Ureteral Stent in Kidney Transplantation: Benefits and Risks in the Prevention of Urological Complications
Keywords:
Ureteral Stent, Kidney Transplantation, Surgical Risk, Urological Complications, Postoperative OutcomesAbstract
Introduction: Kidney transplantation is the most effective treatment for patients with end-stage chronic kidney disease. However, urological complications, such as ureteral obstruction, may compromise the graft. Ureteral stenting is widely used to prevent these complications, although it is associated with risks such as urinary tract infections and stone formation, raising controversies regarding its actual benefit.
Objective: To evaluate the impact of ureteral stent use in kidney transplantation and its influence on reducing urological complications. Methods: An integrative review was conducted in PubMed and Biblioteca Virtual em Saúde (BVS) databases, including articles in Portuguese and English published from 2015 to 2025, available in full text, and involving adult patients. A total of 20 studies were selected after screening 287 records. Results: National and international publications included systematic reviews, clinical trials, and cohort studies, mainly addressing urinary tract infection, ureteral stenosis, and fistula associated with stent use. Discussion: The duration of stent placement showed a direct impact on complications. Early removal, within 14 days, reduced urinary tract infection (UTI) incidence without increasing fistulas or stenosis, while prolonged use favored bacterial colonization. The absence of a stent increased leakage and stenosis rates, confirming its protective role in some scenarios. Double-J stents were associated with a lower risk of severe complications but with a higher UTI incidence. Conclusion: Ureteral stenting reduces urological complications in kidney transplantation, but dwell time directly affects the risk of UTI and stenosis. Further studies comparing duration strategies and different stent materials are needed to support safer clinical protocols.
Downloads
References
1. Batista CM, Moreira RSL, Pessoa JLE, Ferraz AS, Roza BA. Perfil epidemiológico dos pacientes em lista de espera para o transplante renal. Acta Paul Enferm, 2017; 30(6): 614-20. https://doi.org/10.1590/1982-0194201700042
2. McAlister WH, Evans J, Neuberger J, Mushtaq I, Brown P, Robinson AJ, et al. Impact of ureteral stenting on urological complications after kidney transplantation surgery: a single-center experience. Transplantation Proceedings. 2014; 46(10): 3459-3462. https://doi.org/10.1016/j.transproceed.2014.08.051
3. Parapiboon W, Ingsathit A, Disthabanchong S, Nongnuch A, Jearanaipreprem C, Charoenthanakit S, et al. Impact of early ureteric stent removal and cost-benefit analysis in kidney transplant recipients: results of a randomized controlled study. Transplantation Proceedings. 2012; 44(3): 737-739. https://doi.org/10.1016/j.transproceed.2011.11.033
4. Mendes WDS, Silva LF, Espinosa G, Fernandes AL, Furtado R, Gonçalves R. Estenose arterial nos transplantes renais. Rev Col Bras Cir, 2005; 32(4): 193-7. https://doi.org/10.1590/S0100-69912005000500004
5. Pecoits-Filho R, Rosa-Diez G, Gonzalez-Bedat M, Marinovich S, Fernandez S, Lugon J, et al.Tratamento substitutivo da função renal na doença renal crônica: uma atualização do Registro Latino-Americano de Diálise e Transplante. J Bras Nefrol, 2015; 37(4): 476-81. https://doi.org/10.5935/0101-2800.20150002
6. Thompson ER, Hosgood S, Nicholson ML, Wilson CH. Early versus late ureteric stent removal after kidney transplantation: systematic review and meta-analysis. 2018. https://doi.org/10.1002/14651858.CD011455.pub2
7. Ranganathan M, Akbar M, Ilham MA, Chavez R, Kumar N, Asderakis A. Infective complications associated with ureteral stents in renal transplant recipients. Transplant Proc, 2009; 41(1): 162-4. https://doi.org/10.1016/j.transproceed.2008.10.022
8. Souza MT, Silva MD, Carvalho R. Integrative review: what is it? How to do it? Einstein (São Paulo), 2010; 8(1): 102-6. https://doi.org/10.1590/S1679-45082010RW1134
9. Bardin L. Análise de conteúdo. São Paulo: Edições 70; 2016.
10. Cai JF, Wang W, Hao W, Sun ZJ, Su LL, Li X, et al. Meta-analysis of early versus late ureteric stent removal after kidney transplantation. Transplant Proc, 2018; 50(10): 3411-5. https://doi.org/10.1016/j.transproceed.2018.08.033
11. Sarier M, Demir M, Duman I, Yuksel Y, Demirbas A. Evaluation of ureteral stent colonization in live-donor renal transplant recipients. Transplant Proc, 2017; 49(2): 415-9. https://doi.org/10.1016/j.transproceed.2017.01.004
12. 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, 2017; 15(2): 143-9. https://doi.org/10.6002/ect.2016.0051
13. Patel P, Rebollo-Mesa I, Ryan E, Sinha MD, Marks SD, Banga N, et al. Prophylactic ureteric stents in renal transplant recipients: a multicenter randomized controlled trial of early versus late removal. Am J Transplant, 2017; 17(8): 2129-38. https://doi.org/10.1111/ajt.14223
14. Asgari AM, Dadkhah F, Tara SA, Argani H, Tavoosian A, Ghadian A. Early stent removal after kidney transplantation: is it possible? Nephro-Urol Mon, 2016; 8(2): e30598. https://doi.org/10.5812/numonthly.30598
15. Kroth LV, Barreiro FF, Saitovitch D, Traesel MA, d’Avila DOL, Poli-de-Figueiredo CE. Acute graft pyelonephritis occurring up to 30 days after kidney transplantation: epidemiology, risk factors, and survival. Transplant Proc, 2016; 48(8): 2298-300. https://doi.org/10.1016/j.transproceed.2016.06.016
16. Barghouthy Y, Wiseman O, Ventimiglia E, Letendre J, Cloutier J, Daudon M, et al. Silicone-hydrocoated ureteral stents encrustation and biofilm formation after 3-week dwell time: results of a prospective randomized multicenter clinical study. World J Urol, 2021. https://doi.org/10.1007/s00345-021-03646-0
17. LaFranca JA, Visser IJ, van der Staaij JPT, Muthusamy A, Willicombe M, Dor FJMF. Timing of ureteric stent removal and urological complications after kidney transplantation: a systematic review and meta-analysis. J Clin Med, 2019; 8(5): 689. https://doi.org/10.3390/jcm8050689
18. Yahav D, Green H, Eliakim-Raz N, Mor E, Husain S. Early double J stent removal in renal transplant patients to prevent urinary tract infection – systematic review and meta-analysis of randomized controlled trials. Eur J Clin Microbiol Infect Dis, 2018; 37(4): 773-8. https://doi.org/10.1007/s10096-017-3173-7
19. Oudmaijer CAJ, Muller K, van Straalen E, Minnee RC, Kimenai DJAN, Reinders MEJ, et al. Long-term Double-J stenting is superior to short-term Single-J stenting in kidney transplantation. PLoS One, 2025; 20(1): e0317991. https://doi.org/10.1371/journal.pone.0317991
20. Wang Y, Yang Y, Zhang H, Wang Y. Early removal of ureteral stent after kidney transplant could decrease incidence of urinary tract infection: a systematic review and meta-analysis. Exp Clin Transplant, 2022; 20(1): 28-34. https://doi.org/10.6002/ect.2021.0183
21. Ciancio G, Farag A, Gonzalez J, Vincenzi P, Gaynor JJ. Results of a previously unreported extravesical ureteroneocystostomy technique without ureteral stenting in 500 consecutive kidney transplant recipients. PLoS One, 2021;16(1): e0244248. https://doi.org/10.1371/journal.pone.0244248
22. Lee JH, Muthukumar T, Kim J, Aull MJ, Watkins A, Kapur S, et al. Antibiotic prophylaxis for ureteral stent removal after kidney transplantation. Clin Transplant, 2019; 33(4): e13491. https://doi.org/10.1111/ctr.13491
23. Abrol N, Dean PG, Prieto M, Stegall MD, Taner T. Routine stenting of extravesical ureteroneocystostomy in kidney transplantation: a systematic review and meta-analysis. Transplant Proc, 2018; 50(10): 3397-404. https://doi.org/10.1016/j.transproceed.2018.06.041
24. Manassero F, Vistoli F, Mogorovich A, De Maria M, Boggi U, Selli C. Early and late ureteral complications after renal transplant. Minerva Urol Nefrol, 2017; 69(6): 613-8. https://doi.org/10.23736/S0393-2249.17.02786-2
25. Bzoma B, Kostro J, Hellmann A, Chamienia A, Hać S, Dębska-Ślizień A, et al. Ureteric stenting in kidney transplant recipients, Gdansk Centre experience, Poland. Transplant Proc, 2018; 50(6). https://doi.org/10.1016/j.transproceed.2018.02.105
26. Dadkhah F, Yari H, Asgari MA, Fallahnezhad MH, Tavoosian A, Ghadian A. Benefits and complications of removing ureteral stent based on the elapsed time after renal transplantation surgery. Nephro-Urol Mon, 2016; 8(2): e31108. https://doi.org/10.5812/numonthly.31108
27. Fockens MM, Alberts VP, Bemelman FJ, Laguna Pes MP, Idu MM. Internal or external stenting of the ureterovesical anastomosis in renal transplantation. Urol Int, 2016; 96(2): 152-6. https://doi.org/10.1159/000440702
28. Alci E, Ustun M, Sezer T, Yilmaz M, Ozdemir M, Unsal MG, et al. Comparison of patients in whom double-J stent had been placed or not placed after renal transplantation in a single center: a follow-up study. Transplant Proc, 2015; 47(5): 1433-6. https://doi.org/10.1016/j.transproceed.2015.04.064
29. Warzyszyńska K, Zawistowski M, Karpeta E, Dziewa N, Kosieradzki M. How early postoperative urinary tract infections affect renal graft function at 1-year follow-up. Transplant Proc, 2020; 52(10): 1-6. https://doi.org/10.1016/j.transproceed.2020.03.033
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Maria Vina Sousa de Lucena, Rute Macêdo de Santana, Aline Lopes da Silva Pastor , Talita de Jesus Assunção Macedo, João Pedro Costa Silva , José de Bessa Júnior
This work is licensed under a Creative Commons Attribution 4.0 International License.
