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Transpelvic anastomotic stenting: a good option for diversion after pyeloplasty in children
Tan Son Le1, Cong Thang Le, Thanh Hung Le
1Department of Pediatric Surgery, University of Medicine and Pharmacy, 217 Hong Bang St., District 5, Ho Chi Minh City, Viet Nam. letanson54@yahoo.com
Insights
Transrenal pelvic stenting effectively diverts urine after pyeloplasty in children, reducing the need for repeat surgeries. This method offers a favorable outcome for managing ureteropelvic junction obstruction.
Area of Science:
- Pediatric Urology
- Surgical Techniques
- Renal Pelvis Management
Background:
- Dismembered pyeloplasty is a common procedure for ureteropelvic junction obstruction (UPJO).
- Effective postoperative drainage of the renal pelvis is crucial for successful outcomes.
- Various diversion techniques exist, each with potential benefits and drawbacks.
Purpose of the Study:
- To evaluate the efficacy of transrenal pelvic transanastomotic stenting in children undergoing pyeloplasty for UPJO.
- To compare outcomes of different urinary diversion methods post-pyeloplasty.
Main Methods:
- Retrospective review of 238 patients (243 renal units) treated for UPJO between 2004-2007.
- Patients were categorized into four groups based on surgical approach: nephrostomy with delayed pyeloplasty, pyeloplasty without diversion, pyeloplasty with transrenal pelvic stenting, and pyeloplasty with stents and Foley catheters.
- Stents used were 5 Fr or 6 Fr feeding tubes.
Main Results:
- Transrenal pelvic stenting (Group 3) showed no cases requiring re-do pyeloplasty, with only one instance of urine leakage requiring nephrostomy and two spontaneous urine leaks.
- Pyeloplasty without diversion (Group 2) resulted in 2/33 re-do pyeloplasties.
- Pyeloplasty with both stents and Foley catheters (Group 4) also had no re-do pyeloplasties, with minor delays in catheter removal.
Conclusions:
- Transrenal pelvic transanastomotic stenting using feeding tubes is a safe and effective method for urine diversion after pediatric pyeloplasty.
- This technique appears to minimize complications such as urine leaks and the need for revision surgery.
- The study supports transrenal pelvic stenting as a viable option for managing UPJO.
Purpose:
Several options are available to drain the renal pelvis after a dysmembered pyeloplasty. The purpose of our study was to review the results of transrenal pelvic transanastomotic stenting following ureteropelvic junction obstruction pyeloplasty (UPJO).
Patients And Methods:
A retrospective chart review of 238 patients with UPJO (243 renal units) treated in 2004-2007. The patients were divided into 4 groups (1): renal units with very poor function (<10% uptake) having undergone nephrostomy tube placement, with pyeloplasty performed 1 month later for those with improved renal function, and nephrectomy for those with no improvement (2); pyeloplasty without diversion (3); pyeloplasty diverted with transrenal pelvis transanastomotic stenting (4); pyeloplasties diverted with both stents and Foley catheters; the stents used were 5 Fr or 6 Fr feeding tubes.
Results:
Group 1: 13 nephrectomies and 31 pyeloplasties diverted with stents and Foley catheters; 1/31 re-do pyeloplasty. Group 2: 33 pyeloplasties that were performed without diversion or stenting; 2/33 required re-do pyeloplasty. Group 3: 122 pyeloplasties diverted with only stents inserted through renal pelvis with 1 nephrostomy due to urine leakage, 2 prolonged urine leaks that ceased spontaneously, 1 urinary infection, no re-do pyeloplasty needed. Group 4: 44 pyeloplasties that were performed with stents and nephrostomy tubes, 2 delays of removal of Foley catheters, no re-do pyeloplasty needed.
Conclusions:
Transrenal pelvis transanastomotic stenting using a feeding tube is a good option for diverting urine following dysmembered pyeloplasty in children.
