Abstract:

Objective Urological complications such as urinary leakage and ureteral stenosis following transplantation significantly impact the efficacy of renal transplantation surgery. Ureteral stent placement is currently the most common method for reducing ureteral complications; however， the optimal duration for stentindwelling remains controversial. This study aimed to investigate the impact of ureteral stent indwelling time on postoperative outcomes in renal transplant recipients， and to provide clinical evidence for optimal stent removal timing. Methods A prospective cohort study was conducted involving 100 patients who underwent their first allogeneic renal transplantation in Organ Transplant Department，the Second Affiliated Hospital of Guangzhou Medical University between October 2020 and October 2022. Patients were divided into two groups: the stent-on-string group （n ＝ 50）and the conventional stent group （n ＝ 50）. In the stent-on-string group， the stent was removed via the string at 1 week postoperatively. In the conventional stent group， stents were removed via ureteroscopy at 1 month postoperatively. Theincidence of delayed graft function （DGF）， incidence of urological complications， length of hospital stay （LOS）， and renal function during the stable postoperative period were compared between the two groups. Results The stent-on-string group demonstrated a significantly shorter hospital stay and significantly lower incidences of urinary tract infections （UTIs）and BK viremia at 1 month postoperatively compared to the conventional stent group （P ＜ 0.05 for all comparisons）. Conclusion Removal of the ureteral stent at 1 week post-transplantation significantly reduces the incidence of UTIs and BK viremia without increasing the risk of ureteral complications. The use of a stent-on-string avoids patient discomfort which is associated with cystoscopy or ureteroscopy stent removal. Therefore， a stent-on-string should be placed andremoved at 1 week postoperatively when no significant lesions are present in the donor ureter or recipient bladder. 

Key words: Post-renal transplantation,  , Ureteral stent,  , Urinary tract infection,  , BK virus

摘要：

目的 移植术后尿漏、输尿管狭窄等泌尿系并发症严重影响肾移植手术的疗效，为了减少输尿管并发症，目前最常用的方法是置入输尿管支架，但是对于输尿管支架留置的时间仍存在争议。本文将通过观察输尿管支架留置时间长短对于肾移植术后疗效的影响，为临床上输尿管支架移除的时机提供参考。方法 选取 2020 年 10 月至 2022 年 10 月在广州医科大学附属第二医院器官移植中心首次行同种异体肾移植的患者 100 例，分为带线支架管组（50 例），非带线支架管组（50 例）。带线支架管组在术后 1 周移除带线输尿管支架 ；非带线支架管组则在术后 1 个月通过输尿管镜移除输尿管支架。比较两组患者术后移植肾功能延迟恢复的发生率、泌尿系统疾病的发生率、住院时间以及术后稳定期肾功能的情况。结果 带线支架管组在住院时长、泌尿系统感染的发生率、术后 1 个月 BK 病毒尿症的发生率上显著低于非带线支架管组。结论 移植术后 1 周移除输尿管支架可以显著降低泌尿系统感染、BK 病毒尿症的发生率，并且不会增加输尿管并发症的发生。留置带线支架管可以避免使用膀胱镜或输尿管镜拔除支架管时对患者造成痛苦。因此在供肾输尿管及受者膀胱未见明显病变的情况下尽可能留置带线输尿管支架，并且在术后 1 周拔除输尿管支架。 

关键词: 肾移植术后 , 输尿管支架 , 泌尿系感染 ,  , BK 病毒