External Stent Research Articles

Mechanical property analysis and design parameter optimization of a novel nitinol nasal stent based on numerical simulation.

Background: A novel braided nasal stent is an effective alternative to nasal packing after septoplasty that can be used to manage the mucosal flap after septoplasty and expand the nasal cavity. This study aimed to investigate the influence of design parameters on the mechanical properties of the nasal stent for optimal performance. Methods: A braided nasal stent modeling method was proposed and 27 stent models with a range of different geometric parameters were built. The compression behavior and bending behavior of these stent models were numerically analyzed using a finite element method (FEM). The orthogonal test was used as an optimization method, and the optimized design variables of the stent with improved performance were obtained based on range analysis and weight grade method. Results: The reaction force and bending stiffness of the braided stent increased with the wire diameter, braiding density, and external stent diameter, while wire diameter resulted as the most important determining parameter. The external stent diameter had the greatest influence on the elongation deformation. The influence of design parameters on von-Mises stress distribution of bent stent models was visualized. The stent model with geometrical parameters of 25mm external diameter, 30° braiding angle, and 0.13mm wire diameter (A3B3C3) had a greater reaction force but a considerably smaller bending stiffness, which was the optimal combination of parameters. Conclusion: Firstly, among the three design parameters of braided stent models, wire diameter resulted as the most important parameter determining the reaction force and bending stiffness. Secondly, the external stent diameter significantly influenced the elongation deformation during the compression simulation. Finally, 25mm external diameter, 30° braiding angle, and 0.13mm wire diameter (A3B3C3) was the optimal combination of stent parameters according to the orthogonal test results.

Defective autophagy triggered by arterial cyclic stretch promotes neointimal hyperplasia in vein grafts via the p62/nrf2/slc7a11 signaling pathway

Autophagy is an adaptation mechanism to keep cellular homeostasis, and its deregulation is implicated in various cardiovascular diseases. After vein grafting, hemodynamic factors play crucial roles in neointimal hyperplasia, but the mechanisms are poorly understood. Here, we investigated the impacts of arterial cyclic stretch on autophagy of venous smooth muscle cells (SMCs) and its role in neointima formation after vein grafting. Rat jugular vein graft were generated via the ‘cuff’ technique. Autophagic flux in venous SMCs is impaired in 3-day, 1-week and 2-week grafted veins. 10%-1.25 Hz cyclic stretch (arterial stretch) loaded with FX5000 stretch system on venous SMCs blocks cellular autophagic flux in vitro and shows no significant impact on activity of mTORC1 and AMPK. Microtubule depolymerization but not lysosome dysfunction nor autophagosome/amphisome-lysosomal membrane fusion blockade is involved in the impairment of autophagic flux. Microtubule stabilization, induced by paclitaxel treatment and external stents intervention respectively, restores venous SMC autophagy and ameliorates neointimal hyperplasia in vivo. Moreover, autophagy impairment causes accumulation of the cargo receptor p62, which sequesters keap1 to p62 aggregates and results in the stabilization and nuclear translocation of nrf2 to modulate its target antioxidative gene SLC7A11. p62 silencing abrogates the increases of nrf2 and slc7a11 protein expression, glutathione level and venous SMC proliferation triggered by arterial cyclic stretch in vitro, and further hinders nrf2 nuclear translocation, reduces neointimal thickness after vein grafting in vivo. p62 (T349A) mutation also inhibited venous SMC proliferation and alleviated neointimal formation in vivo. These findings suggest that stabilization of microtubules to rescue autophagic flux or direct silencing of p62 are potential therapeutic strategies for neointimal hyperplasia.

Comparison of external stents and DJ stents techniques for pediatric pyeloplasty: A systematic review and meta-analysis.

ObjectiveTo evaluate and compare the efficacy and safety between an external stent and a Double J stent for pediatric Pyeloplasty.MethodsThrough a systematical search of multiple scientific databases in July 2022, we performed a systematic review and meta-analysis of the primary outcomes of interest according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses), whose protocol was registered with PROSPERO(CRD42021274087).ResultsEleven studies involving 1,758 patients were included. No significant differences were observed in operative time (MD: 2.26; 95% CI −9.62 to 14.14; P = 0.79), operative success rate (OR: 1.10; 95% CI 0.57 to 2.10; P = 0.780), length of hospital stay (MD: 0.65; 95% CI −0.04 to 1.34; P = 0.063), or complications (OR: 0.87; 95%CI 0.48 to 1.56; P = 0.630) between external stents and DJ stents in pediatric pyeloplasty. According to the subgroup analysis, we found the external stent group had a shorter operative time than the DJ stent group in terms of robot-assisted laparoscopic pyeloplasty (MD: −17.13; 95% CI −32.8 to −1.45; P = 0.032).ConclusionsThere were no significant differences in operative time, operative success rate, length of hospital stay, or complications between external stents and DJ stents in pediatric pyeloplasty. The external stented procedure seemed to have less operative time when using robot-assisted laparoscopic pyeloplasty. However, due to the limitations of our analysis, more studies are still required to support our conclusion.Systematic review registrationThis systematic review has been registered on PROSPERO, the registration ID is CRD42021274087.

New strategy of using double-network hydrogel extravascular stent for preventing venous graft restenosis after coronary artery bypass grafting.

Effective therapies for the prevention of vein graft failure, which frequently occurs in coronary artery bypass grafting (CABG) due to intimal hyperplasia (IH), are still lacking. Here, we investigated the effects of the perivenous application of double-network hydrogel on vein grafts in carotid artery bypass grafting in a rabbit model. Healthy New Zealand white rabbits were randomized into the following groups: no graft, graft, or graft + Double-network hydrogel external stent (DNHES). The rabbits' carotid artery was bypassed via the jugular vein. Double-network hydrogel external stent was wrapped around the jugular graft after the anastomoses were completed. Blood flow parameters and tissue histology of the vein grafts were evaluated. Compared with the untreated vein grafts at 12 weeks after the surgery, the DNHES significantly improved graft flow, attenuated intimal and medial thickening, reduced the anti-proliferating cell nuclear antigen proliferation index of the vein grafts, decreased the mRNA and protein expression of Mitogen-Activated Protein Kinase (MAPK) and Transforming Growth Factor-β (TGF-β), and increased the mRNA and protein expression of endothelial Nitric Oxide Synthase (eNOS). The perivenous application of DNHES exerts beneficial effects on vein grafts, reduces the inflammatory response in carotid artery bypass grafting in a rabbit model, and appears to be a safe and promising strategy to prevent vein graft failure.

НЕТРАВМАТИЧЕСКИЙ РАЗРЫВ ФОРНИКСА С ЭКСТРАВАЗАЦИЕЙ КОНТРАСТА

Purpose: Description of a clinical case of surgical treatment of nontraumatic rupture of the renal calyx fornix, with extravasation of contrast agent into the perirenal tissue. Material and methods: Provided surgical treatment to a patient with spontaneous rupture of the calyx fornix on the background of ureteral obstruction caused by a stone. Results: Considering the concomitant pathology in the form of obstructive pyelonephritis, it was decided to drain the upper urinary tract with an external stent. After 7 days, the patient underwent replacement of the external stent with the internal one. The patient underwent antibacterial, anti-inflammatory therapy, with a positive clinical, laboratory effect. Retrograde pyelography was performed 7 days later. Violations of the integrity of the cavity system of the left kidney were not revealed. The external stent was replaced with an internal one. After 2 months, ureterolitho-extraction was performed on the left. Conclusion: From the data of the world literature and our own experience, we can conclude that spontaneous, non-traumatic rupture of the fornix is an extremely rare, urgent urological disease. We assume that the development of this process is similar to the Burhave syndrome, since smooth muscle fibers are present in the esophagus as well as in the esophagus. In order to provide immediate assistance to such patients, it is necessary to urgently drain the upper urinary tract. Timely diagnosis of this condition requires rapid tactics in the form of immediate ultrasound, radiological diagnostic methods, as well as computed tomography. The operational manual on the removal of stones in this case should be postponed for 2–3 weeks.

External Stenting and Disease Progression in Vein Grafts After Open Surgical Repair of Popliteal Artery Aneurysms

Open surgical repair has remained the reference standard treatment of popliteal artery aneurysms (PAAs). The objective of the present study was to evaluate the feasibility and safety of external stenting and its potential preventive effect on vein graft disease after open PAA repair.

Effects of the harvesting technique and external stenting on progression of vein graft disease 2 years after coronary artery bypass.

In a post hoc analysis of the VEST III trial, we investigated the effect of the harvesting technique on saphenous vein graft (SVG) patency and disease progression after coronary artery bypass grafting. Angiographic outcomes were assessed in 183 patients undergoing open (126 patients, 252 SVG) or endoscopic harvesting (57 patients, 114 SVG). Overall SVG patency was assessed by computed tomography angiography at 6 months and by coronary angiography at 2 years. Fitzgibbon patency (FP I, II and III) and intimal hyperplasia (IH) in a patient subset were assessed by coronary angiography and intravascular ultrasound, respectively, at 2 years. Baseline characteristics were similar between patients who underwent open and those who underwent endoscopic harvesting. Open compared with endoscopic harvesting was associated with higher overall SVG patency rates at 6 months (92.9% vs 80.4%, P = 0.04) and 2 years (90.8% vs 73.9%, P = 0.01), improved FP I, II and III rates (65.2% vs 49.2%; 25.3% vs 45.9%, and 9.5% vs 4.9%, respectively; odds ratio 2.81, P = 0.09) and reduced IH area (-31.8%; P = 0.04) and thickness (-28.9%; P = 0.04). External stenting was associated with improved FP I, II and III rates (odds ratio 2.84, P = 0.01), reduced IH area (-19.5%; P < 0.001) and thickness (-25.0%; P < 0.001) in the open-harvest group and reduced IH area (-12.7%; P = 0.01) and thickness (-9.5%; P = 0.21) in the endoscopic-harvest group. A post-hoc analysis of the VEST III trial showed that open harvesting is associated with improved overall SVG patency and reduced IH. External stenting reduces SVG disease progression, particularly with open harvesting.

Fluoroscopic removal of fractured, retained, embedded Z self-expanding metal stent using a guidewire lasso technique: A case report

BACKGROUNDThere are few reports of a fractured esophageal self-expanding metallic stent (SEMS) and the lasso retrieval technique, forming a guidewire loop by directing the guidewire back up the external stent for retrieval. CASE SUMMARYA 74-year-old man complained of dysphagia approximately 6 mo after radical resection of esophageal cancer. Benign anastomotic stenosis was diagnosed, and a 20 mm in diameter and 60 mm in length esophageal covered SEMS was inserted after repeated balloon dilatation. About 13.5 mo after stenting, dysphagia recurred and esophagography showed severe stenosis above the proximal stent and stent removal was performed. One-third of the stent was removed and the fractured stent remained in the proximal esophagus. A suction tube was introduced through the guidewire and then the guidewire was grabbed, acting like a “lasso” on tightening. The remaining fractured stent was successfully removed by slowly pulling back the guidewire, with no fragments of stent wires retained.CONCLUSIONThe guidewire lasso technique is a simple, effective method of removing esophageal SEMS in rare cases of stent fracture.

“Mitigation strategies for post-operative pancreatic fistula after pancreaticoduodenectomy in high-risk pancreas: an evidence-based algorithmic approach”—a narrative review

Postoperative pancreatic fistula (POPF) is associated with a mortality of up to 25% apart from significant morbid sequelae related to abdominal sepsis and post pancreatectomy hemorrhage. Numerous strategies to curtail the risk of POPF and associated morbidity have been largely unsuccessful. The pancreaticoenteric anastomosis post pancreaticoduodenectomy in a high-risk pancreas represents a significant surgical and clinical challenge. In this narrative review, we present the strategies for early identification and comprehensive management of the high-risk pancreas as per the available literature and present a stepwise algorithmic approach of different fistula mitigation strategies in patients undergoing pancreaticoduodenectomy. Medline, PubMed, Embase, Cochrane Library, and various center-specific guidelines were searched for the pancreas, pancreatic cancer, pancreatectomy, pancreatoduodenectomy, Whipple's operation, postoperative, complications, fistula, High-risk pancreas, risk assessment, different predictors, and scoring systems for the high-risk pancreas, current and emerging concepts in the development of POPF and mitigation strategies management and treatment in various combinations. Over the years, literature has mainly addressed the technical aspects of pancreatico-enteric anastomosis; however, the impact of different technical modifications has been at the most elusive. Recent literature has focused on other aspects like remnant ischemia, locoregional inflammation, and postoperative acute pancreatitis among others, defining their evolving role in pathophysiology of POPF. Although many pre-operative risk prediction models are available; their intra-operative implications are not clear. Furthermore, the evidence available on the mitigation strategies is limited, heterogeneous, and center specific. Fistula prediction includes numerous potentiating factors in addition to the factors described in various Fistula Risk Scores. Early identification of these high-risk scenarios allows the algorithmic application of mitigation strategies. Management of the high-risk pancreas starts in the pre-operative period by early identifications of the risk factors and then continues into the intra-operative period with strategies to decrease intraoperative blood loss, precise anastomosis, and external stenting wherever feasible; goal-directed fluid therapy as well as total pancreatectomy (TP) in certain highly selected scenarios followed by early identification of complications in the postoperative period and appropriate and early management of the same. The coherent application of these mitigation strategies provides the opportunity for the best possible outcome in this complicated scenario. At present, the zero post-operative pancreatic fistulae seem unattainable, and time has come to study the strategies outside the operation theatre. Till preventive strategies become mainstream, a strategic personalized algorithmic approach may yield best outcomes.

Thirty Years of No-Touch Saphenous Vein Harvesting: A Timely Jubilee Gift

Thirty Years of No-Touch Saphenous Vein Harvesting: A Timely Jubilee Gift

Construction of a pancreatojejunostomy with an external stent: A technical description.

The authors declare no conflict of interest. Data are available from the corresponding author upon reasonable request.

Customizable modification of banding with external stenting for arteriovenous fistula flow reduction.

We performed a single-center retrospective study of prospectively collected data for all patients who had flow reduction surgery with FRAME FR between November 2020 and January 2021. Ten patients had arteriovenous fistula flow reduction surgery with this technique. One patient had a distal fistula, whereas nine were within the cubital fossa. In nine patients the device was applied over the postanastomotic arteriovenous fistula outflow vein and in one in the preanastomotic radial artery. Technical success was achieved in all patients with a median flow reduction from 2150 to 825 mL/min. There were no wound or device-specific complications.

External stenting of saphenous vein grafts for coronary artery bypass: a single-center analysis of clinical outcomes.

Angiographic studies have shown that external stenting reduces disease progression in saphenous vein grafts (SVG) for coronary artery bypass grafting (CABG). However, reports of clinical outcomes of external SVG stenting are limited. We conducted a retrospective analysis using a prospectively maintained national registry to evaluate clinical outcomes in patients undergoing either isolated CABG or combined (CABG + valve) procedures with use of an external SVG stent between December 2015 and December 2019. Median follow-up was 36.2 months (IQR: 24.4-41.6 months). The primary endpoint was ischemia-driven target vessel revascularization at 1 year. Secondary endpoints included all-cause death, non-fatal myocardial infarction (MI), stroke, and the composite of death, non-fatal MI or stroke at 1 year. Kaplan-Meier rates of survival, freedom from the composite of death, non-fatal MI or stroke and freedom from repeat revascularization were calculated at 3 years. The study population included 74 patients (isolated CABG, N.=61; combined procedure, N.=13). Mean age was 65.5±9.2 years, and 81% were male. External stenting of one SVG was performed in 63 patients (85%) and external stenting of 2 SVG in 11 patients (15%). External stenting was most frequently performed on an SVG to the right coronary artery (N.=45 patients; 53%). Ischemia-driven target-vessel revascularization occurred in 0% at 1 year. All-cause death, MI, stroke, and the composite of death, MI, or stroke at 1 year occurred in 2.7% (2/74), 0% (0/74), 1.4% (1/74), and 4.1% (3/74), respectively. At 3 years, the rates of survival, freedom from the composite of death, non-fatal MI or stroke, and freedom from repeat revascularization were 89.7% (95% CI: 78.0-95.3), 88.3% (95% CI: 76.5-94.4), and 94.8% (95% CI: 84.6-98.3), respectively. Clinical outcomes with external SVG stenting are excellent without ischemia-driven target-vessel revascularization at 1 year, and low rates of repeat revascularization at 3 years. Further follow-up will show whether external stenting reduces SVG failure with a benefit on long-term clinical outcomes.

The Challenges of Diagnosing Nondilated Obstructive Uropathy: A Case Report

Rationale:Nondilated obstructive uropathy (NDOU) is a rare cause of acute renal failure reported in less than 5% of cases of obstructive uropathy. It is typically associated with intrapelvic malignancies and diseases causing retroperitoneal lymphadenopathy and retroperitoneal fibrosis. As these conditions may prevent radiographic dilation of the collecting system, the diagnosis of NDOU may be missed by usual diagnostic testing.Presenting concerns of the patient:We present a case of acute anuric renal failure in a middle-aged woman with metastatic breast cancer associated with abdominal and retroperitoneal lymphadenopathy. Acute kidney injury was initially deemed secondary to drug-induced acute tubular necrosis (ATN) from bisphosphonate; however, there remained a high clinical suspicion of NDOU due to the presence of enlarged retroperitoneal lymph nodes on CT abdomen and pelvis with concerns for encasement of bilateral renal pelvic regions and ureters.Diagnoses:The patient underwent a retrograde pyelogram which demonstrated questionable narrowing bilaterally at the level of the renal pelvices. This led to an even stronger clinical suspicion of NDOU and urology service was consulted for evaluation.Intervention:Bilateral ureteral stents were placed by urology which led to robust urine output and rapid reversal of renal failure over the next 24 to 48 hours.Outcomes:Despite 2 weeks of anuria and hemodialysis, this patient’s creatinine came back to her baseline. She was able to discontinue hemodialysis and her creatinine stabilized at 88.4 μmol/L (1 mg/dL).Teaching points:Nondilated obstructive uropathy is rare but important diagnosis that requires a high clinical suspicion in the appropriate clinical scenario. The lack of dilatation is believed to be related to encasement of the collecting system by tumor, fibrosis, or as in our case metastatic retroperitoneal lymphadenopathy. As this diagnosis cannot be overlooked, aggressive direct visualization or even intervention with internal or external stenting may be required to both diagnose and treat this condition.

Short Internal Pancreatic Stent Reduces Pancreatic Fistula in Pancreatoduodenectomy

Introduction: Clinically relevant postoperative pancreatic fistula (CR-POPF) is a major complication of pancreatoduodenectomy (PD). The best type of pancreatic stent for drainage of pancreatic duct remains unclear. The aim of this study was to investigate the risk factors of CR-POPF following PD. Methods: From 2006 to 2019, the records of 246 patients who underwent PD were retrospectively reviewed, and the relationship between perioperative factors including type of pancreatic stent and CR-POPF was investigated. External or internal pancreatic stents were used and the internal stent was inserted 1 cm into the jejunum to decrease obstruction of the stent (short internal stent). Results: External and internal pancreatic stent was used in 137 and 109 patients, respectively. Univariate analyses showed that BMI, thickness of the pancreas, diameter of the pancreatic duct, diagnosis, operation time, blood loss, pancreatojejunostomy method, and type of pancreatic stent were significant factors related to CR-POPF. Multivariate analysis revealed that diameter of the main pancreatic duct (OR = 0.292, 95% CI = 0.140-0.605, P = 0.001), diagnosis (OR = 3.359, 95% CI = 1.498-7.693, P = 0.003), and type of pancreatic stent (OR = 0.435, 95% CI = 0.203-0.934, P = 0.033) were independent factors related to CR-POPF. Internal stent was associated with low rate of CR-POPF (P < 0.001) and short postoperative hospital stay (P < 0.001) compared to external stent. Conclusions: Diameter of the pancreatic duct, diagnosis, and type of pancreatic stent were risk factors for CR-POPF. A short pancreatic internal stent could decrease the incidence of CR-POPF.

2021 Canadian Surgery Forum: Virtual, online Sept. 21-24, 2021.

# 01. Design and validation of a unique endoscopy simulator using a commercial video game {#article-title-2} Procedural simulation has been shown to enhance early endoscopy training. In this proof of concept study, we aimed to show that a first-person shooter (FPS) video game with a novel in-house

Pneumovesicoscopic ureteral reimplantation with intravesical tailoring of obstructive megaureter in pediatric patient

According to available data, there are only few articles describing pneumovesicoscopic (PNV) ureteral reimplantation (UR) for obstructive megaureter without tailoring and with exvivo tailoring in children. To present our experience of the PNV UR using intravesical ureteral tailoring for symptomatic primary obstructive megaureter in children. Between 2014 and 2020, 42 patients (mean age: 3.1 years) underwent a correction of primary obstructive megaureter (POM) via a vesicoscopic approach. Nine of them with the megaureter (diameter > 25mm) underwent the intravesical ureteral tailoring. The analysis included only 9 patients who underwent intravesical tailoring of the ureter using the original technique. The dilated ureter is fixed intravesical by the loop in extended position. This simplifies the tailoring step of the ureter. The tailoring is performed by continuous suture (Star). 43 UR were analyzed (1 bilateral, 1 with diverticulum, 1 with ureterocele). The mean operative time was 142min (83-235min). The mean manipulation time for intravesical tailoring of the megaureter was 18min. After the surgery, the average kidney function doesn't reduce. We observed an increase in renal function by an average of 7% in three patients after the surgery. One patient required a conversion. It was in the early stages of mastering the technique. All patients underwent US 1-3 weeks 3-6-12 months after the operation, the size of the pelvic system and ureter decreased. Eight patients are asymptomatic, and only one has the clinical changes (a persistent leukocyturia, the size of the pelvic-ureteric segment, and the ureter remain unchanged or increased). According to the VCUG vesicoureteral reflux was detected in this case. An endoscopic correction used successful. This possibility of applying our technique is confirmed according to folow-up data and should be used in other researches. The drainage of the ureter with an external stent for 1 month helps to form properly the neo-ureterovesical anastomosis and to prevent episodes of ureteral obstruction as a result the incidence of urinary tract infections reduces in the postoperative period. The use of the Tuohy needle with the loop simplifies the fixation of the ureter. This helps to make the intravesical tailoring of the megaureter easier and faster. It is original and less traumatic for the ureter than existing methods.

Device profile of the VEST for external support of SVG Coronary artery bypass grafting: historical development, current status, and future directions

ABSTRACT Introduction : A search for strategies to address saphenous vein graft (SVG) failure – the main factor limiting the long-term success of coronary bypass grafting – has led to trialing of external stenting technologies. Areas covered : The manuscript covers historical development and current status of external scaffolding for the treatment of SVG intimal hyperplasia. Comprehensive literature review and personal communication with VGS leadership, the developer of the VEST device, served as the sources. Expert opinion : If the external scaffolding concept proves to be successful in mitigating the intimal hyperplasia inherent to arterialized saphenous vein conduits, it could have a dramatic impact on the recurrence of anginal symptoms, the need for repeat revascularization, and the incidence of myocardial infarction following CABG surgery. These laudable sequelae could ultimately convey significant public health repercussions by reducing healthcare resource use and improving the long-term survival and quality of life of CABG recipients.

The effect of various pressure of pneumatic uterine bracket by using saccule sterine external stent on incidence of supine hypotensive syndrome

The saccule uterine external stent with a pneumatic uterine bracket reportedly prevents the incidence of supine hypotension syndrome (SHS) during cesarean section under combined spinal - epidural anesthesia (CSEA). However, the preventive effect is affected by the pressure within pneumatic uterine bracket. This study aims to explore the optimal pressure. One hundred forty-eight pregnant women were selected and randomly divided into three groups: Group A (the control group, n = 49), Group B (n = 49), and Group C (n = 50). The pressure within pneumatic uterine bracket was set at 240 mmHg, 260mmHg, and 280mmHg, respectively, during cesarean section under CSEA for participants in groups A, B and C. The intraoperative comfort rate and incidence of SHS were recorded. No significant difference in the anesthetic efficacy was observed among the three groups (p > 0.05). However, there was a significant difference in the occurrence of SHS, with a reduction of 30 mmHg in blood pressure. The incidence of SHS belong the three groups showed significant differences (36.73% in Group A, 18.37% in Group B and 18.00% in Group C, p < 0.05). In addition, significant differences (p < 0.05) in the intraoperative comfort rate were also found among the three groups, with the comfort rate of 69.39% in group A, 91.84% in group B and 90.00% in Group C. The optimal pressure within pneumatic uterine bracket for preventing SHS hypotension is about 260 mmHg. These findings might contribute to the prevention of SHS.

Comparative Outcomes of Double-J and Cutaneous Pyeloureteral Stents in Pediatric Robot-Assisted Laparoscopic Pyeloplasty.

Background: Comparative outcome studies investigating internal Double-J (DJ) and externalized stents have primarily been performed for open and laparoscopic pyeloplasty, with a paucity of literature surrounding outcomes in robot-assisted laparoscopic pyeloplasty (RALP). Furthermore, outcomes of a modified external stent inserted into the renal pelvis, termed cutaneous pyeloureteral (CPU) stent, remain unexamined. This study investigates outcomes of DJ and CPU stents as methods of trans-anastomotic drainage. Materials and Methods: A retrospective analysis identified pediatric patients who underwent RALP between December 2007 and January 2020 at a single tertiary center, where CPU stents were introduced in June 2012. Operative success was defined as improved or stable hydronephrosis without subsequent redo pyeloplasty. Secondary outcomes included stent reinsertion, anesthesia requirements, opioid administration, urinary tract infection (UTI), and bladder spasms. Results: A total of 103 pediatric RALP procedures were analyzed (DJ = 70, CPU = 33). Operative success (DJ = 95.7%, CPU = 100%, p = 0.55), Society for Fetal Urology (SFU) grade improvement, and length of stay were comparable. Accidental stent expulsion was only seen with CPU stents (9%; p = 0.03). Intracorporeal stent migration also occurred more frequently in CPU stents (DJ = 3%, CPU = 15%, p = 0.03). Stent reinsertion, when needed, used a DJ stent with rates of 4% and 9% for DJ and CPU stents, respectively (p = 0.38). DJ stents were removed at a later postoperative day (DJ = 45.2 ± 25.0, CPU = 8.3 ± 4.2; p < 0.001) with increased general anesthesia (DJ = 99%, CPU = 3%; p < 0.001) and intravenous (IV) opioid (DJ = 27%, CPU = 9%; p = 0.04) requirements. Finally, DJ stents had nonsignificant increased rates of UTI (DJ = 17%, CPU = 3%, p = 0.06) and bladder spasms necessitating postoperative medication (DJ = 26%, CPU = 9%, p = 0.07). Conclusions: DJ and CPU stents display equivalent success rates in pediatric RALP and similar stent reinsertion rates. Appreciable differences can inform stent selection, including higher general anesthesia requirements and IV opioid administration among DJ stents and a higher incidence of accidental stent expulsion among CPU stents. In addition, DJ stents were associated with nonsignificant increased rates of UTI and bladder spasm necessitating medication.