Category: New Technology: Miscellaneous
Introduction & Objective :
Routine use of transplant ureteric stents reduces the incidence of major urological complications (MUCs). Controversy still exists as to the best timing and technique of stent removal. We have recently shown that early removal compared to removal at 6 weeks reduces the rate of UTI1. However an increase in use of extended criteria deceased kidney donors leads to delayed graft function and therefore removal of stents before recovery of ATN maybe disadvantageous. We therefore explored the implementation of novel stent removal techniques (magnetic stent removal and Isiris single use technology) that permit easy and early removal at 2-4 weeks post-transplant and compare this to our standard stent removal using flexible cystoscopy in an outpatient urology clinic.
Prospective data collection of all kidney transplant patients at a single centre from November 2017 to April 2018. Type of stent inserted, method of stent removal, location of stent removal and time to stent removal were recorded. Magnetic stents were only used in female patients (excluding SPK transplants). The indication for use of Isiris technology was ascertained. Hospital costs of the varied stents and stent removal technologies were considered. Major urological complications (urinary leak and ureteric stenosis) were recorded.
103 kidney transplants were performed (53 male). Standard stents were used in 91 (88%) patients. 18% of stents were removed using the Isiris technology, 58% with flexible cystoscopy in a urology department, 4% under GA in theatres, whilst 20% are pending removal. The average time for stent removal was 41 days, 43 days and 37 days respectively. The Isiris single use technology was utilised on ward, ITU, outpatient departments and in theatres.
Of 41 female kidney transplants 29% (n= 12) had a magnetic stent inserted and 50% (n=6) were removed without difficulty, 25% (n=3) fell out prior to removal and one was difficult to remove. The average time to stent removal was 21 days.
Both the magnetic stent and isiris mobile technology have shown to be viable alternatives to standard ureteric stents and flexible cystoscopic stent removal in transplant patients.
To date, we have seen both the cost and efficiency benefits of using the Isiris technology; with each unit costing £180 and freeing up slots in the Urology clinic we estimate a saving of approximately £5120 to date. Furthermore, the portable use of Isiris allows us to use it a number of environments for both ease and convenience. The magnetic stents have demonstrated fast and easy retrieval of stent without requirement of cystoscopy.
Amy Nagle– CT2, Guy's Hospital, London, London, England, United Kingdom
Adefunke Adiki– London, England, United Kingdom
Rhana Zakri– London, England, United Kingdom
Jonathon Olsburgh– London, England, United Kingdom
Nizam Mamode– London, England, United Kingdom