Early versus Late Ureteral Stent Removal in Kidney Transplantation: A Systematic Review and Meta- Analysis of Urological Outcomes

Author(s): Maher Aldemerdash, Ali Hussain AlShaqaq, Abdulnaser AlAbadi, Fahad E AlOtaibe, Khalid Bel'eed-Akkari, Yousef Saleh Alsowayan

Background: The optimal timing for ureteral stent removal following kidney transplantation remains controversial. This meta-analysis aimed to compare outcomes between early and late stent removal.

Methods: A systematic search was conducted in PubMed, Web of Science, Cochrane Library, and Scopus databases up to July 2024 to identify studies comparing early (within 3 weeks) versus late removal of ureteral stents in kidney transplant recipients. The primary outcomes assessed were the incidence of urinary tract infections (UTIs) and ureteric leakage. Data synthesis and meta-analysis were performed using RevMan Software version 5.4.

Results: Fourteen studies comprising 3096 patients were included. Early stent removal was associated with a significantly lower incidence of UTIs compared to late removal (Odds ratio (OR) 0.46, 95% confidence interval 1 0.32-0.66, P<0.0001). This benefit was observed across different early removal time intervals. However, very early removal (within the first week) was associated with a higher risk of ureteric leakage (OR 4.71, 95% CI 1.65-13.44, P=0.004). No significant differences were found between groups for other urological complications.

Conclusion: Early ureteral stent removal, particularly within 1-3 weeks post-transplant, significantly reduces UTI risk without increasing other urological complications. However, removal within the first week posttransplant may increase the risk of ureteric leakage. These findings suggest that adopting protocols for stent removal between 1-3 weeks posttransplant could be beneficial for suitable patients, balancing the reduced risk of UTIs against the potential for early urological complications. Future prospective studies with longer follow-up are needed to further optimize stent management in kidney transplantation.