Double Voiding for Urinary Tract Infection Prevention Post-Kidney Transplant

Overseen By Ananda Kimm-Drapeau

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Weill Medical College of Cornell University

Disqualifiers: Indwelling catheter

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: Unknown

Duration: 12 weeks

438 Participants Needed

Trial Summary

Do I need to stop my current medications for this trial?

The trial information does not specify whether you need to stop taking your current medications. It's best to discuss this with the trial coordinators or your doctor.

What data supports the effectiveness of the treatment Double Voiding for preventing urinary tract infections after a kidney transplant?

A study found that kidney transplant patients who used the double voiding technique had a significantly lower rate of urinary tract infections compared to those who did not use the technique, suggesting it may help reduce infection risk. ^{1 2 3 4 5}

Is double voiding safe for humans?

Double voiding, which involves urinating twice in a short period, is generally safe and may help reduce the risk of urinary infections in kidney transplant patients with stents. No significant safety concerns have been reported in studies involving this technique. ^{1 2 6 7 8}

How does the double voiding treatment prevent urinary tract infections after kidney transplant?

Double voiding is a unique technique where patients urinate twice in a short period to ensure the bladder is fully emptied, which helps reduce the risk of urinary tract infections. This method is different from other treatments like antibiotics or vaccines because it focuses on a physical action rather than medication to prevent infections. ^{1 2 9 10 11}

What is the purpose of this trial?

Urinary tract infections (UTI) are common in kidney transplant recipients and are an important cause of illness and hospital admissions. Past studies have shown that about 1 out of 5 of newly transplanted patients develop UTI within their first 3 months of transplantation. Such UTIs increase the risk for blood stream infection and acute rejection of the kidney, Improvements in urinary voiding techniques may reduce the frequency of UTI. The purpose of this study is to evaluate the benefits of "double voiding" in kidney transplant recipients.

Research Team

Muthukumar Thangamani, M.D.

Principal Investigator

Weill Medical College of Cornell University

Eligibility Criteria

This trial is for adult kidney transplant recipients who are being routinely followed at the NYP-WCM Transplant Clinic. It's not for those discharged with an indwelling catheter (Foley) after their transplant.

Inclusion Criteria

All adults who have had a kidney transplant and are regularly seen at the New York Presbyterian - Weill Cornell Medicine Transplant Clinic.

Exclusion Criteria

You recently had a kidney transplant and still have a catheter in place.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants are instructed to follow either double voiding or regular voiding techniques

12 weeks

Regular follow-up visits for urine culture

Follow-up

Participants are monitored for the incidence of UTIs and other complications

4 weeks

Treatment Details

Interventions

• Double Voiding
• Regular Voiding

Trial Overview The study compares 'double voiding'—a technique to empty the bladder more completely—with regular voiding to see if it reduces urinary tract infections in new kidney transplant patients.

Participant Groups

Group I: Double Voiding Experimental Treatment 1 Intervention

The participant will be instructed to void twice.

Group II: Regular Voiding Active Control 1 Intervention

The participant will be instructed to void normally.

Who Is Running the Clinical Trial?

Weill Medical College of Cornell University

Lead Sponsor

Trials

1,103

Recruited

1,157,000+

Findings from Research

In a study of 65 live kidney transplant recipients, those who practiced the double voiding technique had a significantly lower incidence of urinary tract infections (UTIs) compared to the control group, with only 3.3% testing positive for infections versus 34.2% in the control group.

The findings suggest that implementing the double voiding technique after the removal of urethral catheters may effectively reduce the risk of UTIs in patients with double J stents, highlighting a simple intervention that could improve post-transplant care.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Double urinary bladder voiding technique post removal of urethral catheter in renal allograft recipients. Zomorrodi, A., Bohluli, A.[2015]

In a study of 1038 transplant patients, the use of a double-J catheter was linked to a higher incidence of urinary tract infections (UTIs), with 24.6% of catheter users developing UTIs compared to 16.8% of non-users.

The findings suggest that while double-J catheters are commonly used to prevent urinary complications, they may actually increase the risk and severity of UTIs, leading to higher healthcare costs without reducing other urinary complications.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Association Between the Placement of a Double-J Catheter and the Risk of Urinary Tract Infection in Renal Transplantation Recipients: A Retrospective Cohort Study of 1038 Patients. Mosqueda, AO., Hernández, EEL., Morales, GC., et al.[2021]

In a study of 310 kidney transplant recipients, the use of double-J stents did not significantly affect the incidence of urinary tract infections (UTIs) within the first three months post-transplant, with rates of 43.3% in the stent group and 40.1% in the no-stent group.

The study found that female patients had a higher risk of developing UTIs compared to males, but factors like age, immunosuppressive agents, BMI, and diabetes did not influence UTI rates.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Stented ureterovesical anastomosis in renal transplantation: does it influence the rate of urinary tract infections? Mathe, Z., Treckmann, JW., Heuer, M., et al.[2022]

In a study of 1011 kidney transplantations, the routine use of double J catheters and the Lich-Gregoir technique significantly reduced the incidence of urinary fistulae from 7% to 2%, indicating improved surgical outcomes.

While the use of double J catheters did not show a statistically significant reduction in ureteric strictures (5.3% in group A vs. 3% in group B), the overall findings suggest that combining this technique with established surgical methods can enhance patient safety in kidney transplantation.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Lich-Gregoir technique and routine use of double J catheter as the best combination to avoid urinary complications in kidney transplantation. Moreno-Alarcón, C., López-Cubillana, P., López-González, PÁ., et al.[2014]

In a study of 60 patients with recurrent urinary tract infections (UTIs) and significant vesico-ureteric reflux (VUR) after kidney transplantation, open surgical correction effectively reduced the number of UTI episodes from a median of 4 before surgery to 1 after surgery, indicating a significant improvement in patient outcomes.

The surgery also demonstrated safety and efficacy, as evidenced by a decrease in median serum creatinine levels from 1.5 mg/dL to 1.3 mg/dL, suggesting that the renal function was preserved or improved post-surgery.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Surgical correction of vesico-ureteric reflux for recurrent febrile urinary tract infections after kidney transplantation. Dinckan, A., Aliosmanoglu, I., Kocak, H., et al.[2013]

In a study of 818 renal transplant patients, the optimal timing for the removal of double-J stents (DJS) was suggested to be between 14 to 21 days post-surgery, based on observed outcomes.

The study highlights that while there is no universally accepted timing for DJS removal, earlier removal (within 5 to 14 days) may lead to complications, indicating the importance of careful monitoring after transplantation.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Optimal Timing for Removal of the Double-J Stent After Kidney Transplantation. Yuksel, Y., Tekin, S., Yuksel, D., et al.[2022]

A study involving 200 kidney transplant patients demonstrated that nonoperative removal of double J stents, tied to a Foley catheter, is a safe and effective alternative to traditional endoscopic removal.

The rates of complications such as urinary fistula, ureteral stenosis, and wound infections were similar between the nonoperative group and the endoscopic group, indicating that the nonoperative method does not increase risk.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Stent Removal in 200 Kidney Transplant Recipients: Nonoperative Versus Endoscopic Removal. Simforoosh, N., Obeid, K., Javanmard, B., et al.[2017]

Double J ureteral stents are effective for urinary drainage from the kidney to the bladder and are generally safe and well tolerated in patients.

However, both short and long-term use can lead to complications ranging from minor issues like hematuria and dysuria to serious problems such as stent migration and urinary infections, often necessitating removal of the stent.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Complications of double J ureteral stents]. el Khader, K.[2006]

In a study of 14 renal transplant recipients, immunization with inactivated bacterial strains significantly reduced the incidence of recurrent urinary tract infections (UTIs) from an average of 3.4 to 0.9 episodes per year, representing a 74.9% decrease.

The immunization strategy was well-tolerated with no reported side effects or development of new donor-specific antibodies, suggesting it is a safe and effective alternative for preventing UTIs in this patient population.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Vaccination Against Urinary Tract Infection After Renal Transplantation. Zgoura, P., Waldecker, C., Bauer, F., et al.[2021]

In a study of 212 kidney transplant recipients, urinary tract infections (UTIs) occurred in 20.75% of patients, with female gender, prolonged catheter use, and postoperative urinary fistula identified as significant risk factors for developing UTIs after transplantation.

UTIs after kidney transplantation were associated with worse graft function at 3 months and increased hospital stays and antibiotic costs, highlighting the need for effective prevention strategies.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Risk factors for urinary tract infection in kidney transplantation from brain death donor and its role in graft function. Ye, Q., Wu, L., Zhu, B., et al.[2021]

In a study of 40 patients with chronic renal insufficiency, 20% had vesicoureteral reflux (VUR) affecting their kidneys, highlighting the prevalence of this condition in such patients.

The new ureterocystostomy technique showed a significant advantage in preventing VUR in kidney transplants, as none of the patients who underwent this method experienced VUR, compared to 30% of those who had other surgical procedures.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Vesicoureteral reflux in renal transplantation]. Kazimirov, VG., Butrin, SV., Kharitonov, BI., et al.[2008]

References

1. Saudi Arabia pubmed.ncbi.nlm.nih.gov

Double urinary bladder voiding technique post removal of urethral catheter in renal allograft recipients. [2015]

2. United States pubmed.ncbi.nlm.nih.gov

Association Between the Placement of a Double-J Catheter and the Risk of Urinary Tract Infection in Renal Transplantation Recipients: A Retrospective Cohort Study of 1038 Patients. [2021]

3. England pubmed.ncbi.nlm.nih.gov

Stented ureterovesical anastomosis in renal transplantation: does it influence the rate of urinary tract infections? [2022]

4. United States pubmed.ncbi.nlm.nih.gov

Lich-Gregoir technique and routine use of double J catheter as the best combination to avoid urinary complications in kidney transplantation. [2014]

5. England pubmed.ncbi.nlm.nih.gov

Surgical correction of vesico-ureteric reflux for recurrent febrile urinary tract infections after kidney transplantation. [2013]

6. United States pubmed.ncbi.nlm.nih.gov

Optimal Timing for Removal of the Double-J Stent After Kidney Transplantation. [2022]

7. Turkey pubmed.ncbi.nlm.nih.gov

Stent Removal in 200 Kidney Transplant Recipients: Nonoperative Versus Endoscopic Removal. [2017]

8. France pubmed.ncbi.nlm.nih.gov

[Complications of double J ureteral stents]. [2006]

9. United States pubmed.ncbi.nlm.nih.gov

Vaccination Against Urinary Tract Infection After Renal Transplantation. [2021]

10. China pubmed.ncbi.nlm.nih.gov

Risk factors for urinary tract infection in kidney transplantation from brain death donor and its role in graft function. [2021]

11. Russia (Federation) pubmed.ncbi.nlm.nih.gov

[Vesicoureteral reflux in renal transplantation]. [2008]