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Saudi Journal of Kidney Diseases and Transplantation
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LETTER TO THE EDITOR  
Year : 2016  |  Volume : 27  |  Issue : 1  |  Page : 170-171
An unusual case of urinary incontinence in a post-renal transplant patient


1 Department of Nephrology, S.M.S. Medical College and Hospital, Jaipur, Rajasthan, India
2 Department of Urology, S.M.S. Medical College and Hospital, Jaipur, Rajasthan, India

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Date of Web Publication15-Jan-2016
 

How to cite this article:
Kumar R, Mathur M, Garsa R, Agarwal D, Malhotra V, Yadav S S, Tomar V. An unusual case of urinary incontinence in a post-renal transplant patient. Saudi J Kidney Dis Transpl 2016;27:170-1

How to cite this URL:
Kumar R, Mathur M, Garsa R, Agarwal D, Malhotra V, Yadav S S, Tomar V. An unusual case of urinary incontinence in a post-renal transplant patient. Saudi J Kidney Dis Transpl [serial online] 2016 [cited 2019 Nov 13];27:170-1. Available from: http://www.sjkdt.org/text.asp?2016/27/1/170/174206
To the Editor,

Kidney transplantation is the treatment of choice for end-stage renal disease in most patients. Ureteroneocystostomy is the major step in transplant surgery. Ureteroneocystostomy complications occur in 3-9% of all renal transplants. [1] The use of stents in ureterovesical anastomosis, although beneficial in reducing the rate of urological complications, is also associated with complications related to double-J stents (DJS), including infection, encrustation, stone formation, migration and breakage. [2],[3],[4] Complete urinary incontinence is an extremely rare stentrelated complication. [5] We encountered a case of a 44-year-old man who underwent live, related renal transplantation. His immediate post-transplant course was uneventful, with good urine output and decreasing serum creatinine. The indwelling Foley's catheter was removed on the 4 th post-operative day. Immediately after removal of the Foley's catheter, the patient complained of urinary incontinence with continuous dribbling of urine. He was managed conservatively, but the complaint persisted. There was no previous history of urinary incontinence. On reviewing the surgical records, there was no history of injury to the bladder neck or injury to bladder innervation. On examination, there was a tender cord-like structure palpable in the penile urethra. The patient underwent X-ray of the kidney, ureter and bladder, which is shown in [Figure 1]. As shown, the lower end of the DJS had migrated into the penile urethra without any coiling in the urinary bladder. The DJS was removed via cystoscope and the patient was immediately relieved of incontinence.

DJS is placed for a short duration to prevent vesicoureteric complications, such as urine leaks, ureteric stenosis and obstruction, in kidney transplant patients. [6],[7] However, DJS has its own complications, which include encrustation, fragmentation, distal and proximal migration, stenturia, dysuria and hematuria, besides complications during its removal. [3],[4]
Figure 1: Kidney, ureter and bladder X-ray study showing migration of the double J stent into the urethra in early post-renal transplant period.

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These possible complications can be avoided by using the stents for the minimal possible duration. In a case-controlled study, it was found that stenting for two weeks avoids complications without compromising the benefits. [8]

Migration of a DJS is an unusual complication, with incidence ranging from 0% to 7%. Migrated DJS usually coil up in the urinary bladder and cause irritative symptoms. [4],[9] The highest rate of stent migration and expulsion was reported by Gularia et al, who used the longer (24 cm) stents. The DJS used in our case was 16 cm in length. In our case, the DJS migrated, crossed the membranous urethra and entered the penile urethra without coiling in the urinary bladder [Figure 1] and caused urinary incontinence. This is an extremely rare complication; our case could be the first report of its kind. Meticulous technique during DJS insertion and routine post-procedure X-ray should be carried out to prevent such complications.

 
   References Top

1.
Mangus RS, Haag BW. Stented versus non-stented extravesical ureteroneocystostomy in renal transplantation: A meta-analysis. Am J Transplant 2004;4:1889-96.  Back to cited text no. 1
    
2.
Basseri A, Amiransari B, Yazdani M, Sesavar Y, Gol S. Renal transplantation using ureteral stents. Transplant Proc 1995;27:2593-4.  Back to cited text no. 2
    
3.
Kumar A, Kumar R, Bhandari M. Significance of routine JJ stenting in living related renal transplantation: A prospective randomized study. Transplant Proc 1998;30:2995-7.  Back to cited text no. 3
    
4.
Guleria S, Agarwal S, Kumar R, Khazanchi RK, Agarwal SK, Tiwari SC. The double J stent: Its impact on the urological complications in live - Related transplantation. Indian J Urol 1998;14: 101-4.  Back to cited text no. 4
    
5.
Breau RH, Norman RW. Optimal prevention and management of proximal ureteral stent migration and remigration. J Urol 2001;166: 890-3.  Back to cited text no. 5
    
6.
Konnak JW, Herwig KR, Turcotte JG. External ureteroneocystostomy in renal transplantation. J Urol 1972;108:380-1.  Back to cited text no. 6
[PUBMED]    
7.
Kumar A, Verma BS, Srivastava A, Bhandari M, Gupta A, Sharma R. Evaluation of the urological complications of living related renal transplantation at a single centre during the last ten years: Impact of the double J stent. J Urol 2000;164:657-60.  Back to cited text no. 7
    
8.
Verma BS, Bhandari M, Srivastava A, Kapoor R, Kumar A. Optimum duration of J.J. stenting in live related renal transplantation. Indian J Urol 2002;19:54-7.  Back to cited text no. 8
    
9.
Mongha R, Kumar A. Transplant ureter should be stented routinely. Indian J Urol 2010;26:450-3.  Back to cited text no. 9
[PUBMED]  Medknow Journal  

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Correspondence Address:
Dr. Rajesh Kumar
Department of Nephrology, S.M.S. Medical College and Hospital, Jaipur, Rajasthan
India
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DOI: 10.4103/1319-2442.174206

PMID: 26787589

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