Stented versus nonstented open pyeloplasty for primary ureteropelvic junction obstruction in children

Abstract

PurposeThe aim of the study was to compare the short-term results of stented versus nonstented open Anderson-Hynes dismembered pyeloplasty regarding operative time, hospital stay, functional outcome, and complications.Patients and methodsTwenty-seven pediatric open Anderson-Hynes dismembered pyeloplasties were performed for primary pelviureteric junction obstruction (PUJO) by a single team at a single institution from November 2009 to October 2012. Preoperative investigations included renal function tests, urine microscopy, culture, and sensitivity, renal ultrasonography, and diethylenetriamine pentaacetic acid (DTPA). Patients were simply randomized into two groups: group I, the stented group (either nephrostent or JJ stent), and group II, the nonstented group. Outcome was analyzed with respect to operative time, hospital stay, postoperative complications, postoperative effect on hydronephrosis, and postoperative differential renal function (DRF). Minimal follow-up was 6 months.ResultsThis study included 27 pediatric patients with primary PUJO, 14 patients in group I and 13 patients in group II. The mean age was 5.7΁2.6 years. Twelve (44.4%) cases were right sided and 15 (45.6%) were left sided; no bilateral cases were present. The mean DRF preoperatively was good in both groups (37.5% for group I vs. 35.6% in group II). There was no significant difference in operative time between both groups. The hospital stay was significantly shorter in the stented group, but this was mainly related to postoperative care policy in both groups. There was no significant difference between both groups regarding the complication rate. Postoperative DRF as well as hydronephrosis were significantly improved in both groups, but there was no statistically significant difference between both groups.ConclusionThe use of stents in pyeloplasty is not justified as a routine. The overall success and complication rates are independent of whether or not to drain or of the method of drainage. Therefore, it seems that the choice depends on local circumstances and surgeon preference. A larger number of patients is needed to validate these results.