Birkhäuser Frédéric D, Rütte Thomas von, Moltzahn Felix, Huber Philipp, Zehnder Pascal
Urology St. Anna, Lucerne, Switzerland.
Eur Urol Open Sci. 2025 Feb 21;74:28-33. doi: 10.1016/j.euros.2025.01.014. eCollection 2025 Apr.
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; = 0.237). At 2 yr, the rate of unobstructed drainage increased to 97% in group A and 96% in group B ( = 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.
在腹腔镜肾盂成形术中，常规放置双J输尿管支架以防止吻合口漏尿。然而，对于双J输尿管支架的最佳留置时间尚无共识。本研究旨在评估与长留置时间相比，短双J输尿管支架留置时间对微创肾盂成形术后长期功能结局和并发症的影响。
一项前瞻性随机单术者系列研究比较了2周与6周的留置时间。术前、术后6个月和24个月进行肾闪烁显像。术后3个月进行利尿肾图检查。从第2年到第5年，主要通过访谈对患者进行随访。
中位随访时间为66（范围29 - 104）个月。术前，所有82例患者均有症状，肾闪烁显像显示梗阻。利尿肾图显示所有患者在术后3个月时形态和动力学正常。术后6个月，肾闪烁显像显示A组（2周）84%的患者和B组（6周）95%的患者引流通畅（P = 0.237）。在2年时，A组引流通畅率增至97%，B组为96%（P = 0.962）。对于肾闪烁显像示示踪剂转运延迟的患者，额外的利尿肾图显示形态和造影剂动力学正常。未观察到与支架相关的并发症和尿漏。在最后一次随访时所有患者均无症状。
我们的长期数据表明，肾盂成形术后双J输尿管支架留置2周与留置6周的功能结局相似。此外，未发生与支架相关的并发症。这一发现可安全地应用于所有肾盂成形术患者。
在不影响总体功能成功率或增加并发症发生率的情况下，微创肾盂成形术患者受益于短双J支架留置时间。
