Related Experiment Video
Updated: Feb 10, 2026
Robot-Assisted Kidney Transplantation
Published on: July 19, 2021
Outcomes of externalized pyeloureteral versus internal ureteral stent in pediatric robotic-assisted laparoscopic
D I Chu1, D Shrivastava1, J P Van Batavia1
1Division of Urology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Insights
Externalized pyeloureteral (EPU) stents offer a comparable alternative to double-J (DJ) stents after pediatric robotic-assisted laparoscopic pyeloplasty, avoiding additional anesthesia for removal.
Area of Science:
- Urology
- Pediatric Surgery
- Minimally Invasive Surgery
Background:
- Urinary drainage after pyeloplasty typically involves double-J (DJ) ureteral stents or externalized pyeloureteral (EPU) stents.
- EPU stents may reduce bladder symptoms and avoid anesthesia for removal compared to DJ stents.
- Comparative outcome data for EPU versus DJ stents following pediatric robotic-assisted laparoscopic pyeloplasty (RALP) is limited.
Purpose of the Study:
- To compare operative success, operative time, hospitalization duration, and postoperative complications between EPU and DJ stents after primary RALP in children.
- To evaluate the efficacy and safety of EPU stents as an alternative to DJ stents in this patient population.
Main Methods:
- Retrospective review of consecutive children undergoing primary RALP from October 2013 to September 2015.
- Data collected included patient demographics, stent type, duration, complications, and operative success.
- Propensity score weighting was employed to balance baseline covariates and control for confounding by indication for EPU stent use. Weighted regression analyses compared outcomes between the two stent groups.
Main Results:
- After propensity score weighting, baseline differences between DJ and EPU stent groups (age, antibiotic prophylaxis) were eliminated.
- EPU stents showed no significant difference compared to DJ stents in operative success (95% vs. 94%), complications, or operative time.
- EPU stents were associated with a slightly longer hospitalization duration (0.6 days more). All EPU stents were removed in an outpatient setting, while DJ stents required anesthesia.
Conclusions:
- Externalized pyeloureteral (EPU) stents are a viable alternative to double-J (DJ) stents after pediatric robotic-assisted laparoscopic pyeloplasty (RALP).
- EPU stents provide comparable operative success and complication rates to DJ stents.
- The use of EPU stents avoids the need for additional anesthesia for stent removal, particularly beneficial for younger patients.
Introduction:
After pyeloplasty, urinary drainage options include internal double-J (DJ) ureteral stents or externalized pyeloureteral (EPU) stents, which can avoid bladder symptoms and additional anesthetic exposure from stent removal. Comparative outcome studies, however, are lacking following primary pediatric robotic-assisted laparoscopic pyeloplasty (RALP).
Objective:
To compare operative success, operative time, hospitalization, and postoperative complications of EPU versus DJ stents following RALP.
Study Design:
Consecutive children undergoing primary RALP from 10/2013 to 9/2015 were retrospectively identified. Data collected included patient demographics, stent type and duration, postoperative complications, and operative success. To control for confounding by indication for EPU stent, propensity score weighting was used to balance baseline covariates. Weighted regression analyses compared between-group differences in study outcomes.
Results:
At median follow-up of 12.3 months, 44 and 17 patients underwent DJ and EPU stenting, respectively. At baseline, DJ stent patients were older than EPU stent patients (median 7.7 vs 1.2 years, P = 0.01) and were less likely to be on postoperative antibiotic prophylaxis (25 vs 76%, P < 0.001). After weighting, these differences disappeared. All EPU stents were removed in the outpatient clinic; all DJ stents were removed under anesthesia. On weighted regression analyses (Summary Fig.), EPU stents had no different associations than DJ stents with operative success (95 vs 94%, between-group difference 1%, 95% CI -11, 13; P = 0.86), complications, or operative time, but did have 0.6 of a day more hospitalization (95% CI 0.04, 1.2; P = 0.04).
Discussion:
Patients receiving EPU stents were different at baseline from those receiving DJ stents. After propensity score weighting balanced these covariates, EPU stents were associated with similar operative success, complications, and operative time to DJ stents. Further study is warranted in larger prospective cohorts.
Conclusion:
Use of EPU stents provided a viable alternative, particularly in younger patients, to DJ stenting with comparable success and complications, while avoiding the need for an additional anesthetic.
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