2024]
Abstract
INTRODUCTION The study aim was to analyze the presentation, management, and follow-up of renal transplant patients developing bladder calculi. METHODS Patients who underwent renal transplant with postoperative follow-up at our institution were retrospectively analyzed (1984-2023) to assess for the development of posttransplant bladder stones. All bladder stones were identified by computerized tomography imaging and stone size was measured using this imaging modality. RESULTS The prevalence of bladder calculi post-renal transplantation during the study window was 0.22% (N = 20/8,835) with a median time to bladder stone diagnosis of 13 years posttransplant. Of all bladder stone patients, 6 (30%) received deceased donor and 14 (70%) living donor transplants. There were 11 patients with known bladder stone composition available; the most common being calcium oxalate (N = 6). Eleven (55%) patients had clinical signs or symptoms (most commonly microhematuria). Fourteen of the bladder stone cohort patients (70%) underwent treatment including cystolitholapaxy in 12 subjects. Of these 14 patients, 9 (64%) were found to have nonabsorbable suture used for their ureteroneocystostomy closure. CONCLUSIONS The prevalence of bladder stones post-renal transplant is low. The utilization of nonabsorbable suture for ureteral implantation was the main risk factor identified in our series. This technique is no longer used at our institution. Other factors contributing to bladder stone formation in this population warrant identification.
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Affiliation(s)
- Maxwell Sandberg
- Department of Urology, Atrium Health Wake Forest Baptist Medical Center, Winston Salem, North Carolina, USA
| | - Adam Cohen
- Department of Urology, Atrium Health Wake Forest Baptist Medical Center, Winston Salem, North Carolina, USA
| | - Megan Escott
- Department of Urology, Atrium Health Wake Forest Baptist Medical Center, Winston Salem, North Carolina, USA
| | - Davis Temple
- Wake Forest University School of Medicine, Winston Salem, North Carolina, USA
| | - Claudia Marie-Costa
- Wake Forest University School of Medicine, Winston Salem, North Carolina, USA
| | - Rainer Rodriguez
- Wake Forest University School of Medicine, Winston Salem, North Carolina, USA
| | - Alex Gordon
- Edward Via College of Osteopathic Medicine, Blacksburg, Virginia, USA
| | - Anita Rong
- Wake Forest University School of Medicine, Winston Salem, North Carolina, USA
| | | | - Emily H Roebuck
- Wake Forest University School of Medicine, Winston Salem, North Carolina, USA
| | - Wyatt Whitman
- Department of Urology, Atrium Health Wake Forest Baptist Medical Center, Winston Salem, North Carolina, USA
| | - Christopher J Webb
- Section of Transplantation, Department of Surgery, Atrium Health Wake Forest Baptist Medical Center, Winston Salem, North Carolina, USA
| | - Robert J Stratta
- Section of Transplantation, Department of Surgery, Atrium Health Wake Forest Baptist Medical Center, Winston Salem, North Carolina, USA
| | - Dean Assimos
- Department of Urology, Atrium Health Wake Forest Baptist Medical Center, Winston Salem, North Carolina, USA
- Department of Urology, University of Alabama Birmingham Medical Center, Birmingham, Alabama, USA
| | - Kyle Wood
- Department of Urology, University of Alabama Birmingham Medical Center, Birmingham, Alabama, USA
| | - Maajid Mirzazadeh
- Department of Urology, Atrium Health Wake Forest Baptist Medical Center, Winston Salem, North Carolina, USA
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Ooms LSS, Minnee RC, Dor FJMF, Kimenai DJAN, Tran KCK, Hartog H, van de Wetering J, Willemsen SP, IJzermans JNM, Terkivatan T. Stenting the ureteroneocystostomy reduces urological complications in kidney transplantation: a noninferiority randomized controlled trial, SPLINT trial. Transpl Int 2020; 33:1190-1198. [PMID: 32403158 DOI: 10.1111/tri.13638] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 12/06/2019] [Accepted: 05/04/2020] [Indexed: 12/16/2022]
Abstract
The role of ureteral stents in living-donor kidney transplantation remains uncertain. In this randomized controlled trial (SPLINT), we compared urological complications in living-donor kidney transplantations performed with or without stents. We included 200 consecutive patients that received living-donor kidney transplantations at the Erasmus MC, University Medical Center, Rotterdam. Patients (124 males, 76 females, mean age 54 ± 13) were randomized for suprapubic externalized single J stents (N = 100) or no stent (N = 100). The primary outcome was the probability of a percutaneous nephrostomy insertion (PCN) during a 12-month follow-up. To assess whether no stenting is noninferior to stenting, we allowed the probability of a PCN to increase by at most 5% (this is the noninferiority margin). Baseline characteristics were comparable between groups. In the no-stent group, there were more PCN insertions, 14% (95% CI 4.3-23.7%); urinary leakages, 12% (95% CI 5.4-21.3%); and surgical re-interventions because of urological complications, 8% (95% CI 1.5-14.5%). The stent group had more hematuria, 26% (95% CI 13.1-38.9%); and graft rejections, 15% (95% CI 2.7-27.3%). Patients in both groups had similar mean GFRs at several time points. Besides a better Euro-Qol-5D in the no-stent group at 2 and 6 weeks postoperative, similar quality of life was reported based on SF-36 and Euro-Qol-5D scores. In this trial, noninferiority has not been demonstrated for no-stent placement in relation to the number urological complications.
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Affiliation(s)
- Liselotte S S Ooms
- Department of Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Robert C Minnee
- Department of Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Frank J M F Dor
- Department of Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Diederik J A N Kimenai
- Department of Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Khe C K Tran
- Department of Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Hermien Hartog
- Department of Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | | | - Sten P Willemsen
- Department of Biostatistics, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Jan N M IJzermans
- Department of Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Turkan Terkivatan
- Department of Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
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Ooms LSS, Spaans LG, Betjes MGH, Ijzermans JNM, Terkivatan T. Minimizing the Number of Urological Complications After Kidney Transplant: A Comparative Study of Two Types of External Ureteral Stents. EXP CLIN TRANSPLANT 2016; 15:143-149. [PMID: 27562020 DOI: 10.6002/ect.2016.0051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the effects of 2 types of external ureteral stents on the number of urological complications after kidney transplant. MATERIALS AND METHODS Data were retrospectively collected from 366 consecutive transplants performed between January 2013 and January 2015 in our hospital, in which an external ureteral stent was placed during surgery and removed after 9 days. Urological complications were defined as urinary leakage or ureteral stenosis requiring percutaneous nephrostomy placement. RESULTS A total of 197 patients received a straight stent with 2 larger side holes (type A; 8F "Covidien" tube; Covidien, Dublin, Ireland) and 169 patients received a single J stent with 7 smaller side holes (type B; 7F "Teleflex" single J stent; Teleflex Medical, Athlone, Ireland). We found a significantly higher number of percutaneous nephrostomy placements with type A stents, with 34 (17%) versus 16 (9%) in type B (P = .030). Reason for percutaneous nephrostomy placement, occurrence of stent dysfunction, and need for early removal (< 8 days) were equal in both groups (P = .397), whereas incidence of rejection and urinary tract infection were higher in type B stent group. Patient and graft survival did not differ between the groups. CONCLUSIONS Use of the type B stent was associated with less urological complications compared with the type A stent.
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Affiliation(s)
- Liselotte S S Ooms
- Department of Surgery Division of Transplant Surgery, Erasmus MC, University Medical Center Rotterdam, The Netherlands
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Wu FMW, Lim M, Deng Z, Heng CT, Tiong HY. Successful Endourological Management of the Forgotten' Stent in a Transplanted Kidney. Urol Int 2014; 92:373-6. [DOI: 10.1159/000354936] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Accepted: 08/08/2013] [Indexed: 11/19/2022]
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Divakaruni N, Palmer CJ, Tek P, Bjurlin MA, Gage MK, Robinson J, Lombardo L, Wille MA, Hollowell CMP. Forgotten ureteral stents: who's at risk? J Endourol 2013; 27:1051-4. [PMID: 23590526 DOI: 10.1089/end.2012.0754] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The sequelae from forgotten stents carry significant morbidity and costs. In this study, we attempt to identify potential risk factors that may make patients less likely to follow up for stent removal so that more effective prevention efforts may be directed at these persons. A single-institution retrospective analysis of 187 consecutive patients who had stents placed between January 2010 and December 2010 was performed. Chart review was conducted to see if patients had undergone stent removal beyond the intended maximal stent life (MSL). Patients who were lost to follow-up were contacted to determine if stents were overdue. Logistic regression was performed to determine risk factors. Of the 187 patients who had stents placed, 147 had the stent removed before MSL and 28 had stents removed after the MSL. Twelve patients could not be contacted and were excluded from the analysis. Within our cohort of 175 patients, 48% were males, 73% were minorities (33% Latino, 30% Black, 8% Asian, and 2% Native American), 39% did not speak English, 79% were unemployed, 73% were uninsured, and 35% were married. Among the patients with forgotten stents, 68% were male, 64% were minorities (32% Latino, 29% Black, 4% Native American, and 0% Asian), 82% were unemployed, 39% did not speak English, 93% were uninsured, and 43% were married. Multivariate regression analysis demonstrated that uninsured patients (odds ratio [OR], 6.3; 95% confidence interval [CI], 1.4-28.2; P value 0.01) and males (OR, 2.8; CI, 1.2-6.8; P=0.02) had statistically significant associations with forgotten stents. Men were 2.8 times more likely to have forgotten stents than females. Patients without health insurance were six times more likely to have forgotten stents than patients with insurance. As efforts are made to prevent forgotten stents, increased attention should be given to these higher-risk patient populations.
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Affiliation(s)
- Naveen Divakaruni
- Division of Urology, Department of Surgery, Cook County Hospital, Cook County Health and Hospitals System, Chicago, Illinois 60612, USA
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Current world literature. Curr Opin Urol 2011; 21:166-72. [PMID: 21285721 DOI: 10.1097/mou.0b013e328344100a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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