The following is a summary of “Failure in Double-J stent inserting in laparoscopic pyeloplasty of ureteropelvic junction obstruction: the clinical features and outcomes,” published in the November 2023 issue of Urology by Xinyu, et al.
During laparoscopic pyeloplasty (LP), placing a Double-J (DJ) tube is a key step. If the DJ stent wasn’t put in, it could mean the patient also had a uretero-vesical junction block (UVJO), meaning the doctors had to switch to a different drainage method. For a study, researchers sought to look at the clinical results of these difficult pyeloplasties and the risk factors that made it more likely that the DJ stent would not be placed correctly during the LP. They looked back at the medical records of people with ureteropelvic junction blockage (UPJO) who had LP in their department between January 2016 and September 2020.
The externalized uretero-pyelostomy (EUP) stent was placed for patients with trouble placing the DJ stent. Finally, the patients were split into two groups: the DJ group and the EUP group. The main results were recurrent UPJO, postpartum uretero-vesical junction blockage (UVJO), and complications. The study looked at 535 patients, and 37 (6.9%) failed to place the DJ stent properly. The EUP group had younger and lighter people (P<0.05). Ten patients (1.87%) had repeated UPJO during follow-up; nine were in the DJ group, and one was in the EUP group (P>0.05). After surgery, 10.8% of people in the EUP group had UVJO compared to 0.2% of people in the DJ group (P<0.01). About 74 patients (13.8%) had problems after surgery. Of these, 12 patients (32.4%) were in the EUP group, which is a much higher rate than the 12.4% rate in the DJ group (P<0.01). At three months after surgery, the EUP group had higher APD than the DJ group (3.50 [3.02;4.58] vs. 2.20 [1.50;2.88], P<0.05), but the difference went away after more follow-up.
Patients who are younger, lighter, and had a bigger APD before surgery are more likely to have problems with DJ stent placement. Failure might not raise the risk of repeated UPJO, but it might mean they are more likely to have UVJO after surgery, have more problems, and take longer to heal.
Source: bmcurol.biomedcentral.com/articles/10.1186/s12894-023-01359-7