Use of Ureteral Stents after Endopyelotomy

Abstract

Despite the widespread practice of endopyelotomy for the management of ureteropelvic junction obstruction, the optimal conditions for ureteral healing after endoincision remain largely untested. Current recommendations for the use of large-caliber graduated endopyelotomy stents and a 6-week duration of stenting are being challenged by recent reports of successful outcomes with the use of standard, small-caliber ureteral stents and early stent removal. Moreover, improvements in stent design have led to the development of endopyelotomy stents with improved biocompatibility, enhanced case of insertion, and fewer adverse effects.

Ureteral Double-J Wire Stent Effectiveness after Endopyelotomy: An Animal Model Study

“…The different studies which consider stent size after ureteral incision have not shown a significant advantage of larger over smaller stents [9,14,15] . However, it is possible to extract a series of conclusions from these studies.…”

“…Smaller stents [19] . In various studies, the groups with larger stents were associated with increased periureteral fibrosis and stricture formation, though without statistical significance [9,14] . Larger stents have been shown to be significant factors for patient discomfort [20] .…”

Evaluation of Optimal Stent Size after Antegrade Endopyelotomy: An Experimental Study in the Porcine Model

“…Currently, 4-6 weeks of stenting after endopyelotomy is the standard clinical practice [3]. This recommendation is based on Davis' early work with intubated ureterotomy using the dog model [1], According to Davis, restoration of the muscular layer of the ureter takes at least 6 weeks [1], However, it is unclear whether the stent needs to remain in place for the entire duration of this healing phase.…”

“…The size of this stent must therefore allow effective urine diversion and healing of the ureter with an adequate caliber. However, no consensus regarding this 'ideal endopyelotomy stent' has yet been reached [3]. In a recent heterogeneous clinical series of endopyelotomies and endoureterotomies managed with either a 6 F inter nal stent or a 14/7 F endopyelotomy stent, the difference in success rates between the two groups was not statistical ly significant.…”

“…Conclusion: The use of a large caliber stent after experimental antegrade endopyelotomy does not pro vide any advantage over the use of a smaller easily positioned 7 F stent. faster return to normal activity, together with a long-term success rate of 85% [2], Regardless of the technique used to fully incise the junction thickness, stenting of the ureter seems mandato ry to divert the urine and limit extravasation, as well as to promote ureteral regeneration [3]. However, the optimal stent size allowing satisfactory UPJ healing has still not been determined.…”