Ureteric stents in pyeloplasty: a help or a hindrance?

Abstract 

Objective

To examine whether routine ureteric stenting influences outcome of pyeloplasty for pelvi-ureteric junction obstruction (PUJO).

Patients and methods

A 10-year review was conducted of 105 consecutive open Anderson–Hynes dismembered pyeloplasties performed for PUJO, covering two periods: (1) pyeloplasties performed without ureteric stents (1994–1998) and (2) pyeloplasties performed with ureteric stents (1999–2003). Outcomes (expressed as means±SEM) of unstented patients (UPs; n=47) and stented patients (SPs; n=58) were compared and results analysed using ANOVA and chi-square tests.

Results

Fifty-five patients (53.9%) presented with antenatal hydronephrosis, whilst 47 (46.1%) presented postnatally (at mean age 88.4±7.1months) with one or more of the following: pain (n=30, 63.8%), urinary tract infection (n=16; 34.0%), haematuria (n=3, 6.4%), abdominal mass (n=3, 6.4%), acute renal failure (n=2, 4.3%), incidental finding (n=4, 8.5%). Pyeloplasty was performed (at mean age 58.9±5.3months) for one or more of the following: pain (n=40, 38.1%), haematuria (n=6, 5.7%), urinary tract infection (n=18, 17.1%), poor initial or deteriorating function (n=29, 27.6%), severe or deteriorating hydronephrosis (n=41, 39.0%), calculus (n=1, 0.95%). Recognised complications of surgery were significantly higher in UPs (5 of 47; 10.6%) than SPs (0 of 58); P=0.016. These were leakage (n=4, 8.5%) and obstruction by blood clot (n=1, 2.1%). Nine SPs (15.5%) developed stent-related complications, including stent migration (n=5, 8.6%), infection (n=3, 5.2%) and calculus (n=1, 1.7%). SPs had significantly shorter hospital stay (2.71±0.25days) than UPs (4.30±0.38 days); P<0.01. Preoperative renal pelvis antero-posterior diameter in SPs (3.24±0.25cm) and UPs (3.21±0.28cm) was comparable (P=0.80). Following pyeloplasty, a significant improvement from these preoperative baselines occurred earlier in SPs (at 3.10±0.46months) than UPs (at 15.71±3.05months); P<0.01.

Conclusion

Stented pyeloplasty significantly reduces complications from surgery, particularly leakage, and results in shorter hospital stay and earlier resolution of hydronephrosis, but at the expense of stent-related complications which could be avoided in future by the use of external stents.

Keywords: Anderson–Hynes, Unstented patients, Stented patients, Pelvi-ureteric junction obstruction