Stentless Pyeloplasty Research Articles

Primary pyeloplasty for uretero-pelvic obstruction in the USA adult population with or without double-J indwelling ureteral stents. Insurance claims data on contemporary time to removal trends, perioperative complications, health care costs, and re-intervention rates.

Using a large population-based dataset, we primarily sought to compare postoperative complications, health-care expenditures, and re-intervention rates between patients diagnosed with ureteropelvic junction obstruction (UPJO) undergoing stented vs. non-stented pyeloplasty. The secondary objective was to investigate factors that influence the timing of DJ stent removal. Patients ≥18 years old with UPJO treated with primary open or minimally-invasive pyeloplasty were identified using the Merative™ Marketscan® Databases between 2007-2021. Multivariable modeling was implemented to investigate the association between Double-J (DJ) stent placement and post-pyeloplasty complications, hospital costs, and re-intervention rates and the role of the perioperative predictors on time to DJ stent removal. Subgroup analyses stratified by ureteral stenting duration were additionally performed. Out of 4872 patients who underwent primary pyeloplasty, 4154 (85.3%) had DJ placement. Postoperative complications were rare (N.=218, 4.47%) and not associated with ureteral stenting (odds ratio [OR]: 0.78, 95% confidence interval [CI]: 0.55-1.12). The median cost for in-hospital charges was $21,775, with DJ stent placement independently increasing the median aggregate amount (OR: 1.29, 95% CI: 1.09-1.53). Overall, re-interventions were performed in 21.18% of patients, with DJ stenting found to be protective (OR: 0.79, 95% CI: 0.66-0.96). Higher Charlson Comorbidity Index, longer hospital stay, and open surgical approach were independent predictors for prolonged DJ stenting time to removal. Our study suggests that patients undergoing stent-less pyeloplasty did have a higher rate of secondary procedures, but not higher complications when compared to those undergoing stented procedures. Concurrently, the non-stented approach is associated with decreased health-care expenditures, despite the increased rates of secondary procedures.

Stentless pyeloplasty for paediatric ureteropelvic junction obstruction: a 15-year experience at Red Cross War Memorial Children’s Hospital

Stentless pyeloplasty for paediatric ureteropelvic junction obstruction: a 15-year experience at Red Cross War Memorial Children’s Hospital

Topic Stent versus stentless pyeloplasty in congenital pelvic ureteric junction obstruction kidney in children

Topic Stent versus stentless pyeloplasty in congenital pelvic ureteric junction obstruction kidney in children

Stentless pyeloplasty in childhood pelviureteric junction obstruction: 27 years experience

We are presenting our experience with childhood pelviureteric junction obstruction (PUJO) over 27 years, including the demographic characteristics, etiology, clinical features, and management. Ureteropelvic obstruction (PUJO) is the most common cause of congenital hydrocephalus diagnosed antenatally. It should be managed early after birth to preserve the renal function.

A comparative study of pyeloplasty in children with and without stenting

Background: PUJ obstruction is the most common among the major obstructive pathologies in pediatric patients. The study aims to compare the benefits and drawbacks of stentless pyeloplasty in pediatric population with routine DJ stent insertion.Methods: Data was collected for operated cases of PUJ obstruction and categorised into those who had DJ stent in situ and those without DJ stent. Complications associated with both these approaches was systematically assessed.Results: In patients with DJ stent in situ the perinephric drain was minimal and hence most of the patients had their drain removed on the 2nd or 3rd day. In those patients without DJ stent in situ, the average duration for removal of drain was prolonged to about 7 days.Conclusions: Routine use of Ureteric stenting with DJ stent in this series of patients was associated with decreased hospital stay and morbidity in patients without DJ stent.

Is peri-operative urethral catheter drainage enough? The case for stentless pediatric robotic pyeloplasty

The necessity for urinary diversion with trans-anastomotic ureteral stenting during pyeloplasty is currently under debate. Performing a stentless repair could eliminate stent-related morbidity, including: stent migration, urinary tract infection, flank pain, and bladder spasms. In addition, there would be no need for a second procedure and associated anesthesia required for stent removal. This study describes the outcomes of robotic-assisted laparoscopic pyeloplasty without use of a ureteral stent. An IRB-approved prospective database of all pediatric patients undergoing robotic pyeloplasty from July 2012 to July 2014 at a single institution was reviewed. The 'bypass pyeloplasty' or Anderson-Hynes dismembered pyeloplasty (DP) technique was performed. In both groups, neither a ureteral stent nor an abdominal drainage catheter was utilized. Complications were recorded, including: postoperative pain, bladder spasms, fever, and urinary tract infections. Follow-up renal ultrasound was reviewed for hydronephrosis. Twenty-seven children (17 male, 10 female) with a mean age of 25 months (range 6-157 months) underwent robotic ureteral stentless pyeloplasty during the study time period. The bypass pyeloplasty technique was performed on 19 children (70%). Mean length of stay was 20.2 hours (range 11-46). No fever, urinary tract infections, or hematuria requiring intervention were experienced. Additionally, there were no reports of bladder spasms or pain requiring pharmacotherapy. The mean follow-up was 8 months (range 4-21). Pre-operative Society of Fetal Urology grading was 3.5 and 3.4 for the dismembered and bypass cohort, respectively, with improvements to 1.1 for both groups at 3 months. Postoperative renal ultrasound hydronephrosis resolved in eight children (29.6%), improved in 14 (51.9%), and was stable in five (18.5%). The overall success rate was 100%. This study was limited by its small cohort and short follow-up, which may not thoroughly describe the efficacy of the stentless repair as it has been shown that stricture and re-obstruction can occur several years after surgery. Robotic stentless pyeloplasty is a feasible alternative to conventional methods, with excellent success rates and minimal complications. Importantly, this technique circumvents the need for a second procedure and the associated risks of anesthesia.

Stentless pyeloplasty for ureteropelvic junction obstruction in children

Introduction Stenting after pyeloplasty is an established practice and helps in ensuring a patent anastomosis until healing has completed. Stents, however, may cause complications such as infection and displacement and increase the cost of management; therefore, stentless pyeloplasty is now considered as feasible alternative. Patients and methods From August 2008 to October 2010, we retrospectively analyzed the results of stentless surgery in patients with ureteropelvic junction (UPJ) obstruction. In all, 42 patients with UPJ obstruction were managed. Nine patients who were treated conservatively, one who underwent nephrectomy, and one pyelostomy for pyonephrosis in solitary kidney were excluded. Age range at surgery was 14 days–12 years with a mean age of 12.7 months. Results There were 23 male patients and eight female patients with a male-to-female ratio of 3 : 1. Fourteen patients had left, 12 right, and five had bilateral UPJ obstruction. A total of 34 pyeloplasties were performed in 31 patients. Of the five patients with bilateral UPJ obstruction, three underwent bilateral pyeloplasty and remaining two underwent unilateral pyeloplasty with conservative management on the opposite sides. Two patients underwent laparoscopic pyeloplasties and 32 pyeloplasties by open technique. Double J stent was placed at initial surgery in three patients and 31 stentless pyeloplasties were performed. The mean operative time was 75 min. The mean perinephric drain removal time was 2 days. None of the patients had persistent urinary leak. The mean hospital stay was 3.2 days. Reduction in anteroposterior diameter was noticed in 91% cases on 12 weeks follow-up scan. Complications included persistent or increase in hydronephrosis in three (9%) patients. In all the three patients, cystoscopic stenting was attempted. In two patients, size 4 Fr double J stent was passed easily into the renal pelvis. One patient improved, whereas other still has a dilated pelvis with static anteroposterior diameter after removal of stent at 6 weeks; patient is kept on close surveillance on regular ultrasonography. Re-exploration was performed in one patient, which showed kinking at the anastomosis site. Pyeloplasty was revised and patient improved. Other complications included lumbar hernia in one patient, which improved at 6-month follow-up, and stitch granuloma in one patient, which improved after removal of residual stitch. Conclusion Stentless surgery for UPJ obstruction is a safe and feasible technique; it reduces the cost of surgery and avoids multiple procedures. Keywords : management, pyeloplasty, stentless, ureteropelvic junction obstruction

Stentless laparoscopic pyeloplasty: A single center experience.

Aim:To assess the effectiveness of laparoscopic stentless pyeloplasty for congenital ureteropelvic junction obstruction.Materials and Methods:This was a prospective comparative study conducted over a period of 5 years. The study included 35 cases of primary ureteropelvic junction obstruction (UPJO) with mean age of 29.5 years, divided in two groups- Group A (stent-less, 18 patients) and Group B (stented, 17 patients). Follow up ranged from one to 4years (mean 2 years). Transperitoneal laparoscopic Anderson- Hyene's pyeloplasty was standard for both the groups. Perioperative and postoperative complications were prospectively collected and analyzed by Statistical Package for Social Sciences (SPSS) 17 version using Pearson chi square test.Results:Both the groups were comparable with respect to preoperative differential renal function (DRF) and time required for maximum activity in minutes (tmax.min). Average post operative DRF was significantly higher than preoperative DRF in both the groups. Average tmax was significantly lower after pyeloplasty than pre operative tmax. Mean operative time, mean duration of urethral catheter, and mean duration of drain removal were comparable in both the groups. However bothersome irritative lower urinary tract symptoms (LUTS) and hematuria were significantly more in group B patients (P < 0.0001 and <0.013 respectively).Conclusion:In experienced hands, laparoscopic stentless pyeloplasty is as effective method for treating UPJO as its stented counterpart. It is cost effective, avoids stent-related morbidity, and could be performed without compromising the success rate. However, more randomized studies are needed to evaluate the safety of stentless pyeloplasty.

Laparoscopic Pyeloplasty in Adults: Stented Versus Stentless

In this study, we aimed to investigate the efficacy and feasibility of stentless laparoscopic pyeloplasty (LP), compared with the stented counterpart. We compared the results of stented and stentless LP procedures performed at two centers. The indications included symptoms such as loin pain or urinary tract infection with documented obstruction on renal scintigraphy. Transperitoneal approach was standard for both techniques. The stented and stentless patient groups were compared with regard to surgical duration, length of hospital stay, postoperative symptomatology, complications, and radiologic and scintigraphic findings. Twenty-seven patients with stentless pyeloplasty with at least 6 months of follow-up were included in the study and compared with a matched group of 21 stented LP patients. All had Anderson-Hynes dismembered pyeloplasty. Mean operative time was 151.9 minutes and 144.6 minutes in the stented and stentless groups, respectively (p > 0.05). Mean drain removal time and hospital stay were 1.9 days (range: 1-9 days) and 3.4 days (range: 2-9 days) in the stented group, respectively, and 2 days (range: 1-10 days) and 3.1 days (range: 1-10 days) in the stentless group, respectively (p > 0.05). Renal scintigraphy studies improved in 14 patients in the stented group and in 22 patients in the stentless group during the 6-month follow-up. Symptoms completely resolved in 19 of the stented and in 24 of the stentless cases. Stentless LP is a feasible technique as its stented counterpart. Although it has a relatively high prolonged leakage risk, it could be performed without compromising the success rate by experienced surgeons.