Early versus late ureteric stent removal after kidney transplantation

Emily R Thompson; Sarah A Hosgood; Michael L Nicholson; Colin H Wilson

doi:10.1002/14651858.CD011455.pub2

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Figure 1

Flow chart of study selection

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Figure 2

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

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Figure 3

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

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Analysis 1.1

Comparison 1 Major urological complications, Outcome 1 Major urological complications.

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Analysis 2.1

Comparison 2 Urinary tract infection, Outcome 1 Urinary tract infection.

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Summary of findings for the main comparison. Early versus late ureteric stent removal after kidney transplantation

Early versus late ureteric stent removal after kidney transplantation
Patient or population: kidney transplant recipients Intervention: early ureteric stent removal Comparison: late ureteric stent removal
Outcomes	*Anticipated absolute effects^ (95% CI)**		Relative effect (95% CI)	No. of participants (studies)	Quality of the evidence (GRADE)
	Risk with late removal	Risk with early removal
Major urological complications: all stents follow‐up range: 3 to 12 months	Study population		RR 1.87 (0.61 to 5.71)	1127 (5)	⊕⊕⊕⊕ LOW ¹
	12 per 1,000	23 per 1,000 (7 to 69)
Major urological complications: bladder indwelling stents follow‐up range: 3 months to 12 months	Study population		RR 1.67 (0.52 to 5.36)	539 (3)	⊕⊕⊕⊕ LOW ¹
	15 per 1,000	24 per 1,000 (8 to 79)
Major urological complications: per‐urethral stents follow‐up range: 3 months to 12 months	Study population		RR 1.51 (0.03 to 74.45)	588 (2)	⊕⊕⊕⊕ LOW ¹
	10 per 1,000	15 per 1,000 (0 to 732)
Urinary tract infection: all stents	Study population		RR 0.49 (0.30 to 0.81)	1126 (5)	⊕⊕⊕⊝ MODERATE ^{1 2}
	185 per 1,000	91 per 1,000 (56 to 150)
Urinary tract infection: bladder indwelling stents	Study population		RR 0.45 (0.29 to 0.70)	539 (3)	⊕⊕⊕⊝ MODERATE ^{1 2}
	209 per 1,000	94 per 1,000 (61 to 146)
Urinary tract infection: per‐urethral stents	Study population		RR 0.60 (0.17 to 2.03)	587 (2)	⊕⊕⊝⊝ LOW ^{1 2}
	164 per 1,000	98 per 1,000 (28 to 333)
*The risk in the intervention group (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk ratio
GRADE Working Group grades of evidence High quality: We are very confident that the true effect lies close to that of the estimate of the effect Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect
¹ All studies were unblinded, however, this was unavoidable given the nature of the intervention. The majority of studies provided minimal information on processes of randomisation and allocation ² Inconsistent definition and variable reporting of urinary tract infection across included studies

Summary of findings for the main comparison. Early versus late ureteric stent removal after kidney transplantation

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Table 1. Reported adverse events

Study ID	Adverse events
Gunawansa 2011	Two patients in the late group required re‐stenting due to ureteric stenosis
Huang 2012	Three patients in the late group had forgotten stents that were subsequently removed at 12 weeks
Indu 2012	Six patients in the early and 5 patients in the late group had acute rejection that required intervention
Parapiboon 2012	No adverse events reported
TrUST 2017	Sixteen patients did not receive their allocated treatment as there were technical difficulties attaching the stent to the catheter. In the early removal group, 1 patient's stent removal was delayed by 1 day because the urethral catheter balloon needed percutaneous needle puncture due to the stent suture There were 5 complications in patients who had early stent removal and these were all related to the percutaneous technique used in which the stent was tied to the catheter

Table 1. Reported adverse events

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Comparison 1. Major urological complications

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Major urological complications Show forest plot	5	1127	Risk Ratio (M‐H, Random, 95% CI)	1.87 [0.61, 5.71]

1.1 Bladder indwelling stents	3	539	Risk Ratio (M‐H, Random, 95% CI)	1.67 [0.52, 5.36]
1.2 Per‐urethral stents	2	588	Risk Ratio (M‐H, Random, 95% CI)	1.51 [0.03, 74.45]

Comparison 1. Major urological complications

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Comparison 2. Urinary tract infection

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Urinary tract infection Show forest plot	5	1126	Risk Ratio (M‐H, Random, 95% CI)	0.49 [0.30, 0.81]

1.1 Bladder indwelling stents	3	539	Risk Ratio (M‐H, Random, 95% CI)	0.45 [0.29, 0.70]
1.2 Per‐urethral stents	2	587	Risk Ratio (M‐H, Random, 95% CI)	0.60 [0.17, 2.03]

Comparison 2. Urinary tract infection

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