Abstract
BACKGROUND AND OBJECTIVE: During laparoscopic pyeloplasty, double-J ureteral stents are routinely placed to protect the anastomosis from urinary leakage. However, no consensus exists on the optimal double-J ureteral stent indwelling time. This study aims to evaluate the impact of a short compared to a long double-J ureteral stent indwelling time on long-term functional outcomes ans complications following minimally invasive pyeloplasty. METHODS: A prospective randomized single-surgeon series compared 2- versus 6-wk indwelling time. Renal scintigraphy was performed preoperatively, and at 6 and 24 mo postoperatively. Diuretic renography was performed 3 mo postoperatively. From year 2 to 5, patients were followed mainly with interviews. KEY FINDINGS AND LIMITATIONS: The median follow-up was 66 (range 29-104) mo. Preoperatively, all 82 patients were symptomatic and renal scintigraphy revealed an obstruction. Diuretic renography documented regular morphology and kinetics in all patients at 3 mo. Six months postoperatively, renal scintigraphy detected unobstructed drainage in 84% of patients in group A (2 wk) and in 95% of patients in group B (6 wk; p = 0.237). At 2 yr, the rate of unobstructed drainage increased to 97% in group A and 96% in group B (p = 0.962). In patients with scintigraphically delayed tracer transportation, additional diuretic renography proved regular morphology and contrast media kinetics. No stent-related complications and urinary leakage were observed. All patients were asymptomatic at the last follow-up. CONCLUSIONS AND CLINICAL IMPLICATIONS: Our long-term data demonstrate that 2 wk of double-J ureteral stenting following pyeloplasty provides similar functional outcome to 6 wk of stenting. Furthermore, no stent-related complications occurred. This finding may safely be applied to all pyeloplasty patients. PATIENT SUMMARY: Without comprising overall functional success or increasing the rate of complications, patients following minimally invasive pyeloplasty benefit from a short double-J stent indwelling time.