Department of Urology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health (NCCH), Beijing, 100045, China.
BMC Urol. 2023 Nov 18;23(1):192. doi: 10.1186/s12894-023-01359-7.
Double-J (DJ) stent placement is an important procedure during laparoscopic pyeloplasty (LP). Failing to insert the DJ stent may indicate the patient was also complicated with uretero-vesical junction obstruction (UVJO), and surgeons have to change to another alternative drainage method. In the present study, we analyzed the risk factors of failure of DJ stent placement during the LP and reviewed the clinical outcomes of these challenging pyeloplasties.
We retrospectively analyzed the clinical data of patients with ureteropelvic junction obstruction (UPJO) who underwent LP in our department from January 2016 to September 2020. For patients who developed a difficult process of inserting the DJ stent, the externalized uretero-pyelostomy (EUP) stent was indwelled. Patients were finally divided into two groups: DJ group and EUP group. The primary outcomes were recurrent UPJO, postoperative uretero-vesical junction obstruction (UVJO) and complications.
A total of 535 patients were included in the study, of which 37 patients (6.9%) failed to insert the DJ stent. Age was younger, and weight was lower (P < 0.05) in the EUP group. Within follow-up, recurrent UPJO occurred in ten (1.87%) patients, nine in the DJ group and one in the EUP group (P > 0.05). The incidence of postoperative UVJO in the EUP group was significantly higher than in the DJ group (10.8% vs. 0.2%, P < 0.01). 74 patients (13.8%) developed complications after surgery, 12 patients (32.4%) in the EUP group, significantly higher than that in the DJ group (32.4% vs. 12.4%, P < 0.01). Compared with the DJ group, the larger APD were observed in the EUP group at three months postoperatively (3.50 [3.02;4.58] vs. 2.20 [1.50;2.88], P < 0.05), but the difference vanished in further follow-up.
The failure of DJ stent placement tends to occur in patients with younger age, lower weight, and larger preoperative APD. Failure may not increase the recurrent UPJO rate, but may indicate a higher probability of postoperative UVJO and may develop more postoperative complications and slower recovery.
双 J（DJ）支架置入术是腹腔镜肾盂成形术（LP）中的重要步骤。如果无法置入 DJ 支架，则可能表明患者还伴有输尿管-膀胱连接部梗阻（UVJO），此时外科医生需要更换另一种引流方法。本研究分析了 LP 中 DJ 支架置入失败的危险因素，并回顾了这些具有挑战性的肾盂成形术的临床结果。
我们回顾性分析了 2016 年 1 月至 2020 年 9 月在我科接受 LP 治疗的输尿管肾盂连接部梗阻（UPJO）患者的临床资料。对于置入 DJ 支架过程中出现困难的患者，留置外置输尿管-肾盂支架（EUP）。最终患者分为两组：DJ 组和 EUP 组。主要结局为复发性 UPJO、术后 UVJO 和并发症。
本研究共纳入 535 例患者，其中 37 例（6.9%）患者无法置入 DJ 支架。EUP 组患者年龄较小，体重较轻（P<0.05）。在随访期间，10 例（1.87%）患者发生复发性 UPJO，DJ 组 9 例，EUP 组 1 例（P>0.05）。EUP 组术后 UVJO 的发生率明显高于 DJ 组（10.8%比 0.2%，P<0.01）。74 例（13.8%）患者术后发生并发症，EUP 组 12 例（32.4%），明显高于 DJ 组（12.4%，P<0.01）。与 DJ 组相比，EUP 组术后 3 个月时的 APD 较大（3.50[3.02；4.58]比 2.20[1.50；2.88]，P<0.05），但在进一步随访中差异消失。
DJ 支架置入失败倾向于发生在年龄较小、体重较轻和术前 APD 较大的患者中。失败不会增加复发性 UPJO 的发生率，但可能提示术后 UVJO 的发生概率更高，且可能会发生更多的术后并发症，恢复较慢。
