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Sarhan O, Al Awwad A, Al Otay A, Al Faddagh A, El Helaly A, Al Ghanbar M, Al Kawai F, Nakshabandi Z. Comparison between internal double J and external pyeloureteral stents in open pediatric pyeloplasty: A multicenter study. J Pediatr Urol 2021; 17:511.e1-511.e7. [PMID: 33865709 DOI: 10.1016/j.jpurol.2021.03.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 03/09/2021] [Accepted: 03/25/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION AND OBJECTIVE Anderson-Hynes dismembered pyeloplasty is considered the standard surgical treatment for ureteropelvic junction obstruction (UPJO). After pyeloplasty, stent drainage remains controversial. The commonly used stents are either an internal double-J (DJ) or an externalized pyeloureteral (PU) stents. We evaluated the outcome of using DJ versus PU stents following open pyeloplasty for UPJO in children. STUDY DESIGN We retrospectively evaluated 175 patients who underwent primary open pyeloplasty in two tertiary hospitals. A total of 110 patients underwent internal DJ stent insertion (63%) while 65 patients (37%) underwent placement of external PU stent. The type of stent used at the time of surgery was according to surgeon preference and experience. Operative time, postoperative hospital stay, overall complications and success rates were compared between the two groups. RESULTS The mean age was 3.8 years, and the mean follow-up was 4 years. Mean operative time was similar in the two groups (145 min). Mean hospital stay was 3.7 and 4.2 days in DJ and PU stent, respectively (p = 0.003) Summary Table . Postoperative complication developed in 9 out of 110 patients with DJ stent (8%), while complications developed in 6 out of 65 patients with PU stent (9%) (p = 0.81). Success rate of pyeloplasty was 95.5% for DJ group versus 97% for PU group (p = 0.63). DISCUSSION Dismembered pyeloplasty remains the standard treatment of choice as a surgical management for UPJO. A debate is still there in respect to the method of PU anastomotic stenting and which stent can be used. The major advantage for external PU stents is that it can be removed safely in the outpatient clinic without any sedation preventing the risk of repeated exposure to general anesthesia. Internal DJ stent provides a shorter hospital stay and comparable complication and success rates compared with PU stent. If we manage to overcome the longer DJ stent duration and facilitate early removal by an easy mode, that does not require another anesthesia at that moment we can find the optimal stent for all pyeloplasty cases. CONCLUSIONS The two types of stents are comparable as regard overall complication and success rates after pyeloplasty. Although internal DJ stent insertion provides a relatively shorter hospital stay, a second operating room visit and anesthesia for removal remains unavoidable.
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Affiliation(s)
- Osama Sarhan
- Urology and Nephrology Center, Faculty of Medicine, Mansoura University, Mansoura, Egypt; Urology Department, King Fahad Specialist Hospital, Dammam, Saudi Arabia.
| | - Ahmed Al Awwad
- Urology Department, King Fahad Military Medical Complex, Dhahran, Saudi Arabia
| | - Abdulhakim Al Otay
- Urology Department, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | | | - Ahmed El Helaly
- Urology Department, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Mustafa Al Ghanbar
- Urology Department, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Fouad Al Kawai
- Urology Department, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Ziad Nakshabandi
- Urology Department, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
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Lombardo A, Toni T, Andolfi C, Gundeti MS. Comparative Outcomes of Double-J and Cutaneous Pyeloureteral Stents in Pediatric Robot-Assisted Laparoscopic Pyeloplasty. J Endourol 2021; 35:1616-1622. [PMID: 34074116 DOI: 10.1089/end.2020.1115] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
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.
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Affiliation(s)
- Alyssa Lombardo
- University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
| | - Tiffany Toni
- University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
| | - Ciro Andolfi
- Pediatric Urology, Section of Urology, Department of Surgery, Division of the Biological Sciences and Pritzker School of Medicine, The University of Chicago, Chicago, Illinois, USA.,The MacLean Center for Clinical Medical Ethics, The University of Chicago, Chicago, Illinois, USA
| | - Mohan S Gundeti
- Pediatric Urology, Section of Urology, Department of Surgery, Division of the Biological Sciences and Pritzker School of Medicine, The University of Chicago, Chicago, Illinois, USA
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Le HK, Gleber R, Bush RA, Marietti S, Alagiri M, Chiang G, Swords K. Cost analysis of removing pediatric ureteral stents with and without a retrieval string. J Pediatr Urol 2019; 15:624.e1-624.e6. [PMID: 31582337 DOI: 10.1016/j.jpurol.2019.08.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 08/06/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND Indwelling ureteral stents are commonly placed in urologic surgeries where optimal urinary drainage is necessary. In the pediatric population, removing a stent without retrieval string (SWOS) requires a secondary operation and additional anesthetic exposure. Although these burdens can be mitigated through the placement of a stent with retrieval string (SWS), fears of complications may prevent widespread adoption of this practice by pediatric urologists. OBJECTIVE The authors sought to assess the differential cost of removing SWS and SWOS. It was hypothesized that costs associated with removing SWS are significantly lower than those associated with removing SWOS, without increasing complications. STUDY DESIGN A retrospective chart review was performed on pediatric patients undergoing common urologic surgeries with concurrent stent placement at a single tertiary referral center. Charges and healthcare costs surrounding the removal of ureteral stents were evaluated using the institution-specific ratio of cost to charges, by estimating lost wages, and by exploring differences in poststent healthcare-related events that incur additional cost. RESULTS A total of 109 patients with a median age of 5 years (range: 6 months-20 years) were reviewed. A total of 29 patients had SWS, and 80 had SWOS. The theoretical cost of SWS removal in clinic was $400.48 compared with $2290.86 ± $119.30 for operative removal of SWOS, with mean difference of $1890.38 (P < 0.01). The mean stent duration of SWOS was 34.0 ± 13.2 days vs. 10.1 ± 4.9 days for SWS (P < 0.01). Subgroup analysis of the ureteral reconstruction group showed no difference in any complications (35% vs 27%, respectively), early dislodgment (7% vs 7%, respectively) or costly healthcare utilization (23% vs 20%, respectively) among patients with SWOS compared with those with SWS. In SWS group with early dislodgment, neither required a secondary procedure. DISCUSSION With rising healthcare expenditures, physicians must be able to provide cost-effective treatment while not compromising safety or outcomes. Unlike prior analyses of cost related to the type of the stent used, the present study specifically reviewed costs of removing SWS versus SWOS and evaluated rates of costly complications. The study findings provide a preliminary basis for advocating the more economical use of SWS when indicated. Lack of power and heterogeneity of the groups need to be addressed in future analyses with larger, matched cohorts. CONCLUSION Removal of SWS is more cost-effective than that of SWOS while maintaining similar safety outcomes and should be considered in certain pediatric urology cases to decrease healthcare cost. SWS should be preferred for uncomplicated ureteroscopy, but benefits are less certain in ureteral reconstruction; further studies are needed.
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Affiliation(s)
- Hoang-Kim Le
- Division of Pediatric Urology, University of California San Diego, Rady Children's Hospital San Diego, 3020 Children's Way MC - 5120, San Diego, CA, 92123, USA; Section of Pediatric Urology, Baylor Scott & White Health, 2401 S 31st Street, Temple, TX, 76504, USA.
| | - Ryan Gleber
- University of California San Diego School of Medicine, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Ruth A Bush
- Beyster Institute for Nursing Reseach, Hahn School of Nursing, University of San Diego, 5998 Acala Park, San Diego, CA, 92110, USA
| | - Sarah Marietti
- Division of Pediatric Urology, University of California San Diego, Rady Children's Hospital San Diego, 3020 Children's Way MC - 5120, San Diego, CA, 92123, USA
| | - Madhu Alagiri
- Division of Pediatric Urology, University of California San Diego, Rady Children's Hospital San Diego, 3020 Children's Way MC - 5120, San Diego, CA, 92123, USA
| | - George Chiang
- Division of Pediatric Urology, University of California San Diego, Rady Children's Hospital San Diego, 3020 Children's Way MC - 5120, San Diego, CA, 92123, USA
| | - Kelly Swords
- Division of Pediatric Urology, University of California San Diego, Rady Children's Hospital San Diego, 3020 Children's Way MC - 5120, San Diego, CA, 92123, USA
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Robot-assisted laparoscopic pyeloplasty in infants and children: is it superior to conventional laparoscopy? World J Urol 2019; 38:1827-1833. [PMID: 31506749 DOI: 10.1007/s00345-019-02943-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Accepted: 08/30/2019] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Open pyeloplasty (OP) has been the first-line treatment for ureteropelvic junction obstruction (UPJO) since it was first described by Anderson and Hynes. The use of minimally invasive surgery (MIS) to treat UPJO in the pediatric population has increased in recent years, due to decreased morbidity and shorter recovery times. Recently, robot-assisted laparoscopic pyeloplasty (RALP) has seen a steady expansion. Unlike laparoscopic pyeloplasty (LP), RALP comes with a more manageable learning curve aided by specialized technological advantages such as high-resolution three-dimensional view, tremor filtration with motion scaling, and highly dexterous wrist-like instruments. With this review, we aim to highlight the trend toward robotic pyeloplasty over laparoscopy and current available evidence on outcomes. METHODS We systematically searched the PubMed and EMBASE databases, and we critically reviewed the available literature on the use of laparoscopy and robotic technology in pediatric patients with UPJO. RESULTS Overall, we selected 19 original articles and 5 meta-analyses. The available literature showed that the robotic approach to the UPJO allowed for decreased operative times, shorter length of hospital stay, lower complication rates, with success rates comparable to LP. Conflicting results persist regarding robotic platform and equipment costs. CONCLUSION While laparoscopy requires advanced skills for complex reconstructive procedures, such as pyeloplasty, robot-assisted surgery offers the valuable potential of making MIS more accessible to these types of procedure. Robotic technology has contributed to shortening the learning curve by acting as a bridge between open and endoscopic approach. There is still a strong need for higher quality evidence in the form of prospective observational studies and clinical trials, as well as further cost-effectiveness analyses. As robotic surgical technology spreads, future systems will be developed, offering smaller and more flexible tools, allowing enhanced applications on pediatric patients.
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Gopal M, Peycelon M, Caldamone A, Chrzan R, El-Ghoneimi A, Olsen H, Leclair MD, Stillebroer A, MacDonald C, Tonnhofer U, Strasser C, Adam A, Spinoit AF, Haid B. Management of ureteropelvic junction obstruction in children-a roundtable discussion. J Pediatr Urol 2019; 15:322-329. [PMID: 31227314 DOI: 10.1016/j.jpurol.2019.05.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 05/08/2019] [Indexed: 12/13/2022]
Abstract
The investigation, management and follow-up of paediatric ureteropelvic junction obstruction is not standardized. The Young Pediatric Urology Committee of the European Society of Pediatric Urology interviewed five experts in the field on various aspects of management and compared this with published literature.
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Affiliation(s)
- M Gopal
- Department of Paediatric Surgery, Great North Children's Hospital, Newcastle Upon Tyne, UK.
| | - M Peycelon
- Robert-Debré University Hospital (Assistance-Publique Hôpitaux de Paris), Department of Pediatric Surgery and Urology, Reference Center for Rare Diseases (CRMR), Malformations Rares des Voies Urinaires (MARVU), Université Paris Diderot, Sorbonne Paris CitéParis, France; Riley Hospital for Children, Indiana University and Purdue University in Indiana, Indianapolis, IN, USA
| | - A Caldamone
- Division of Pediatric Urology, Hasbro Children's Hospital, Warren Alpert School of Medicine at Brown University, Providence Rhode Island, USA
| | - R Chrzan
- Department of Paediatric Urology, Jagiellonian University Medical College, Krakow, Poland
| | - A El-Ghoneimi
- Robert-Debré University Hospital (Assistance-Publique Hôpitaux de Paris), Department of Pediatric Surgery and Urology, Reference Center for Rare Diseases (CRMR), Malformations Rares des Voies Urinaires (MARVU), Université Paris Diderot, Sorbonne Paris CitéParis, France
| | - H Olsen
- Department of Urology, Aarhus University Hospital, Arhus, Denmark
| | - M-D Leclair
- Department of Paediatric Surgery, Children University Hospital, NANTES, France
| | - A Stillebroer
- Department of Urology, University Medical Centre Groningen, Groningen, the Netherlands
| | - C MacDonald
- Department of Paediatric Surgery, Royal Hospital for Children, Glasgow, UK
| | - U Tonnhofer
- Department of Pediatric Surgery, Medical University Vienna, Austria
| | - C Strasser
- Department of Pediatric Urology, Hospital of the Sisters of Charity, Linz, Austria
| | - A Adam
- The Division of Urology, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - A-F Spinoit
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - B Haid
- Department of Pediatric Urology, Hospital of the Sisters of Charity, Linz, Austria
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6
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Hennessey DB, Kinnear NJ, Evans RM, Hagan C, Thwaini A. Is confirmation of ureteric stent placement in laparoscopic pyeloplasty necessary? Int Urol Nephrol 2017; 49:931-936. [PMID: 28260225 DOI: 10.1007/s11255-017-1560-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 02/24/2017] [Indexed: 10/20/2022]
Abstract
PURPOSE Placement of an antegrade double-J (JJ) ureteric stent is an important component of pyeloplasty. Correct siting of distal end of the stent in the bladder is essential for ease of removal. To date, no studies have compared methods for confirming stent position. This study aims to address that void in the literature. METHODS Eligible patients underwent laparoscopic pyeloplasty with antegrade stent placement at our institution from 2007 to 2015 inclusive. Methods to verify distal stent position of rigid cystoscopy, artificial bladder filling or no confirmation were compared. Effectiveness was determined by the proportion of malpositioned stents detected intra-operatively compared to the total found malpositioned, both intra-operatively and during follow-up. RESULTS A total of 75 patients underwent laparoscopic pyeloplasty. Forty-six (61.3%) patients had distal stent position assessed intra-operatively, comprising 27 by cystoscopy and 19 by artificial bladder filling, while for 29 (38.7%) patients no verification method was used. Cystoscopy, artificial bladder filling and no confirmation detected intra-operatively 2, 1 and 0 malpositioned stents, from malpositioned stent totals of 2, 2 and 1, respectively. CONCLUSION Malposition of JJ ureteric stent is uncommon, and omitting intra-operative position verification appears reasonable in select cases. Artificial bladder filling can help detect malpositioned JJ stents without repositioning the patient for cystoscopy. However, our results suggest both may be unreliable. If stent malposition is suspected, certainty is desired or extended operative duration is less critical, then the surgeon should proceed with cystoscopy.
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Affiliation(s)
- D B Hennessey
- Department of Urology, Belfast City Hospital, Lisburn Road, Belfast, UK.,Department of Urology, Austin Hospital, 145 Studley Road, Heidelberg, VIC, 3084, Australia
| | - N J Kinnear
- Department of Urology, Austin Hospital, 145 Studley Road, Heidelberg, VIC, 3084, Australia.
| | - R M Evans
- Department of Urology, Belfast City Hospital, Lisburn Road, Belfast, UK
| | - C Hagan
- Department of Urology, Belfast City Hospital, Lisburn Road, Belfast, UK
| | - A Thwaini
- Department of Urology, Belfast City Hospital, Lisburn Road, Belfast, UK
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7
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Chrzan R, Panek W, Kuijper CF, Dik P, Klijn AJ, de Mooij KL, de Jong TP. Short-term Complications After Pyeloplasty in Children With Lower Urinary Tract Anomalies. Urology 2016; 100:198-202. [PMID: 27771423 DOI: 10.1016/j.urology.2016.08.058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 07/28/2016] [Accepted: 08/01/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To investigate whether children with lower urinary tract (LUT) anomalies are at greater risk for postoperative complications after laparoscopic pyeloplasty stented with a double-J catheter (JJC). MATERIALS AND METHODS Prospectively collected data of laparoscopic pyeloplasty (LP) performed between 2006 and 2015 were analyzed. Inclusion criteria are (1) toilet-trained child and (2) unilateral dismembered pyeloplasty stented with a JJC done by the same surgeon. Our pyeloplasty protocol includes cystoscopy and retrograde pyelography. JJC is left in for 3weeks. Asymptomatic patients with infravesical LUT anomalies (a-LUTA) and those with history of LUT symptoms (LUTS) were identified. Any short-term complication was classified according to Clavien-Dindo. Fisher's exact test was used for statistical analysis. RESULTS Fifty-four children (mean 9.8 years) were included. Ten of 54 patients had LUTS. In 4 of those 10, anatomical infravesical anomaly was found during cystoscopy. Accidental urethral anomaly was found in 11 patients (a-LUTA). The control group (CG) consisted of 33 patients. Postoperative hospital stay ranged from 1 to 8 days (mean 2 days). Overall complication rate was 8 of 54 (14%). Grade 1 complications occurred in 3 patients in the CG. Five patients had grade 3 complications (2 needed replacement of bladder catheter, and 3 had diversion of the upper tract). Those problems occurred in 1 of 10 patients with LUTS and 3 of 11 patients with a-LUTA compared to 1 of 33 in the CG. This difference was statistically significant (P < .05). CONCLUSION Careful history should be taken in toilet-trained children before pyeloplasty. If any infravesical abnormality is discovered, internal diversion should probably be avoided. Special attention must be paid to bladder function in the postoperative period.
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Affiliation(s)
- Rafal Chrzan
- Department of Pediatric Urology, University Children's Hospital AMC/EKZ, Amsterdam, The Netherlands; Department of Pediatric Urology, UMC/WKZ, Utrecht, The Netherlands.
| | - Wojciech Panek
- Department of Urology, 4th Military Hospital, Wroclaw, Poland
| | - Caroline F Kuijper
- Department of Pediatric Urology, University Children's Hospital AMC/EKZ, Amsterdam, The Netherlands; Department of Pediatric Urology, UMC/WKZ, Utrecht, The Netherlands
| | - Peter Dik
- Department of Pediatric Urology, University Children's Hospital AMC/EKZ, Amsterdam, The Netherlands; Department of Pediatric Urology, UMC/WKZ, Utrecht, The Netherlands
| | - Aart J Klijn
- Department of Pediatric Urology, University Children's Hospital AMC/EKZ, Amsterdam, The Netherlands; Department of Pediatric Urology, UMC/WKZ, Utrecht, The Netherlands
| | - Keetje L de Mooij
- Department of Pediatric Urology, University Children's Hospital AMC/EKZ, Amsterdam, The Netherlands; Department of Pediatric Urology, UMC/WKZ, Utrecht, The Netherlands
| | - Tom P de Jong
- Department of Pediatric Urology, University Children's Hospital AMC/EKZ, Amsterdam, The Netherlands; Department of Pediatric Urology, UMC/WKZ, Utrecht, The Netherlands
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Lee LC, Kanaroglou N, Gleason JM, Pippi Salle JL, Bägli DJ, Koyle MA, Lorenzo AJ. Impact of drainage technique on pediatric pyeloplasty: Comparative analysis of externalized uretero-pyelostomy versus double-J internal stents. Can Urol Assoc J 2015; 9:E453-7. [PMID: 26279715 DOI: 10.5489/cuaj.2697] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Pediatric pyeloplasty with double J (DJ) stent drainage requires manipulation of the uretero-vesical junction (UVJ) and a second anesthetic for removal. Externalized uretero-pyelostomy (EUP) stents avoid these issues. We report outcomes of laparoscopic and open pyeloplasty with EUP compared to DJ stents in children. METHODS We retrospectively reviewed 76 consecutive children who underwent pyeloplasty for ureteropelvic junction (UPJ) obstruction over a 1-year period by 5 pediatric urologists at a single institution. The exclusion criteria included patients with concomitant urological procedures, other urinary drainage strategies, "stentless" pyeloplasty or patients without follow-up data. Based on surgeon preference, 24 patients had a EUP stent and 38 had a DJ stent placed. RESULTS The mean follow-up was 23.8 ± 10.9 months and 21.1 ± 11.1 months for the EUP and DJ stent groups, respectively (p = 0.32). The mean age was 40 ± 54 months and 80 ± 78 months for the EUP and DJ groups, respectively (p = 0.04). The EUP group had a greater proportion of open pyeloplasties (n = 17, 71%) versus the DJ group (n = 16, 42%; p = 0.04). There were no statistically significant differences in operative time, length of stay, and overall complication rate between groups. Complications were divided by timing of complication (intraoperative, before and after 3 months) and according to the Clavien Classification system. There were no statistically significant differences between these subgroups. The limitations of this study include small sample size, potential selection bias, and heterogeneity between both study groups. CONCLUSIONS Pyeloplasty using EUP stents does not incur prolonged operative time, longer length of stay or higher complication rate when compared to DJ stents. Within the limitations of this study, EUP stents may be a safe alternative to DJ stents.
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Affiliation(s)
- Linda C Lee
- Division of Urology, Hospital for Sick Children and Department of Surgery, University of Toronto, Toronto, ON
| | - Niki Kanaroglou
- Division of Urology, Hospital for Sick Children and Department of Surgery, University of Toronto, Toronto, ON
| | - Joseph M Gleason
- Division of Urology, Hospital for Sick Children and Department of Surgery, University of Toronto, Toronto, ON
| | - Joao L Pippi Salle
- Division of Urology, Hospital for Sick Children and Department of Surgery, University of Toronto, Toronto, ON
| | - Darius J Bägli
- Division of Urology, Hospital for Sick Children and Department of Surgery, University of Toronto, Toronto, ON
| | - Martin A Koyle
- Division of Urology, Hospital for Sick Children and Department of Surgery, University of Toronto, Toronto, ON
| | - Armando J Lorenzo
- Division of Urology, Hospital for Sick Children and Department of Surgery, University of Toronto, Toronto, ON
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Fotso Kamdem A, Nerich V, Auber F, Jantchou P, Ecarnot F, Woronoff-Lemsi MC. Quality assessment of economic evaluation studies in pediatric surgery: a systematic review. J Pediatr Surg 2015; 50:659-87. [PMID: 25840083 DOI: 10.1016/j.jpedsurg.2015.01.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Revised: 12/27/2014] [Accepted: 01/14/2015] [Indexed: 01/20/2023]
Abstract
PURPOSE To assess economic evaluation studies (EES) in pediatric surgery and to identify potential factors associated with high-quality studies. METHODS A systematic review of the literature using PubMed and Cochrane databases was conducted to identify EES in pediatric surgery published between 1 June 1993 and 30 June 2013. Assessment criteria are derived from the Drummond checklist. A high quality study was defined as a Drummond score ≥7. Logistic regression analysis was used to determine factors associated with high quality studies. RESULTS 119 studies were included. 43.7% (n=52) of studies were full EES. Cost-effectiveness analysis was the most frequent (61.5%) type of full EES. Only 31.6% of studies had a Drummond score ≥7 and 73% of these were full EES. The factors associated with high quality were identification of costs (OR: 14.08; 95% CI: 3.38-100; p<0.001), estimation of utility value (OR: 8.13; 95% CI: 2.02-43.47; p=0.005) and study funding (OR: 3.50; 95% CI: 1.27-10.10; p=0.02). CONCLUSION This review shows that the number and the quality of EES are low despite the increasing number of studies published in recent years. In the current context of budget constraints, our results should encourage pediatric surgeons to focus more on EES.
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Affiliation(s)
- Arnaud Fotso Kamdem
- UMR-INSERM-1098, Department of Pediatric Surgery, Besançon University Hospital, 3 Boulevard Fleming, F-25000 Besancon, France.
| | - Virginie Nerich
- INSERM U645 EA-2284 IFR-133, Department of Pharmacy, Besançon University Hospital, 3 Boulevard Fleming, F-25000 Besancon, France.
| | - Frederic Auber
- UMR-INSERM-1098, Department of Pediatric Surgery, Besançon University Hospital, 3 Boulevard Fleming, F-25000 Besancon, France.
| | - Prévost Jantchou
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Sainte-Justine University Hospital, 3175, Chemin de la Côte Sainte-Catherine, H3T 1C5, Montréal, Quebec, Canada.
| | - Fiona Ecarnot
- EA3920, Department of Cardiology, Besançon University Hospital, 3 Boulevard Fleming, F-25000 Besançon, France.
| | - Marie-Christine Woronoff-Lemsi
- UMR-INSERM-1098, Department of Clinical Research and Innovation, Besançon University Hospital, 2 place Saint Jacques, F-25000 Besançon, France.
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Stentless pyeloplasty for ureteropelvic junction obstruction in children. ANNALS OF PEDIATRIC SURGERY 2015. [DOI: 10.1097/01.xps.0000455092.43161.ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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11
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Urbine TF, Schneider PJ. Estimated cost savings from reducing errors in the preparation of sterile doses of medications. Hosp Pharm 2014; 49:731-9. [PMID: 25477598 PMCID: PMC4252201 DOI: 10.1310/hpj4908-731] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Preventing intravenous (IV) preparation errors will improve patient safety and reduce costs by an unknown amount. OBJECTIVE To estimate the financial benefit of robotic preparation of sterile medication doses compared to traditional manual preparation techniques. METHODS A probability pathway model based on published rates of errors in the preparation of sterile doses of medications was developed. Literature reports of adverse events were used to project the array of medical outcomes that might result from these errors. These parameters were used as inputs to a customized simulation model that generated a distribution of possible outcomes, their probability, and associated costs. RESULTS By varying the important parameters across ranges found in published studies, the simulation model produced a range of outcomes for all likely possibilities. Thus it provided a reliable projection of the errors avoided and the cost savings of an automated sterile preparation technology. The average of 1,000 simulations resulted in the prevention of 5,420 medication errors and associated savings of $288,350 per year. The simulation results can be narrowed to specific scenarios by fixing model parameters that are known and allowing the unknown parameters to range across values found in previously published studies. CONCLUSIONS The use of a robotic device can reduce health care costs by preventing errors that can cause adverse drug events.
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Affiliation(s)
- Terry F. Urbine
- Associate Research Scientist and Instructor, Department of Pharmacy Practice and Science, University of Arizona College of Pharmacy, Phoenix, Arizona
| | - Philip J. Schneider
- Professor and Associate Dean, Department of Pharmacy Practice and Science, University of Arizona College of Pharmacy, Phoenix, Arizona
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Ost MC. Editorial comment for Dangle et al. J Endourol 2014; 28:1172. [PMID: 24999742 DOI: 10.1089/end.2014.0488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Michael C Ost
- Department of Urology, Children's Hospital of Pittsburgh, University of Pittsburgh , Pittsburgh, Pennsylvania
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Urinary Diversion during and after Pediatric Pyeloplasty: A Population Based Analysis of More than 2,000 Patients. J Urol 2014; 192:214-9. [DOI: 10.1016/j.juro.2014.01.089] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2014] [Indexed: 11/18/2022]
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Dangle PP, Shah AB, Gundeti MS. Cutaneous pyeloureteral stent for laparoscopic (robot)-assisted pyeloplasty. J Endourol 2014; 28:1168-71. [PMID: 24484221 DOI: 10.1089/end.2013.0499] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND PURPOSE In select centers, laparoscopic (robot)-assisted pyeloplasty has emerged as a viable approach for the treatment of ureteropelvic junction obstruction (UPJO). Stent placement for urinary diversion is a common postoperative practice with several potential techniques and respective challenges. Robot-assisted diversion techniques such as indwelling Double-J or nephroureteral stents require either additional anesthesia or costs or they carry bleeding risks. Herein we describe an alternative postpyeloplasty cutaneous pyeloureteral (CPU) stenting technique that minimizes these challenges and achieves effective urinary diversion.
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Affiliation(s)
- Pankaj P Dangle
- 1 Department of Surgery, Division of Urology, The University of Chicago Medicine and Biological Sciences , Chicago, Illinois
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Zoeller C, Lacher M, Ure B, Petersen C, Kuebler JF. Double J or transrenal transanastomotic stent in laparoscopic pyeloplasty in infants and children: a comparative study and our technique. J Laparoendosc Adv Surg Tech A 2014; 24:205-9. [PMID: 24568602 DOI: 10.1089/lap.2013.0338] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE We compared our experience with intra- and extracorporeal stenting in laparoscopic transabdominal pyeloplasty in children and adolescents. As the placement of transanastomotic stents during laparoscopy can be difficult, we developed a technique for laparoscopic transrenal stent placement. SUBJECTS AND METHODS Eighty-six consecutive patients who underwent laparoscopic transabdominal pyeloplasty in our institution from December 2003 to November 2012 were retrospectively analyzed. Initially we antegradely placed the double J catheter (n=48), whereas in later patients transrenal/transcutaneous stents were inserted (n=38), either via a cannula from the flank (n=33) or from the inside-out by transrenal puncture using a specially constructed spear (n=5). End points of the analysis were stent-related technical problems and complications and the need for reoperation. RESULTS Sixty-two boys and 24 girls with a mean age of 5.6 years (range, 78 days-17.3 years) and mean weight of 22.1 kg (range, 5.5-71 kg) underwent laparoscopic transabdominal pyeloplasty. The most common technical problem in the double J group was inability to place the double J catheter in 9 of the 48 patients. In combination with other complications such as dislocations, urinary tract infections, or catheter occlusions, this led to an overall complication rate of 35% in the group that underwent double J catheter insertion versus 13% in the group with transrenal stenting (P<.05). In the whole series, 4 patients required a redo pyeloplasty, all of them in the double J group. CONCLUSIONS We recommend transrenal stents to facilitate stent removal without general anesthesia and to minimize complications such as stent dislocation. The initial experience with our simple device for transrenal puncture and stent placement is promising.
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Affiliation(s)
- Christoph Zoeller
- Center of Pediatric Surgery Hannover, Hannover Medical School and Bult Children's Hospital , Hannover, Germany
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External extension of double-J ureteral stent during pyeloplasty: inexpensive stent and non-cystoscopic removal. Int Urol Nephrol 2013; 46:671-6. [PMID: 24202957 DOI: 10.1007/s11255-013-0594-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Accepted: 10/22/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE The purpose of the study is to describe our experience with the application of externalized double-J ureteral stent (DJUS) during pyeloplasty for correction of ureteropelvic junction obstruction (UPJO) in order to avoid cystoscopy for stent removal. MATERIALS AND METHODS Pyeloplasty was performed in 523 infants with UPJO using miniature pyeloplasty technique. After removing the obstructed segment, a 3-Fr. DJUS was placed into the ureter. In order to avoid cystoscopy for the removal of the stent, a feeding tube was passed through the skin and renal pelvis via a separate stab incision, connected to the DJUS and secured to the external body surface (skin), and the pyeloplasty was completed. The feeding tube along with the stent was removed after 3-4 weeks, respectively. Postoperative follow-up visits were performed 1, 3, and 6 months after the procedure. RESULTS The mean operative time was 49 min (range 41-79). Patients were discharged after 17 ± 2 h (mean ± SD). No patient experienced bladder spasm or anticholinergic administration. Forty-four patients (8.4 %) experienced minor complications including non-febrile urinary tract infections and mild hematuria. No major complication including urinoma, leakage, and stent migration or displacement was observed during the follow-up period. Stent removal was tolerated by 99.8 % of patients in an outpatient setting with minimal discomfort without performing cystoscopy. CONCLUSIONS Using external DJUS along with a pyelocutaneous stent extension during pyeloplasty is a safe, feasible, and beneficial technique. This technique resulted in high success rate with minimal cost and no renal injury. The non-cystoscopic stent removal and elimination of urethral catheterization following pyeloplasty are the other advantages of this technique.
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Liss ZJ, Olsen TM, Roelof BA, Steinhardt GF. Duration of urinary leakage after open non-stented dismembered pyeloplasty in pediatric patients. J Pediatr Urol 2013; 9:613-6. [PMID: 22846468 DOI: 10.1016/j.jpurol.2012.06.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2011] [Accepted: 06/08/2012] [Indexed: 11/17/2022]
Abstract
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.
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Affiliation(s)
- Zachary J Liss
- Department of Urology, Wayne State University School of Medicine, Grand Rapids, MI 49503, USA
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Yiee JH. Research in Pediatric Urology: Past, Present and Future. J Urol 2011; 186:15-6. [DOI: 10.1016/j.juro.2011.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Jenny H. Yiee
- Department of Urology, University of California, Los Angeles, Los Angeles, California
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Peters CA. Urinary tract obstruction: stents in pyeloplasty: beware of false precision. Nat Rev Urol 2011; 8:239-40. [PMID: 21562481 DOI: 10.1038/nrurol.2011.52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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