Can the Double-J Ureteric Stent be Dispensed? A Prospective Randomized Study in Renal Transplant Recipients

Research Article

Austin J Nephrol Hypertens. 2017; 4(1): 1063.

Can the Double-J Ureteric Stent be Dispensed? A Prospective Randomized Study in Renal Transplant Recipients

Murthy PVLN*, Ramreddy CH, Ramachandraiah G, Kiran Kumar D, Vidyasagar S and Devraj R

Department of Urology and Renal Transplantation, Nizam’s Institute of Medical Sciences, India

*Corresponding author: Murthy PVLN, Department of Urology and Renal Transplantation, Nizam’s Institute of Medical Sciences, 202,10-2-289/12, Sripadaresidency, Shantinagar-1st Lane, Hyderabad-500028, India

Received: March 12, 2017; Accepted: April 18, 2017; Published: May 03, 2017


The use of prophylactic double-J ureteric (DJ) stent during renal transplantation is debatable. The authors who favor stenting claim the incidence of urological complications and morbidity were less. On the other hand, literature shows routine stenting is unnecessary as it adds to the cost and complications. With this background, we performed a prospective randomized controlled study in live related renal transplant recipients with and without a DJ stent to know whether it can be avoided.

Seventy-six consenting patients for live related renal transplantation were recruited in this study between November 2014 to August 2015 at our centre. Patients were randomized in to two groups, group A with DJ-stent and group B without a stent based on computer randomization. These patients were evaluated in the immediate and at the end of 4, 12 & 24 weeks post operatively for urological complication. Urine culture, serum creatinine, ultrasound and Doppler examination of the graft were performed as per the protocol. DJ- stent was removed at the end of 4 weeks.

Thirty six patients in group A with stent and 36 in group B without a stent were evaluated for urinary tract infection, urinary leak and ureteric obstruction postoperatively and found no statistical difference between the two groups. Four patients were excluded

Routine use of DJ- stents may not be indicated during Kidney transplantation. Careful surgical technique with selective stenting of problematic anastomoses yields similar results. The incidence of UTI is comparable in both groups.

Keywords: Renal transplantation; Urological complications; DJ-Stent; Urine leak


DJ Stent: Double J Stent; UTI: Urinary Tract Infection


In renal transplantation, the use of DJ - stents to prevent postoperative complications like urine leaks, obstruction or strictures is well known [1]. But however there is controversy in placement of DJ- stents during renal transplantation, as observed in retrospective [2] and prospective randomized trials as well [3].

Proposed benefits to a stented anastomosis include continuous decompression of the ureter to avoid anastomotic tension, maintenance of the ureter in a more linear alignment to avoid kinking and protection from ureteral narrowing or postoperative ureteric obstruction due to edema or external compression [4].

Routine use of DJ stents in an immunosuppressed transplant recipient, places him or her at high-risk for development of complications like urinary tract infection (UTI), stent encrustation and stone formation. The incidence of UTI is not only higher in the immediate postoperative period, but also after removal of the stents [5]. Placing a DJ stent means, it has to be enrolled in a stent registry to avoid the possibility of a retained or forgotten stent. Extra cost involved in removal of the stent by cystoscopy and additional need for anesthesia should be considered in these immunocompromised individuals, especially in children [6].

The aims and objectives of our study was to evaluate the incidence of UTI, Urinary leak and obstruction with and without a DJ stent during ureteroneocystostomy and whether a DJ stent can be avoided.

Materials and Methods

After obtaining ethics committee approval, the study was carried out from November 2014 to August 2015 at our centre. Seventy six consecutive patients were enrolled into this study after taking informed consent. They were randomized into two groups of 38 each. In Group A DJ stent was placed and Group B was without a stent based on computer generated random numbers using Rand between function of Microsoft Excel.

All patients underwent live related donor renal transplantation in which the kidney was procured by open donor nephrectomy and extravesical ureteroneocystostomy by Lich-Gregoir technique with or without DJ (double J) stent. A 6-0 double arm (13 mm) PDS suture was used for the anastomosis.

Urethral Foleys catheter was removed on 3rd and wound drain on 4th post operative days. DJ stent was removed cystoscopically 4 weeks after surgery.

Urine samples for culture were collected preoperatively, postoperatively on day 3, (after removal of Foley’s catheter), 4 weeks (after surgery before removal of DJ stent), 3months post op and whenever needed depending upon the patients’ symptomatology (fever, dysuria). Serum creatinine: (normal: 0.7-1.5 mg) evaluated before discharge, at 1 month, 3 months and 6months respectively.

Ultrasonography was performed on 3rd postoperative day to detect any perinephric collection and ureteric obstruction along with Doppler for graft vascularity (as a protocol) and Graft ultrasonography at three months follow up.

Statistical Analysis was done using SPSS version 17. Continuous variables were represented as mean with standard deviation (SD) and categorical variables as numbers with percentages. Continuous variables are compared between both the groups using independent sample t-test and categorical variables are compared using Chi-square test and Fisher exact test when expected cell value is less than 5.


Between November 2014 to August 2015, 76 consecutive live related renal transplants were enrolled into the study of which four patients were excluded. The reasons being one patient (with DJ stent, group-A) died of pseudomonas sepsis on 7th post op day. The source of infection was proved to be internal jugular vein catheter and the graft function was normal at the time of death.

The second patient developed ureteric leak (group-B) due to ureteral ischemia which required exploration and repeat ureteroneocystostomy with a DJ stent after excising the ischemic ureter. In the 3rd patient, diuresis was delayed (group-B) and required stenting. Fourth patient (group A) underwent graft nephrectomy for renal artery thrombosis on 7th post op day.

Finally 72 patients 36 in each group were analyzed. Group A (n=36) with a DJ stent and Group-B (n=36) without a stent (Table 1) summarized the characteristics of the patient population.