Background: The use of ureteral stents with extraction strings in robotic pyeloplasty obviates the need for a secondary procedure and anesthetic for ureteral stent removal but are thought to increase risk for postoperative UTI. We sought to review our experience with robotic pyeloplasty in a large series of patients managed with ureteral stents with and without extraction strings.Methods: All robotic pyeloplasty at our institution from 2012 - present were retrospectively reviewed. Patients with less than 60 days of follow-up were excluded. Patient demographics, perioperative details, and complications within 60 days were evaluated. Statistical analysis was performed with Fisher’s exact testing.Results: A total of 218 patients underwent robotic pyeloplasty during the study period: 188 (86%) patients had ureteral stents with extraction strings and 30 (14%) patients had internalized stents. Study groups were similarly weighted with regards to demographics, presenting symptoms, functional parameters prior to surgery, and length of stay.A total of 13 (6%) patients in our series required treatment for UTI following discharge: 4 patients were treated on an outpatient basis (3 string (1.6%) vs 1 non-string (3.4%), p=0.45) and 9 patients were admitted for inpatient treatment (9 string (4.8%) vs 0 non-string (0%), p=0.61). In subgroup analysis of patients with extraction strings, 67% (2/3) of patients requiring outpatient treatment for UTI and 78% (7/9) requiring inpatient treatment for UTI were female. Gender was not associated with an increased risk of complications (p=0.19) or UTI (p=0.59) on subgroup analysis.Complications were similar between the two groups (22 vs. 4, p=0.50). A total of 11 (5.8%) Clavien 3 complications were noted in the group with extraction strings. Among this group, 5 patients underwent percutaneous nephrostomy tube placement (2 for clot obstruction, 2 for urinoma, 1 for ureteral stent dislodgement) and 5 underwent ureteral stent replacement (2 due to distal ureteral edema, 2 due to stent fracture during removal, and one due to urine leak). No Clavien 3 complications were noted in the internal stent group. A total of 7 (3.7%) extraction string patients required stent removal in the operating room under anesthesia. Fourteen (7.4%) patients came to the office for ureteral stent removal. All patients in the internal stent group required removal under anesthesia in the operating room.Conclusions: Ureteral stents with extraction strings were not associated with an increased risk of complications or postoperative UTI in our series.
Outcomes | Extraction string(N=188) | Internal stent(N=30) | Total(N=236) | p-value |
Any complication within 60 days | p = 0.33 | |||
Number (%) | 22 (12%) | 4 (13%) | 26 (12%) | |
Outpatient Treatment for UTI within 60 days | p = 0.45 | |||
Number (%) | 3 (2%) | 1 (3%) | 4 (2%) | |
Inpatient Treatment for UTI within 60 days | p = 0.61 | |||
Number (%) | 9 (5%) | 0 (0%) | 9 (4%) | |
Any Treatment for UTI within 60 days | p = 1.00 | |||
Number (%) | 12 (6%) | 1 (3%) | 13 (6%) | |
Clavien-Dindo IIIb complications | ||||
Number (%) | 11 (6%) | 0 (0%) | 11 (5%) | p = 0.37 |