The role of triple double-J stents in managing uretero-ileal anastomotic strictures following urinary diversion.

PURPOSE: To evaluate the efficacy and safety of triple double-J (DJ) stents in treating uretero-ileal anastomotic strictures (UIAS) following urinary diversion procedures (ileal conduit and ileal orthotopic neobladders).

PATIENTS AND

METHODS

A prospective analysis and follow-up observation were conducted on patients who underwent triple-stent placement for UIAS after urinary diversion at our center between August 2022 and January 2024. During follow-up, surgical success rates, renal function parameters, and complication incidence were evaluated. Surgical success was defined as either ureteral stents remaining in situ with unobstructed urinary drainage or, in cases where there was unplanned stent replacement or removal, the sustained maintenance of stable renal function parameters without subsequent deterioration.

RESULTS

During the 2-year follow-up period, patients underwent regular triple-stent replacement at our hospital every 6 months. The overall success rate of triple-stent reached 83.3% among 29 patients (36 cases). At the 2-year follow-up, there was a statistically significant decrease in hydronephrosis volume (59.0 ± 55.8 vs. 30.2 ± 17.0 cm³, p = 0.008), blood creatinine level (124.7 ± 38.3 vs. 109.6 ± 22.3 µmol/L, p < 0.001), and urea nitrogen level (7.4 ± 2.6 vs.6.6 ± 1.8 mmol/L, p < 0.001). Glomerular filtration rate remained stable (54.1 ± 22.0 vs. 53.3 ± 20.6 mL/min/1.73 m², p = 0.067). Surgical complications during follow-up included pain (5.6%), hematuria (2.8%), urinary tract infection (11.1%), and lower urinary tract symptoms (13.9%).

CONCLUSIONS

Our center innovatively proposed the triple-stent for treating UIAS in patients after urinary diversion. Two-year follow-up data demonstrate that, for patients unsuitable for surgical reconstruction or with limited financial resources, regular triple-stent placement and replacement is feasible, showing good long-term patency rates and a low incidence of adverse events.

CLINICAL TRIAL REGISTRATION: Our clinical trial is registered in the Chinese Clinical Trial Registry ( https://www.chictr.org.cn ), and registration identifier: ChiCTR2400079508.