Comparative outcomes of internal, external, and no stent in ureteroileal anastomosis for ileal orthotopic neobladder reconstruction.

Abstract

Background: Ureteral stents, including internal stents and stentless techniques, are commonly employed in urological procedures such as urinary stone management and deformity correction. However, their use in radical cystectomy for bladder cancer remains relatively limited. This study aimed to compare the efficacy of internal stent, external stent, and no-stent treatments for ureteroileal anastomosis in laparoscopic radical cystectomy (LRC) combined with ileal orthotopic neobladder (IONB). The goal was to compare postoperative outcomes and complications to identify the optimal stent choice.

Methods: A retrospective analysis was conducted on 51 patients who underwent LRC with IONB between April 2013 and December 2023. Patients were divided into three groups: internal stent (Group A), external stent (Group B), and no stent (Group C). Baseline characteristics, perioperative data, and postoperative complications were compared across three groups.

Results: Among the 51 patients (42 males, 9 females; median age: 62 years), internal stents were used in 18 (35.3%, Group A), external stents in 20 (39.2%, Group B), and no stents in 13 (25.5%, Group C) patients. Group A demonstrated significantly shorter hospital stays compared to Groups B and C (P=0.02). Abnormal renal function occurred less frequently in Group A (16.7%) and Group B (15.0%) than in Group C (53.8%, P=0.04). Early postoperative hydronephrosis was significantly different among the three groups (Group A: 5.6%, Group B: 5.0%, Group C: 38.5%; P=0.02). Ureteroileal anastomotic stricture (UIAS) was observed less frequently in Group A (0%) than in Group B (12.5%) and Group C (20.0%, P=0.01). No significant differences were found in other perioperative characteristics or complications.

Conclusions: Internal stents reduce early postoperative complications, including hydronephrosis and renal dysfunction, while lowering the risk of late UIAS. Internal stent use is a safe and effective option that promotes faster recovery and better postoperative outcomes.