Are double-J stents in surgery for deep infiltrating endometriosis always necessary? A retrospective analysis

Introduction
The therapy of deep infiltrating endometriosis places the highest demands. Double-J (DJ) stent insertion is recommended preoperatively. However, we could not find any publication in PubMed that showed the relevant advantages of double-J stent insertion in surgery of deep infiltrating endometriosis (DIE).

Aim
To report the advantages and disadvantages of inserting double-J stents in surgery for deep infiltrating endometriosis.

Material and methods
All patients who underwent surgery for deep infiltrating endometriosis at Academic Hospital Cologne Weyertal (a level III endometriosis center with up to approximately 900 endometriosis laparoscopic procedures annually) between January 2017 and September 2021 were included in this retrospective analysis. A total of 197 cases were included. The urinary tract complications were analyzed and they were divided into infections, pyelonephritis, urosepsis, intraoperative and postoperative ureteral lesions. Patients were divided into three groups: 1) with DJ stents in whom DJ stents were left in place postoperatively for at least 2 weeks, 2) with DJ stents in whom DJ stents were removed directly at the end of the surgery, 3) without DJ stents.

Results
There was a significant difference between all three groups in urinary tract complications: group 1 – 32%, group 2 – 11.6% and group 3 – 7%. The p value of .01 shows statistical significance between group with DJ stents and the group without DJ stents. Urinary tract infection occurred in 25.5% in the first group, 11.6% in the second group and 3.6% in the third group. Here, too, the p value shows statistical significance between the group with DJ stents and the group without DJ stents. Ureteral injury, on the other hand, occurred rarely and no statistically significant difference was found between group 3 and the total population, 3.6% versus 2.5%. In group 1, the injury rate was minimally higher, 6.4%. After comparing groups 1 and 2 with group 3, there was also no significant difference in ureter injury (6.4% vs. 3.6%, p = 0.42).

Conclusions
The authors of this study recommend that DJ stent insertion should not be part of the general preoperative preparation.