| Objective: To investigate the impact of short-term extubation of D-Jstent in patients with ureteropelvic junction (UPJ) obstruction undergoingdismembered laparoscopic pyeloplasty (LP) and the optimal indwellingduration, contributing to decreasing the morbidity of stent-relatedcomplications and improving patients’ quality of life.Methods:28consecutive patients (age range16-45yrs) with unilateralUPJ obstruction (17left,11right) undergoing retroperitoneal standardAnderson-Hynes LP by a single surgeon between2012and2013wereretrospectively reviewed. D-J stents were antegrade inserted intra-operatively,and retrograde extubated under surface anesthesia by cystoscopy at ourinstitution. Indications for surgery included severe ipsilateral flank pain (25cases), T1/2>20min (2cases), and renal dysfunction (1case). The exclusivecriteria included:(1) medications with anticholinergics, analgesics orα-blockers;(2) procedure associated complications, for instance, surgicalinjury, infection, or stent fracture;(3) other concomitant urological diseasesresulting in cystospasm or lower urinary tract symptoms, such as overactivebladder, benign prostate hypertrophy, interstitial cystitis or urinary tractinfection; and (4) concomitant urolithiasis or residual stones on thepostoperative ultrasound or plain film (KUB). Patients were required toaccomplish the self-administered questionnaire (USSQ [ureteral stentsymptom questionnaire]) to evaluate stent-related symptoms in the course ofD-J stent placement. Blood and urine routine examination were regulated aftersurgery to certify the existence of bacteriuria. A plain film (KUB) wasacquired to ascertain the stent position and integrity along with the presence ofhydronephrosis, and a voiding cystourethrogram (VCUG) was rendered to illustrate the presence and degree of vesicoureteral reflux (VUR)3monthsafter surgery. Aforementioned examinations were arranged to evaluate ofstent-related consequences and complications. Moreover, renal function(Scr[Serum creatinine]), urological ultrasound (APPD[renal anteroposteriorpelvic diameter]), and diuretic renal scintigraphy (T1/2, GFR [glomerularfiltration rate]) were measured pre-and postoperatively to evaluate theamelioration of hydronephrosis and postoperative outcome. The meanfollow-up duration was6.2±3.2months. Cases were randomly classified intothe short term group (<14days) and the longer durations (>15days) group.Statistical analysis was performed by utilizing SPSS ver.19.0to analyze theimpact of short term extubation of D-J stent.(The continuous quantitativevariable was tested by independent samples T test, and the Fisher exact testwas utilized for categorical variable. P＜0.05was considered as statisticallysignificant.)Results: All patients underwent retroperitoneal standard Anderson-HynesLP successfully. None of operative method conversions or intraoperativecomplications occurred. Perirenal drain was removed at mean postoperativeday2.3±1.1in the light of drainage volume <10mL. The mean length ofhospital stay for all patients was5.6±2.4days. The mean duration of stentindwelling was15.2±4.5days, and all patients tolerated stent removal viacystoscopy under surface anesthesia with a little discomfort. No prolongedhospital stay or redo pyeloplasty was required ascribed to persistent urinaryleakage. During the period of follow-up lasting6.3±0.2months, all patientswere under intermittent contact and accomplished scheduled questionnaire andexamination. No patients required to return to the emergency department orrehospitalization owing to severe procedure-associated complications orstent-related symptoms. No accidental D-J stent malposition, migration,encrustation, ureteral erosion, fistulization, or fracture. The majority ofpatients tolerated the D-J stent indwelling compatibly, with the exception that5cases manifested bacteriuria administrated with antibiotics,2participantshad flank pain relieved by arranged stent extubation,2respondents presented urination frequency necessitating anticholinergics, and1patient wasdiagnosed as vesicoureteral reflux ameliorated after extubation (2simultaneously manifesting bacteriuria and lumbago and1presentingbacteriuria and urination frequency). Though no statistical significance existedbetween two groups of patients manifested frequency, plain, or vesicoureteralreflux(P＞0.05), difference in term of bacteriuria was obvious(P＜0.05). Theoverall morbidity of adverse events in long-duration group was50%,definitely surpassing the0%of short-term group. In the long duration group,the mean preoperative and postoperative serum creatinine were128.7μmol/Land79.2μmol/L (P＜0.05), the mean anteroposterior pelvic diamete were43.4mm and18.8mm(P＜0.05), and the mean T1/2were16.3min and8.7min(P＜0.05). In the short term group, the mean preoperative andpostoperative serum creatinine were142.1μmol/L and84.7μmol/L (P＜0.05),the mean anteroposterior pelvic diamete were41.3mm and19.6mm (P＜0.05), and the mean T1/2were14.0min and9.8min (P＜0.05). No statisticalsignificance of patient’s demographics and postoperative outcome existedbetween the two groups within the follow-up period (P＞0.05).Conclusions: Depending on the comparison of the long duration groupand the short term group undergoing retroperitoneal dismembered LP inpatients with UPJ obstruction, we reached a conclusion that shorterduration(＜14days) of D-J stent placement might decrease the morbidity ofadverse events and antibiotics required and presented no statistical differencein short-term postoperative outcome. Further large-sample prospective studieswith long-term follow-up are necessitated to explore the optimal time of D-Jextubation. |
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