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Omic H, Eder M. Effect of increasing age and ureteral stent implantation on urinary tract infections after kidney transplantation - update of recent literature. Curr Opin Urol 2024; 34:146-153. [PMID: 38426237 PMCID: PMC10990026 DOI: 10.1097/mou.0000000000001163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
PURPOSE OF REVIEW This review aims to present the recent literature regarding effects of aging and ureteral stent implantation (UrS) on the risk of urinary tract infections (UTIs) in kidney transplant (KTX) recipients. RECENT FINDINGS UTIs in kidney transplant recipients remain a clinical challenge and represent a leading cause of morbidity, hospitalization rates, and mortality. Higher age was described as a significant risk factor for UTIs in several studies including a recent Brazilian analysis, indicating a 3.6%/years of age increase in UTI risk. Subsequently, a large meta-analysis, published in 2023, confirmed the correlation between older age and elevated UTI risk. The Swiss Transplant Cohort Study in 2022, largest of its kind, similarly confirmed a link between advanced age and heightened risk of recurrent UTIs in KTX. A recent prospective study highlighted UrS placement as a modifiable risk factor, emphasizing the need for careful consideration and antibiotic prophylaxis. Additionally, the type of stents played a crucial role, with external stents associated with a 1.69 times higher UTI risk. The challenge of determining optimal UrS removal timing further complicates posttransplant care, with insufficient evidence to guide practices. SUMMARY The aging population of KTX recipients requires a personalized approach to effectively reduce and manage UTIs as one of the most important complications following KTX. Prophylactic stent implantation is successful in lowering ureteral complications, however, is associated with an increased incidence of UTIs. To reduce the increased risk of UTIs, the length of stent insertion requires strict supervision and maintenance.
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Affiliation(s)
- Haris Omic
- Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, Vienna, Austria
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Caamiña L, Pietropaolo A, Prudhomme T, Bañuelos B, Boissier R, Pecoraro A, Campi R, Dönmez MI, Sierra A, Piana A, Somani BK, Territo A. Endourological Management of Ureteral Stricture in Patients with Renal Transplant: A Systematic Review of Literature. J Endourol 2024; 38:290-300. [PMID: 38185833 DOI: 10.1089/end.2023.0478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2024] Open
Abstract
Purpose: To analyze the utility and outcomes of available endourologic options to treat ureteral stricture after kidney transplantation (KT). Methods: A systematic review was carried out for all English language articles from 2000 to 2023 according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) standards using EMBASE, MEDLINE, SCOPUS, Google scholar, and Cochrane library. The search term combination for the string was follows: [(Ureteral stricture) OR (ureter stenosis) OR (ureteral stenosis) OR (Stricture ureter) OR (Narrowing ureter) OR (Ureter restriction) OR (ureteral restriction) OR (ureteral narrowing) OR (ureteral obstruction) OR (ureter obstruction) OR (obstructing ureter) OR (obstructive ureter) OR (narrow ureter) OR (ureteral narrow)] AND [(kidney transplant) OR (transplanted kidney) OR (transplant) OR (transplantation)] AND [(management) OR (Robotic) OR (laser) OR (stent) OR (dilatation) OR (dilation) OR (endoscopic) OR (endourological) OR (Urologic) OR (laparoscopic) OR (surgery) OR (treatment)]. Case reports, review articles, animal and laboratory studies were excluded. Risk of bias assessment was conducted using the RoB 2 and ROBINS-I tools. Results: A total of 1102 relevant articles published from 2000 to 2023 were found. After screening of titles and abstracts, a total of 19 articles were included in our systematic review. Ureteral stent/nephrostomy placement, balloon dilatation (ureteroplasty) with or without laser was used as initial approaches whereas follow-up and success rate were analyzed among other parameters. Conclusions: The management of ureteral strictures after KT is challenging and selecting the most appropriate treatment is crucial for successful outcomes. Our review suggests that, an endourologic management is a safe option with good long-term outcomes, especially in short and early strictures.
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Affiliation(s)
- Leticia Caamiña
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Amelia Pietropaolo
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
- Kidney Transplantation Working Group, European Association of Urology-Young Academic Urologists (EAU-YAU), Arnhem, The Netherlands
| | - Thomas Prudhomme
- Kidney Transplantation Working Group, European Association of Urology-Young Academic Urologists (EAU-YAU), Arnhem, The Netherlands
- Department of Urology, Kidney Transplantation and Andrology, Toulouse Rangueil University Hospital, Toulouse, France
| | - Beatriz Bañuelos
- Kidney Transplantation Working Group, European Association of Urology-Young Academic Urologists (EAU-YAU), Arnhem, The Netherlands
- Division Renal Transplantation and Reconstructive Urology, Hospital Universitario El Clínico San Carlos, Madrid, Spain
| | - Romain Boissier
- Kidney Transplantation Working Group, European Association of Urology-Young Academic Urologists (EAU-YAU), Arnhem, The Netherlands
- Department of Urology and Renal Transplantation, La Conception University Hospital, Marseille, France
| | - Alessio Pecoraro
- Kidney Transplantation Working Group, European Association of Urology-Young Academic Urologists (EAU-YAU), Arnhem, The Netherlands
- Puigvert Foundation, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Riccardo Campi
- Kidney Transplantation Working Group, European Association of Urology-Young Academic Urologists (EAU-YAU), Arnhem, The Netherlands
- Unit of Oncologic Minimally Invasive Urology and Andrology, Department of Experimental and Clinical Medicine, Careggi Hospital, University of Florence, Florence, Italy
| | - Muhammet Irfan Dönmez
- Kidney Transplantation Working Group, European Association of Urology-Young Academic Urologists (EAU-YAU), Arnhem, The Netherlands
- Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Alba Sierra
- Kidney Transplantation Working Group, European Association of Urology-Young Academic Urologists (EAU-YAU), Arnhem, The Netherlands
- Urology Department, Hospital Clinic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Alberto Piana
- Kidney Transplantation Working Group, European Association of Urology-Young Academic Urologists (EAU-YAU), Arnhem, The Netherlands
- Department of Urology, University of Turin, Turin, Italy
- Department of Urology, Romolo Hospital, Rocca di Neto, Italy
| | - Bhaskar K Somani
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Angelo Territo
- Kidney Transplantation Working Group, European Association of Urology-Young Academic Urologists (EAU-YAU), Arnhem, The Netherlands
- Puigvert Foundation, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
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