A Short Double-J Ureteral Stent Indwelling Time Is Safe and Effective Following Minimally Invasive Pyeloplasty: Long-term Results from a Prospective Randomized Controlled Trial

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Our long-term data demonstrate that 2-wk double-J stenting following minimally invasive pyeloplasty provides similar functional outcome to 6-wk double-J stenting in the absence of stent-related complications. We therefore suggest that all patients following pyeloplasty can be treated safely with a uniform 2-wk double-J stent indwelling interval. 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. 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. 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. 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. 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.

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