Stenting versus Splinting of Uretero-Intestinal Anastomoses: Our Experience

Abstract

The role and type of temporary ureteral splints to be used for uretero-intestinal anastomoses is not yet clear, especially regarding whether they help prevent stenoses or fistulas, which are complications that can affect the successful outcome of the actual operation. The aim of this study is to assess the results using the double J ureteral stent and the splint in patients subjected to radical cystectomy and urinary diversion using the intestine.

Material and methods

From November ‘94 to December ‘97, 109 patients underwent radical cystectomy: 60 orthotopic neobladders were created (53 VIP, 4 Reddy 2, 2 Studer, 1 Carney 2), 42 ileal conduits, 4 heterotopic diversions (2 Indiana, 1 Mainz1, 1 Mainz2), 3 USS and 216 u-i anastomoses (93 Le Duc, 6 Leadbetter, 4 Goodwin, 2 Split-cuff, 2 Main, 2 Ghoneim, 41 Nesbit, 35 Wallace1, 13 Bricker, 12 Polsino, 6 Wallace2). 115 splints were used (in orthotopic and heterotopic diversions the counter-opening was through the abdominal wall) and 101 double J stents. A check by neocystography/Brikergraph and transplintgraph (with possible removal of the splint) was carried out on the 15th day, while the double J stent was removed on the 30th day by flexible cystoscopy.

Results

18 stenoses occurred, of which 7/115 patients subjected to splinting and 11/101 patients subjected to stenting. Fistulas occurred in 6 patients: 5/6 with stent, 1/6 with splint (5 VIP with 5 Le Duc, 1 Bricker with Nesbit): these resolved spontaneously keeping the ureteral splint in situ for a longer period (average 20 days, range 15–32). These is consequently no statistically significant difference between the two groups of patients (p = 0,09 for stenoses and p = 0,11 for fistulas).

Conclusions

The importance of the temporary ureteral splint in u-i anastomoses in order to prevent stenoses or fistulas seems to be recognised in literature, but the type of splint is not clarified. Our study does not seem to indicate a substantial preference. The choice of splint depends on the personal preference of the surgeon, also taking into account that although the splint allows radiological (also serial) control of the upper urinary tracts (important with urinary fistulas), the stent is perhaps easier to handle and better tolerated by the patient.