Outcomes of Retrograde Transileal Ureteric Stents for Chronic Urinary Drainage: Comparison with Chronic Nephrostomy...

To characterize the clinical and tube maintenance outcomes for patients with ileal conduits who require chronic urinary drainage with retrograde transileal ureteric stents (RUSs).

A retrospective study from January 2010 to December 2021 reviewed 30 patients with chronic RUS drainage (1,148 exchange procedures), evaluating the adverse events (AEs), maintenance burden, and change in renal function. RUS results were compared with 71 conventional patients managed with chronic percutaneous nephrostomy (PCN) (1,068 exchanges).

Change in renal function was not significantly different between RUS and PCN patients at 1 year (glomerular filtration rate [GFR], -10 mL/min/1.73 m² vs -5 mL/min/1.73 m²; P = .16) and 2-3 years (GFR, -16 mL/min/1.73 m² vs -7 mL/min/1.73 m²; P = .38) after insertion. RUS had lower rates of nonroutine interventions (5.9% vs 20.1%, P < .001) due to fewer tube dislodgement events; however, RUS required shorter routine maintenance intervals (P = .019) with median routine exchanges booked every 8.5 weeks (interquartile range [IQR], 6.3-10.9 weeks) at 3 years compared with 12.9 weeks (IQR, 9.5-13.1 weeks) for PCN patients. At 1 year after insertion, 30% of RUS patients required routine exchange intervals ≤6 weeks (3% for PCN patients). Unlike PCN, every year, more RUS patients required shorter routine maintenance intervals, typically due to tube encrustation, with 81% of patients requiring exchange intervals < 10 weeks at 4 years after insertion compared with 47% at 1 year. RUS patients experienced higher rates of moderate to severe AEs (30% vs 4.2%, P < .001), mostly due to tube dislodgements requiring a new PCN insertion under sedation to reestablish the RUS.

Chronic RUS is effective for urinary diversion but requires significantly shorter intervals between routine tube maintenance than conventional PCN.