Externalized Percutaneous Stent Versus Internal Double J Stent: Short- and Long-term Complications After Kidney Transplantation

BACKGROUND In patients undergoing kidney transplantation, ureteral stents are an established technique to reduce major urologic complications such as leakage and stenosis of the ureter. However, the best technique for ureteral stenting remains unclear. The aim of this study was to compare the outcome of percutaneous ureteral stents (PS) with internal double J stents (JJS) after kidney transplantation. METHODS All patients undergoing kidney transplantation between 2005 and 2014 were retrospectively analyzed. After excluding patients <18 years old, patients without stenting, and patients who underwent multiorgan transplantation, a total of 308 patients were included in the study. Two consecutive cohorts of patients were compared. In the cohort transplanted between 2005 and 2010, stenting was routinely performed using PS (216 patients), and in the second cohort, those transplanted after 2011, stenting was routinely performed using JJS (92 patients). For ureteric anastomosis, the Lich-Gregoir technique was used in all patients. RESULTS There was no statistical difference in postoperative urinary tract infections (P = .239) between the 2 cohorts. In patients with PS, the incidence of major urologic complications (11.6% vs 3.3%; P = .018), vesicoureteral reflux (14.3% vs 2.2%; P < .001), and urologic reinterventions (14.4% vs 5.4%; P = .031) was significantly higher when compared with JJS patients. Multivariable logistic regression revealed increased incidence of major urologic complications (odds ratio [OR] 3.66, 95% confidence interval [CI] 1.07-12.55, P = .039) and vesicoureteral reflux (OR 5.29, 95% CI 1.21-23.10, P = .027) in patients with PS compared with JJS. CONCLUSION Stenting of ureterovesical anastomosis using JJS is associated with reduced complications compared with PS after kidney transplantation.