Double-J ureteral stents: an alternative to external urinary stents in orthotopic bladder substitution.
OBJECTIVE
The aim of this study was to compare advantages and disadvantages of using double-J or external stents to preserve the uretero-ileal anastomosis in patients receiving an orthotopic neobladder.


METHODS
77 consecutive patients with bladder cancer who underwent radical cystoprostatectomy and Studer neobladder were evaluated. All patients received a direct spatulated end-to-side uretero-ileal anastomosis in the afferent loop (Nesbit technique). In 45 patients (group A), the stents (Bracci ureteral splint) were brought our through the reservoir and anchored to the skin; in 32 patients (group B), an internal double-J stent was used. Median follow-up was 30 months.


RESULTS
9 (11.5%) uretero-ileal anastomosis strictures in group A and 7 (11.6%) in group B were observed. There was a significant difference in the side of stricture with a greater prevalence on the left side (p<0.004). Stricture formation and side were not related to the type of stent used. 14 (20%) neobladder-ureteral refluxes occurred, with a non-significant difference between the two groups (p = 0.37). 12 patients (86%) were asymptomatic; two patients developed pyelonephritis and needed antibiotic treatment. Neobladder catheter was removed after 17 days (range: 15-18 days) and 14 days (range: 12-15 days), respectively, in group A and group B with an earlier discharge of the patients in group B. There was a significant difference in mean hospital stay between the two groups (Mann-Whitney test p<0.0001). Discomfort related to the stent was mild for most of the patients of group B (84%).


CONCLUSIONS
Internal stenting is an equally effective alternative to external stent in patients undergoing bladder replacement. The use of double-j stents appears to be associated with minimal discomfort, earlier mobilization and a shorter hospital stay.
Micali
S
S
Department of Urology, Tor Vergata University, Regina Elena Cancer Institute, Rome, Italy. ivlas@tiscalinet.it
De Carli
P
P
Miano
R
R
O'Sullivan
D
D
Lamanna
L
L
Micali
F
F
D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods; D003251:Constriction, Pathologic / Q000209:etiology; D004867:Equipment Design; D006801:Humans; D007082:Ileum / Q000601:surgery; D008297:Male; D008875:Middle Aged; D015607:Stents; D014513:Ureter / Q000601:surgery; D001743:Urinary Bladder / Q000601:surgery*; D014547:Urinary Diversion / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods