LAUSR

Background Comparative outcome studies investigating internal Double-J (DJ) and externalized stents have primarily been performed for open and laparoscopic pyeloplasty, with a paucity of literature surrounding outcomes in robotic-assisted laparoscopic pyeloplasty (RALP). Furthermore, outcomes of a modified external stent inserted into the renal pelvis, termed cutaneous pyeloureteral stent (CPU), remain unexamined. This study investigates outcomes of DJ and CPU stents as methods of trans-anastomotic drainage. Materials and Methods A retrospective analysis identified pediatric patients who underwent RALP between 12/2007 and 01/2020 at a single tertiary center, where CPU stents were introduced in 06/2012. Operative success was defined as improved or stable hydronephrosis without subsequent redo pyeloplasty. Secondary outcomes included stent reinsertion, anesthesia requirements, opioid administration, UTI, and bladder spasms. Results A total of 103 pediatric RALP procedures were analyzed (DJ=70, CPU=33). Operative success (DJ= 95.7%, CPU=100%, p=0.55), SFU grade improvement, and length of stay were comparable. Accidental stent expulsion was only seen with CPU stents (9%; p=0.03). Intracorporeal stent migration also occurred more frequently in CPU stents (DJ=3%, CPU=15%, p=0.03). Stent reinsertion, when needed, utilized a DJ stent with rates of 4% and 9% for DJ and CPU stents, respectively (p=0.38). DJ stents were removed at a later postoperative day (DJ=45.2+/-25.0, CPU=8.3+/-4.2; p<0.001) with increased general anesthesia (DJ=99%, CPU=3%; p<0.001) and IV opioid (DJ=27%, CPU=9%; p=0.04) requirements. Finally, DJ stents had nonsignificant increased rates of UTI (DJ=17%, CPU=3%, p=0.06) and bladder spasms requiring postoperative medication (DJ=26%, CPU=9%, p=0.07). Conclusions DJ and CPU stents display equivalent success rates in pediatric RALP and similar stent reinsertion rates. Appreciable differences can inform stent selection, including higher general anesthesia requirements and IV opioid administration among DJ stents and a higher incidence of accidental stent expulsion among CPU stents. Additionally, DJ stents were associated with nonsignificant increased rates of UTI and bladder spasm requiring medication.