Introduction: It has been demonstrated that ureteral stents should be implanted during renal transplant procedures to lessen urological problems. After performing its purpose, the double J (DJ) stent is frequently removed via a rigid cystoscope inserted per urethra while under general anaesthesia. Alternatively, the literature has described successful retrograde fluoroscopy guided removal procedures carried out in the interventional suite. The aim of this study was to assess the routine feasibility of transurethral retrieval of DJ stents and to affirm the interventional radiology technique as an alternative to cystoscopic replacement.
Method: Between August 2011 and August 2023, a retrospective analysis was applied to 425 kidney transplant recipients. A vascular introducer sheath (Calibre 7-11 F; length 10-25) was used to catheterize the bladder. After placing a 6F guiding catheter into the bladder, distal end of the DJ stent was held with a 35 mm loop snare. Different methods have also been used in cases where it cannot be removed with simple snare technique or in cases where the stent remains in the urethra during removal. One of these methods is to rotate a 4F or 5F pigtail catheter around the DJ stent to hold it and thus allow it to be brought out. Another method is the alternative loop snare method, which is made by twisting 0.018-inch wire. In this method, after one end of the wire is fixed outside the catheter, the wire is bent and sent with the help of a guiding catheter, and the wire makes loops inside the bladder. In this way, a loop with a loop diameter equal to the bladder diameter is provided. Demographic information, size and number of stents, procedure time, fluoroscopic time, and radiation dose were recorded.
Results: 244 patients were enrolled in this study (68.9% males and 31.1% females; average age: 57 years; range: 2–68 years). We removed 282 DJ stents in 244 patients (mean age 57.98 years, range 2-68); 225 patients received a single treatment, and 19 underwent two or more procedures (mean 2, range 2-5). Most of the DJs were shot using the simple snare technique (n=233). The pigtail method was used in four patients and the alternative loop technique was used in one patient. There were no major complications. Within a day following the operations, 10 cases of temporary mild haematuria spontaneously disappeared. Mean overall procedure time (From entrance to exit of the operation room) was 25 min (range 18–41 min). Mean fluoroscopic time was 6 min, 38 s (range 3 min, 3 s–20 min, 30 s). Mean radiation dose of the procedure was 37.32 Gy cm2 (range 19.14–75.70 Gy cm2). Technical success was 97.5%
Conclusion: In summary, the fluoroscopically guided transurethral removal of DJ in renal transplant recipients emerges as a viable and secure substitute for cystoscopy. Radiation doses remain within acceptable limits, and while an initial learning curve is acknowledged, operators tend to enhance their proficiency with the procedure over time.