Re: Outcome analysis and cost comparison between externalized pyeloureteral and standard stents in 470 consecutive open pyeloplasties. L. H. P. Braga, A. J. Lorenzo, W. A. Farhat, D. J. Bagli, A. E. Khoury and J. L. Pippi Salle. J Urol 2008; 180: 1693-1699.

摘要

The authors compare 2 types of pyeloplasty stenting, an internal Double-J~R stent and a modified externalized multipurpose stent (Pippi Salle stent). The latter proved to be slightly cheaper, and allowed avoidance of a second general anesthesia for removal and performance of contrast studies, if appropriate. We agree with these advantages and think that externalized stents have other putative advantages, such as the possibility of flushing the tube if blood clots block it. We also agree that costs represent a major point in selecting the type of stent, particularly in consideration of the high success rate reported with nonstented repairs.1 For this reason in our practice we have opted for a Bracci ureteral splint/stent (Coloplast, Humlebaek, Denmark). Although comparison of costs is difficult among health systems, the cost of this device, as obtained from our 2008 theater expenses database, is about 7 euros (corresponding to around 9 United States dollars and 11 Canadian dollars), hence about 15 times less than the Pippi Salle stent. The Bracci splint/stent is a straight tube with holes every 5 mm in the last 6.5 cm that we use for any kind of ureteral stenting including stenting after ureteral reimplantation (see figure). For pyeloplasties we prefer the 6Fr size because smaller stents are more elastic and fragile, and in an early case of ours a 5Fr stent broke when pulled for removal. In contrast, we have never failed to negotiate the proximal ureter with the 6Fr stent, even in neonates.