Stenting In Pyeloplasty Research Articles

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

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.

The Impact of Surgical Approach and Urinary Diversion on Patient Outcomes in Pediatric Pyeloplasty

Recent comparisons of the impact of the surgical approach on pediatric pyeloplasty outcomes have generally incorporated a form of internal ureteral drainage. We hypothesized that the surgical approach does not affect outcomes in children who undergo unstented pyeloplasty and stenting offers no long-term benefit in those with pediatric pyeloplasty. After receiving institutional review board approval we examined the records of all children who underwent initial pyeloplasty from December 2001 to December 2009. We compared unstented and stented pyeloplasties, and each surgical approach in the unstented group. During the study period 367 pyeloplasties were performed, including 231 unstented and 136 stented procedures. When comparing unstented to stented pyeloplasties, there was no difference in the complication or failure rate. Of unstented pyeloplasties 71, 67 and 93 were done using a transperitoneal laparoscopic approach, a flank approach and dorsal lumbotomy, respectively. There were 5 failures, of which 2 were laparoscopic, 2 used a flank approach and 1 used dorsal lumbotomy (p = 0.51). A total of 31 patients, including 10 treated with a laparoscopic approach, 3 with a flank approach and 18 with dorsal lumbotomy (p = 0.02), required second procedures, of which 24 were temporary drainage for a urine leak. Univariate analysis of factors associated with secondary procedures in the unstented pyeloplasty group showed that only surgical approach was significant (p = 0.05). In pediatric pyeloplasty there is no significant difference in outcome between stented and unstented repairs. In unstented repairs complications may vary by surgical approach. Regardless of the approach unstented pyeloplasty is safe and effective in the pediatric population.

Ureteric stents in pyeloplasty: a help or a hindrance?

Objective To examine whether routine ureteric stenting influences outcome of pyeloplasty for pelvi-ureteric junction obstruction (PUJO). Patients and methods A 10-year review was conducted of 105 consecutive open Anderson–Hynes dismembered pyeloplasties performed for PUJO, covering two periods: (1) pyeloplasties performed without ureteric stents (1994–1998) and (2) pyeloplasties performed with ureteric stents (1999–2003). Outcomes (expressed as means ± SEM) of unstented patients (UPs; n = 47) and stented patients (SPs; n = 58) were compared and results analysed using ANOVA and chi-square tests. Results Fifty-five patients (53.9%) presented with antenatal hydronephrosis, whilst 47 (46.1%) presented postnatally (at mean age 88.4 ± 7.1 months) with one or more of the following: pain ( n = 30, 63.8%), urinary tract infection ( n = 16; 34.0%), haematuria ( n = 3, 6.4%), abdominal mass ( n = 3, 6.4%), acute renal failure ( n = 2, 4.3%), incidental finding ( n = 4, 8.5%). Pyeloplasty was performed (at mean age 58.9 ± 5.3 months) for one or more of the following: pain ( n = 40, 38.1%), haematuria ( n = 6, 5.7%), urinary tract infection ( n = 18, 17.1%), poor initial or deteriorating function ( n = 29, 27.6%), severe or deteriorating hydronephrosis ( n = 41, 39.0%), calculus ( n = 1, 0.95%). Recognised complications of surgery were significantly higher in UPs (5 of 47; 10.6%) than SPs (0 of 58); P = 0.016. These were leakage ( n = 4, 8.5%) and obstruction by blood clot ( n = 1, 2.1%). Nine SPs (15.5%) developed stent-related complications, including stent migration ( n = 5, 8.6%), infection ( n = 3, 5.2%) and calculus ( n = 1, 1.7%). SPs had significantly shorter hospital stay (2.71 ± 0.25 days) than UPs (4.30 ± 0.38 days); P < 0.01. Preoperative renal pelvis antero-posterior diameter in SPs (3.24 ± 0.25 cm) and UPs (3.21 ± 0.28 cm) was comparable ( P = 0.80). Following pyeloplasty, a significant improvement from these preoperative baselines occurred earlier in SPs (at 3.10 ± 0.46 months) than UPs (at 15.71 ± 3.05 months); P < 0.01. Conclusion Stented pyeloplasty significantly reduces complications from surgery, particularly leakage, and results in shorter hospital stay and earlier resolution of hydronephrosis, but at the expense of stent-related complications which could be avoided in future by the use of external stents.

Is routine stenting necessary in pyeloplasty?

Although the evaluation of surgical procedures for the repair of ureteropelvic junction obstruction continues, open pyeloplasty is still the gold standard in the management of pediatric cases. The use of stents in open pyeloplasty is subject to discussion among pediatric urologists. To clarify this question on the basis of our experience, we retrospectively reviewed our 28 stented and 15 unstented pediatric pyeloplasty operations in terms of hospital stay, early and late complications, and success rates. While there were no differences between both groups in terms of early and late complications and success rates, hospital stay favored the unstented cases. We have concluded that routine stenting in pyeloplasty is not necessary unless a perfect anastomosis is accomplished.