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Transanastomotic stents for dismembered pyeloplasty in children
I Serdar Arda1, Pelin Oguzkurt, Sinasi Sevmis
1Baskent University Faculty of Medicine, Department of Pediatric Surgery, Fevzi Cakmak caddesi 10. sokak No:45, 06490 Bahcelievler, Ankara, Turkey.
Insights
This study found no significant difference in outcomes for pediatric pyeloplasty with or without a transanastomotic stent. Draining the upper urinary tract after pyeloplasty is not necessary, simplifying the procedure.
Area of Science:
- Pediatric Urology
- Surgical Outcomes
Background:
- Debate exists among pediatric urologists regarding the necessity of upper urinary tract drainage after pyeloplasty.
- Ureteropelvic junction obstruction (UPJO) is a common cause of UPJO in children.
Purpose of the Study:
- To compare early and late outcomes of pediatric pyeloplasty with and without a transanastomotic stent.
- To evaluate the necessity of upper tract drainage after pyeloplasty in children.
Main Methods:
- Prospective, randomized clinical study involving 31 children undergoing Anderson-Hynes pyeloplasty.
- Patients were divided into two groups: 15 with a transanastomotic stent and 16 without.
- Evaluation included stent/drain removal time, urine leakage, hospital stay, and early/late complications.
Main Results:
- No statistically significant differences were observed between the stented and non-stented groups.
- Key outcomes including drain removal, urine leakage duration, hospitalization, and complications showed no variation.
- Stenting did not increase patient morbidity.
Conclusions:
- Pyeloplasty in children can be safely performed without upper-tract drainage.
- Transanastomotic stenting does not appear to offer significant advantages in terms of outcomes or complications.
- A feeding tube with multiple holes at the tip is recommended for post-pyeloplasty management.
Abstract:
Among pediatric urologists, there is a debate whether to drain the upper system after pyeloplasty in children. In a prospective, randomized clinical study we compared the early and late results of patients operated upon for ureteropelvic junction obstruction (UPJO) with or without a transanastomotic stent. Anderson-Hynes pyeloplasty was performed in 31 children during a 5-year period. In 15 a transanastomotic stent with multiple holes was used; the upper system was not drained in 16. A Penrose drain was placed in the perinephritic area in all patients. Patients were evaluated in regard to the time of removal of the stent and the Penrose drain, duration of urine leakage, and duration of hospital stay in the early postoperative period, and favorable or unfavorable outcome during follow-up. The statistical analysis showed no significant difference in regard to the removal time of the stent and Penrose drain, duration of drainage, duration of hospitalization, and early or late complications between the groups. Although stenting does not increase morbidity, we believe that pyeloplasty can be performed in children without upper-tract drainage. A feeding tube with multiple holes at the tip is recommended.