Ryan is a junior surgical registrar currently working in Palmerston North Hospital. Previously he’s worked in Auckland DHB in General Surgery and Paediatric Surgery.
TRUST Trial: Timing of Removal for Ureteric Stents Post-Transplant – Early Vs Standard Removal
Background Routine placement of ureteric stent across the anastomosis at the time of transplant reduces the rate of early urological complications. However there is no reported optimal time of ureteric stent removal. The timing of stent removal involves a balance between prevention of early urological complications and development of stent-related complications.
Aim A prospective randomised controlled trial was designed to determine whether early removal (day 4) of ureteric stent is equally effective and safe as late removal (4-6 weeks with cystoscopy) in patients following kidney transplant.
Method From October 2010 and August 2012, 100 adult patients who underwent kidney transplantation at a single centre were randomised equally to control (standard removal) and intervention (early removal) group. In intervention group, the double J ureteric stents were secured to the urinary catheter by Surgeon A or B and removed with the bladder catheter on day 4 post kidney transplant. Control group recipients had their stents removed as an outpatient procedure by flexible cystoscopy at 4-6 weeks post transplant.
Results In total, 50 patients in early removal group and 50 patients in late removal group were analysed. The baseline Primary outcome of graft survival at 12-month showed no difference in two groups (p = 0.4947). Urine output and serum creatinine day 0 to day 10 after transplant were generally higher in control group but there was no statistically significant difference. Similarly, no statistical difference was found in secondary outcomes including patient survival at 12 month, urological complications (leak and obstruction), graft rejection and infection.
Conclusion Early ureteric stent removal at the time of removal of bladder catheter is equally as safe and effective (non inferior) as standard removal of the ureteric stent with flexible cystoscopy at 4-6 weeks post kidney transplant.