Unintubated pyeloplastic operations for hydronephrosis: results of 21 cases

The incidence of post-operative urinary tract infection in patients with ureteric stents

Despite the many advantages provided by the ureteric stent, it produces a foreign body reaction and increases the risk of infection. We undertook a study on the rate of infection in a group of paediatric patients with ureteric stents; 40 ureteric stents, 6 to 9 F, were used in 36 children undergoing the following procedures: 18 pyeloplasties, 20 antireflux ureteric reimplantation and 2 uretero-rectal anastomoses. Only patients with sterile urine pre-operatively were included in the study. All received antibiotic cover in the post-operative period. Positive urine cultures were found in only 3 patients (7.5%). In spite of this low incidence, the urine specimens collected from all children 1 month after removal of the stent showed a much higher incidence of infection. It was concluded that ureteric stenting is a safe procedure with a low rate of infection provided that antibiotic cover is given.

Endoscopic transvesical ureterotomy

Endoscopic transvesical ureterotomy was used in 2 cases of lower ureteral stricture. Ureteral catheterization was performed after dilation. Then, with cutting diathermy a Colling's knife was directed so that an incision was made at the 12 o'clock position, cutting onto the catheter and, thus, completing the ureterotomy. In each case the incision extended outside the bladder through the strictured segment of the ureter and above to the dilated ureter proximal to the stenosis. Obstruction was relieved in both cases and, although vesicoureteral reflux was present during voiding, excretory urography at 12 months demonstrated acceptable tracts.