None listed
Conditions
Brief summary
Kidney transplantation is the best treatment option for patients with end-stage kidney disease (ESKD). Re-establishing urine drainage by anastomosing the donor ureter to the recipients bladder is prone to complications (leak, obstruction). These complications are associated with significant morbidity and potential mortality. Previous studies have shown that placing a stent across the ureteric anastomosis at the time of the transplant reduces the chance of ureteric complications. The optimal timing for removal of these stents remains unknown. The probability of stent related complications increases the longer the stent remains in situ. A balance between prevention of early ureteric complications and development of stent-related complications needs to be achieved. It is our current practice to remove the ureteric stent at 4-6 weeks following transplant by cystoscopy. There is evidence to suggest that removal of the ureteric stent as early as day 4 post-transplant may still prevent early urological complications. In addition, tying the stent to the urinary catheter at the time of the operation allows for the stent to be removed at the same time the urinary catheter is taken out on day 4, thereby preventing the need for a cystoscopy procedure. The aim of this study is to undertake a pilot study to compare early removal (day 4) with the current practice of leaving the ureteric stent for 4 weeks in patients with ESKD undergoing kidney transplantation
Interventions
Following the establishment of general anaesthesia, an indwelling catheter will be inserted into the bladder and irrigated with neostigmine. urinary continuity will be re-established by anastomosing the donor ureter to the recipient bladder using a standard technique over a double-J ureteric stent as per our Transplant Unit's protocol. In the intervention arm, at the time the double-J stent is inserted during the transplant operation the distal end of the stent will be sutured to the indwelling
Following the establishment of general anaesthesia, an indwelling catheter will be inserted into the bladder and irrigated with neostigmine. urinary continuity will be re-established by anastomosing the donor ureter to the recipient bladder using a standard technique over a double-J ureteric stent as per our Transplant Unit's protocol. In the intervention arm, at the time the double-J stent is inserted during the transplant operation the distal end of the stent will be sutured to the indwelling bladder catheter. At the time the bladder catheter is removed on day 4 post kidney transplant the ureteric stent will be simultaneously removed, eliminating the need for cystoscopy.
Sponsors
Department of Surgery, University of Auckland
Study design
Allocation
Randomised controlled trial
Primary purpose
Treatment
Eligibility
Sex/Gender
All
Age
16 Years to No maximum
Healthy volunteers
No
Inclusion criteria
All adult patients (>16 years at time of transplant) placed on the waiting list for kidney transplantation at Auckland City Hospital will be eligible.
Exclusion criteria
1. Age <16 years at time of transplant 2. Neurogenic bladder dysfunction diagnosed pre-transplant by the presence of large residual volumes on bladder scan in the presence of peripheral neuropathy 3. Re-transplants 4. Patients in whom pre-operative consent cannot be obtained.
Outcome results
None listed