Transplant ureteric stents are routinely placed at the time of transplant ureteric anastomosis. These are removed approximately 3 weeks from the date of transplantation, in Edinburgh or at the patient’s local centre.
Just prior to discharge the duty ward team should confirm the need for stent removal at 3 weeks after reviewing the operation record. Documentation (in the electronic record (Vitaldata) and in discharge letters) should include whether standard prophylaxis (currently a single 500mg dose of oral ciprofloxacin 30-60 mins pre-procedure) or other agent should be given at the time of stent removal, depending on microorganism sensitivities and allergies.
A pre-printed waiting list office booking form for stent removal, with or without peritoneal dialysis catheter removal, is completed by the consultant surgeon responsible for the transplant operation as part of the transplant records. The transplant coordinator passes this to the waiting list office who assigns a procedure date.
There is dedicated theatre time allocated for transplant ureteric stent removal. Patients are notified by letter from the waiting list office regarding attendance date and time in advance of the procedure.
The removal procedure is undertaken under sterile conditions in the operating theatre using local anaesthetic gel (Instillagel, Farco-Pharma GmbH, Germany) administered urethrally. After cleaning the area with sterile saline and patient draping, the disposable cystoscope system (Isiris, Coloplast, United Kingdom) is set up and checked to ensure correct operation of the camera, retrieving forceps and instillation fluid channel. The cystoscope is inserted and the urethra traversed under vision. The appearance of the bladder mucosa and content of the bladder is noted and the stent located, grasped and removed together with the cystoscope. A transurethral catheter (12F, Pennine, United Kingdom) is inserted until the bladder is drained and then removed. The stent is discarded and is not sent for microbiological analysis. The patient is transferred directly to day surgery without admission to recovery. Written and dictated procedure notes are completed by the operating surgeon.