Background: Renal transplantation is the most effective treatment for end stage renal disease. Urological complications are the most common surgical complication following transplant surgery and can adversely affect patient’s outcomes. Prophylactic ureteric stenting has been demonstrated to reduce urological complications significantly. Recently there has been a trend toward shorter duration of ureteric stent placement due to the associated risk of urinary tract infection. The aim of this study was to determine if early ureteric stent removal was associated with higher rates of urological complications.

Patients and Methods: We included all adult patients who underwent renal transplantation at Auckland city hospital over a 12-month period from August 2018 to August 2019. Patient characteristics, surgical and timing of stent removal data was collected. The primary outcome event was hydronephrosis requiring intervention. Secondary outcomes consisted of other urological complications requiring intervention (including perinephric collection and urine leak), total urological complications and urinary tract infections. We performed a multivariate analysis using a logistic regression model to adjust for various patient and surgical variables.

Results: There was a total of 118 patients included in the analysis, 52 had their ureteric stents removed early (post-operative day 4) and 66 had late removal (4 weeks). All patients undergoing renal transplantation had a ureteric stent placed and timing and method of removal was determined by the surgeon at time of surgery. 17.8% of the patients in this study had hydronephrosis that required intervention, and this was observed more frequently in patients with early stent removal (OR 8.36, p value 0.001).[JA1]  Perinephric collections requiring intervention were also observed more frequently with early stent removal (OR 6.05, p value 0.011). We reported a high rate of urological complications (26%) in this population, with higher rates in the early removal group (OR 3.48, p value 0.013). Urinary tract infection rates were lower in the early removal group (OR 0.32, p value 0.058).

Conclusion: We found a very strong correlation with the early removal of ureteric stents and the development of hydronephrosis requiring intervention following renal transplantation. We recommend this practice needs to be reviewed and further assessed with preferably a larger randomized prospective analysis.