Stent vs Stentless Ileal Conduits After Radical Cystectomy: Is There a Difference in Early Postoperative Outcomes?

Introduction: Placing ureteral stents at the ureteroileal anastomosis for radical cystectomy with ileal conduit (RCIC) has long been common practice. Recently, some providers have begun omitting stents. We sought to investigate differences in perioperative and 30-day outcomes between patients who underwent RCIC with and without stents placed at the ureteroileal anastomosis.

Methods: We identified RCICs performed between 2019 and 2021 in the National Surgical Quality Improvement Program database and corresponding Cystectomy-Targeted Participant Use File. Baseline demographics, comorbidities, and operative parameters were compared via Pearson's χ² and t tests between stented and stentless RCICs. Outcomes of interest, including rates of UTIs, acute kidney injury, renal failure requiring dialysis, ileoileal anastomotic leaks, ureteral obstruction, urinary leak or fistula formation, reoperations, and 30-day hospital readmissions, were compared using Pearson's χ². All statistical tests were 2-tailed with P < .05 considered significant.

Results: A total of 5418 RCICs were identified. Four hundred ninety-eight (9.2%) were stentless. There were no differences in baseline demographics or comorbidities. Significantly fewer stented patients had robotic-assisted operations (23% vs 29%, P < .01). Stented patients had lower rates of urinary leak or fistula formation (3.1% vs 4.8%, P = .04). There was no significant difference in 30-day rates of UTIs, acute kidney injuries, renal failure, ileoileal anastomotic leaks, ureteral obstruction, reoperations, and readmissions. Limitations include retrospective design and lack of longitudinal tracking past 30 days.

Conclusions: Stentless patients had noninferior outcomes compared to stented patients in most important 30-day outcomes. Our analysis suggests that stents may not be necessary in ileal conduit urinary diversion procedures.