To analyze the association between the febrile urinary tract infection (fUTI) after
Double-J (DJ) stents removal and restenosis after laparoscopic pyeloplasty (LP).
We retrospectively reviewed the clinical data of patients who were treated with transperitoneal
LP for ureteropelvic junction obstruction from 2016 to 2020. Patients were divided
into two groups according to whether they developed fUTI after DJ stent removal within
48 h. The 1:3 Propensity Score Matched (PSM) method was used to balance confounding
503 patients were included in the study. 28 (5.57%) patients developed fUTI after
DJ stent removal. Compared with the non-fUTI group, age was younger, and weight was
lower (P < 0.05) in the fUTI group. Restenosis occurred in 11 (2.2%) patients, of
which six patients developed fUTI after DJ stent removal. The revision surgery rate
in the fUTI group was significantly higher than in the non-fUTI group (21.4% vs. 1.1%, P < 0.01). After PSM, the results remained consistent. For 492 patients without
restenosis, 22 patients developed fUTI. Compared with the non-fUTI group, the larger
anteroposterior diameter (APD) and higher APD/cortical thickness (P/C) ratio were
observed in the fUTI group at three months and six months postoperatively (P < 0.05),
but the difference vanished at 12 months and 24 months after surgery (Figure).
FUTI after DJ stent removal is not uncommon after LP, and surgeons are often concerned
about the possibility of restenosis. In the present study, although our results demonstrated
a significant association between them, restenosis patients comprise only about 20%
of fUTI patients. Based on our clinical observations, fUTI is often developed in children
from 1 to 6 years of age, and the younger patients may be afraid of voiding because
of the postoperative pain after DJ stent removal. Besides, intraoperative manipulation
of DJ stent removal may lead to transient edema in the anastomotic site, causing the
fUTI. For patients who develop fUTI after DJ stent removal but without persistent
symptoms, the transient worsening of hydronephrosis during the early postoperative
period may not impact long-term outcomes (As shown in Figure). Additional follow-up
is needed to prevent the deterioration of renal function.
Our result demonstrated that fUTI after DJ stent removal is associated with restenosis
after LP. For fUTI patients without restenosis, APD and P/C ratio exhibited transient
worsening at three months and six months postoperatively, decreasing gradually during
follow-up. Patients who develop fUTI after DJ stent removal should be monitored.