One day hospitalization after open, double-J stented pyeloplasty

A Randomized Control Trial Comparing Outcome after Stented and Nonstented Anderson-Hynes Dismembered Pyeloplasty

Aim

The aim of the study was to compare the efficacy and postoperative complications of stented and nonstented open pediatric dismembered pyeloplasty for ureteropelvic junction (UPJ) obstruction.

Settings and Design

A balanced, parallel group, prospective randomized controlled trial comparing stented and nonstented Anderson-Hynes Dismembered Pyeloplasty.

Subjects and Methods

It included 42 children who required Anderson-Hynes dismembered pyeloplasty for UPJ obstruction (UPJO). Patients were randomized into stented (double "J" [DJ] stent) and nonstented pyeloplasty groups. The intraoperative and postoperative course was compared. Both groups were analyzed for problems such as dysuria, frequency, pain, hematuria and urinary tract infection, and postoperative renal status.

Statistical Analysis

Mann-Whitney U-test, Fisher's exact test, Student's t-tests, and Chi-squared test were used.

Results

Surgical duration was significantly shorter for the nonstented group as compared to the stented group (60.4 ± 6.49 min vs. 78.9 ± 8.17 min). The intraoperative negotiation of DJ stent was troublesome in 21.7% patients belonging to the stented group. The hospital stay was comparable in both groups (4.67 ± 1.9 vs. 4.28 ± 0.67 days). Patients in stented group had experienced dysuria, loin pain, lower abdominal spasmodic pain, and frequency significantly higher than nonstented group. However, the other problems such as fever, hematuria, and urinary tract infections were more common in stented group, but the difference was not statistically significant. There was no difference in resolution of hydronephrosis in both groups.

Conclusions

There is no statistically significant difference in resolution of hydronephrosis following nonstented or stented dismembered pyeloplasty in children with UPJO. However, the patient is more symptomatic due to stent in the postoperative period.

Pyeloplasty for hydronephrosis: Issues of double J stent versus nephrostomy tube as drainage technique

Aims:

To compare the efficacy, complications, cost analysis and hospital stay between two methods of drainage of the kidney: double J (DJ) stent versus nephrostomy tube following open pyeloplasty for ureteropelvic junction obstruction hydronephrosis.

Patients and Methods:

This was a prospective randomized study of 20 patients in each group over 14 months. Pre and post-operative (3 months) function and drainage were assessed by ethylenedicysteine scan and intravenous urogram.

Results:

Both groups showed similar good improvement in function and drainage. Nephrostomy group had significantly longer hospital stay (P < 0.001) but incurred less cost. Complications with nephrostomy included tube breakage (n = 1) and urine leak after tube removal (n = 2). DJ stents were associated with stent migration (n = 4), increased frequency of micturition (n = 9), dysuria (n = 4) and urinary tract infection (n = 1).

Conclusion:

Both methods of drainage did not interfere with improvement after pyeloplasty. Minor complications were more with DJ stent (P = 0.0003). Although overall cost of treatment was more with stents, they reduced length of hospital stay. Optimal length of stent is essential to reduce complications secondary to migration and bladder irritation.

Our experience with open dismembered pyeloplasty for uretero-pelvic junction obstruction

OBJECTIVE

To report our experience with open dismembered pyeloplasty for uretero-pelvic junction obstruction.

METHODS

Retrospective study was conducted in the Department of Urology, Jinnah Postgraduate Medical Centre, Karachi for a period of five and half years from May, 2006 to December, 2011. All patients with uretero-pelvic junction obstruction were entered into a database to record patients clinical features, diagnostic tools, operative and post-operative details and follow-up. Over a five-years period, 13 procedures were performed. After clinical evaluation all patient had extensive haematological and radiological workup for diagnosis of uretero-pelvic junction obstruction. All were subjected to open pyeloplasties, out of these 13 patients; one had an aberrant lower pole vessel compressing uretero-pelvic-junction. All procedures were stented. Repair was done with 3/0 vicryl sutures all patients were catheterized and wound drained.

RESULTS

Mean operating time was 60 - 100 minutes with about 100cc blood loss requiring no transfusion. The mean follow up was one year. One patient developed post-operative haematuria and was managed conservatively. Two patients developed fever secondary to urinary tract infection despite adequate treatment of urinary tract infection according to culture and sensitivity pre-operatively. One patient developed surgical emphysema detected post-operatively, which required tube thoracostomy. Neither patient developed recurrent symptoms nor had any evidence of obstruction on the renogram on follow-up. OBJECTIVEly all patients were followed up by intravenous urogram, stress renogram, Urine C/S. Subjective and objective follow-up revealed success in 100% of patients whereas success is defined as no or minimal holder on DTPA renogram, improving renal function and decreasing dilatation on successive intravenous urogram. All patients had a mean post-operative hospital stay of 02 - 04 days Folley catheter was removed after 10-days, double-j- stents were removed after two to three weeks.

CONCLUSION

Our success rate following open pyeloplasty with limited follow-up was 100%. It is comparable with International data. Recent international trend is toward Uretro-pelvic Junction Obstruction (UPJO) repair with laparoscopic approach, they are claiming success rate of 95%.

Duration of urinary leakage after open non-stented dismembered pyeloplasty in pediatric patients

OBJECTIVE

We aimed to determine the duration and associated complications of postoperative urinary leakage in pediatric patients undergoing open, non-stented dismembered pyeloplasty for ureteropelvic junction obstruction.

METHODS

A retrospective review of 100 patients who underwent an open non-stented dismembered pyeloplasty between 2003 and 2008 was performed. Duration of urinary leakage and postoperative complications were tabulated. Patients were considered to have a dry anastomosis if the Penrose drain was removed within one week of surgery.

RESULTS

Duration of leakage ranged from 0 to 27 days. 86% had Penrose drain removal within 7 days of surgery and were considered dry.14 patients demonstrated a persistent urinary leakage (PUL) ranging from 7 to 27 days. Complications of any type were significantly more likely in the group with prolonged drainage (p = .0126). UTI and obstruction were not significantly more likely to occur in patients with PUL (p = .0931 and p = .2616 respectively). Only one patient with PUL required placement of a ureteral stent.

CONCLUSION

We demonstrate that stentless dismembered pyeloplasty is feasible with a low rate of urinary drainage beyond one week. The character and quality of the slightly increased complications in those that demonstrated PUL were not great and not bothersome enough to warrant routine stenting.