Decision crossroads in pediatric pyeloplasty: DJ stent vs. EUP stent.

Stent Showdown: Which Drainage Technique Reigns Supreme in Pediatric Pyeloplasty?

Lena Voss in Health & Wellness December 2025 • 4 min read.

"A comparative look at externalized uretero-pyelostomy (EUP) versus double-J (DJ) internal stents for pediatric pyeloplasty reveals surprising insights into safety and effectiveness."

When a child needs surgery for a ureteropelvic junction obstruction (UPJO), a blockage where the ureter connects to the kidney, one of the key decisions is how to drain the area during healing. For years, surgeons have used different types of stents—small tubes that keep the passageway open. Two popular options are double-J (DJ) stents, which sit entirely inside the body, and externalized uretero-pyelostomy (EUP) stents, which have one end that exits the body.

DJ stents have been a mainstay, but they come with a catch: they require a second procedure under anesthesia for removal. This raises concerns about the potential risks of anesthesia, especially in young children. EUP stents, on the other hand, can be removed without additional anesthesia, but some worry about other potential complications.

A recent study published in the Canadian Urological Association Journal dives deep into this debate. Researchers compared outcomes of children who underwent pyeloplasty with either EUP or DJ stents, aiming to determine if one technique truly offers an advantage over the other. Let's break down the findings and explore what they mean for families facing this decision.

EUP vs. DJ Stents: Decoding the Differences in Pediatric Pyeloplasty Drainage

Decision crossroads in pediatric pyeloplasty: DJ stent vs. EUP stent.

The study, conducted at a single center in Toronto, Canada, retrospectively reviewed the cases of 76 children who underwent pyeloplasty for UPJO. The surgeries were performed by five different pediatric urologists over a one-year period. To ensure a fair comparison, children with other urological issues or those who had "stentless" pyeloplasty were excluded.

Based on surgeon preference, 24 children received an EUP stent, while 38 received a DJ stent. The researchers then meticulously analyzed various factors, including:

Operative time
Length of hospital stay
Overall complication rates
Timing of complications (intraoperative, early, and late)
Severity of complications (using the Clavien-Dindo classification system)

The goal was to uncover any statistically significant differences in these outcomes between the two groups. While the study revealed that children in the EUP group were younger (40 months vs. 80 months) and had a higher proportion of open pyeloplasties (71% vs. 42%), the core findings were quite reassuring.

The Bottom Line: Is One Stent Better Than the Other?

Ultimately, the study concluded that pyeloplasty using EUP stents doesn't lead to longer operative times, extended hospital stays, or higher complication rates compared to DJ stents. Within the study's limitations (small sample size, potential selection bias), EUP stents appear to be a safe and viable alternative to DJ stents. The most significant advantage? Avoiding a second anesthetic for stent removal.

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Everything You Need To Know

What is the key difference between EUP and DJ stents in pediatric pyeloplasty?

The primary difference lies in stent removal. Double-J (DJ) stents are entirely internal and necessitate a second procedure under anesthesia for removal. Externalized uretero-pyelostomy (EUP) stents, however, have an external component, allowing for removal without the need for additional anesthesia. This is a significant advantage of EUP stents, especially considering the risks associated with anesthesia in young children.

Why is the choice of drainage technique, such as EUP or DJ stents, important in pediatric pyeloplasty?

The drainage technique is crucial because it impacts the healing process after surgery for a ureteropelvic junction obstruction (UPJO). Both EUP and DJ stents are designed to keep the ureter passageway open while the area heals. However, the choice has implications for patient comfort, the risk of complications, and the number of procedures required. Using DJ stents requires a second procedure for removal, while EUP stents offer a potentially less invasive option.

What were the main findings of the study comparing EUP and DJ stents in pediatric pyeloplasty?

The study compared outcomes in children who underwent pyeloplasty with either EUP or DJ stents. The research found that EUP stents didn't lead to longer operative times, extended hospital stays, or higher complication rates compared to DJ stents. The main benefit of EUP stents as noted in the study is the avoidance of a second anesthetic for stent removal. However, the study acknowledges limitations such as a small sample size and potential selection bias.

What are the potential risks or complications associated with either EUP or DJ stents?

Both EUP and DJ stents have potential complications. The use of DJ stents requires a second procedure for removal, exposing children to additional risks associated with anesthesia. While EUP stents avoid this, they may have other complications, although the study didn't find evidence of higher complication rates compared to DJ stents. The study meticulously analyzed the timing and severity of complications using the Clavien-Dindo classification system.

How did the study methodology ensure a fair comparison between EUP and DJ stents?

The study used a retrospective review of 76 children who underwent pyeloplasty for UPJO. To ensure a fair comparison between the two groups, the researchers excluded children with other urological issues or those who had stentless pyeloplasty. This helped to focus the comparison on the effects of the EUP and DJ stents themselves. Furthermore, the study considered several factors, including operative time, length of hospital stay, overall complication rates, and the timing and severity of these complications.