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 disadvantage s of using double-J or external stents to preserve the uretero-ileal anasto mosis in patients receiving an orthotopic neobladder. Methods: 77 consecutive patients with bladder cancer who underwent radical cystoprostatectomy and Studer neobladder were evaluated. All patients recei ved a direct spatulated end-to-side uretero-ileal anastomosis in the affere nt loop (Nesbit technique). In 45 patients (group A), the stents (Bracci ur eteral splint) were brought our through the reservoir and anchored to the s kin; 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 (1 1.6%) in group B were observed. There was a significant difference in the s ide of stricture with a greater prevalence on the left side (p <0.004). Str icture formation and side were not related to the type of stent used. 14 (2 0%) neobladder-ureteral refluxes occurred, with a non-significant differenc e between the two groups (p = 0.37). 12 patients (86%) were asymptomatic; t wo patients developed pyelonephritis and needed antibiotic treatment, Neobl adder catheter was removed after 17 days (range: 15-18 days) and 14 days (r ange: 12-15 days), respectively, in group A and group B with an earlier dis charge of the patients in group B. There was a significant difference in me an hospital stay between the two groups (Mann-Whitney test p <0.0001). Disc omfort related to the stent was mild for most of the patients of group B (8 4%). Conclusions: Internal stenting is an equally effective alternative to exter nal stent in patients undergoing bladder replacement. The use of double-j s tents appears to be associated with minimal discomfort, earlier mobilizatio n and a shorter hospital stay. Copyright (C) 2001 S, Karger AG, Basel.