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Urinary diversion during and after pediatric pyeloplasty: a population based analysis of more than 2,000 patients

Renea M Sturm1, Thenappan Chandrasekar1, Blythe Durbin-Johnson1

  • 1Department of Urology, University of California Davis, Sacramento and Division of Biostatistics, University of California Davis, Davis (BD-J), California.

The Journal of Urology
|February 13, 2014
PubMed

Insights

Intraoperative urinary diversion using a stent or nephrostomy tube during pediatric pyeloplasty, along with higher surgeon volume, slightly reduced the need for postoperative urinary diversion. This approach did not affect the rate of repeat pyeloplasty procedures.

Area of Science:

  • Pediatric Urology
  • Surgical Outcomes
  • Urinary Diversion Techniques

Background:

  • Pyeloplasty is a common surgical procedure for ureteropelvic junction obstruction in children.
  • The role of intraoperative urinary diversion (ureteral stent or nephrostomy tube) during pyeloplasty remains a subject of investigation.
  • Optimizing surgical techniques to minimize postoperative complications and re-interventions is crucial in pediatric urology.

Purpose of the Study:

  • To evaluate the efficacy of intraoperative urinary diversion (ureteral stent or nephrostomy tube) during pediatric pyeloplasty.
  • To determine the association between intraoperative urinary diversion and the need for postoperative urinary diversion.
  • To assess the impact of intraoperative urinary diversion and surgeon volume on the rate of repeat pyeloplasty.

Main Methods:

  • A retrospective analysis of the Faculty Practice Solutions Center® national billing database.
  • Identification of pediatric pyeloplasty cases performed between 2009 and 2012.
  • Comparison of outcomes based on surgical approach (open vs. laparoscopic/robotic) and use of intraoperative urinary diversion.

Main Results:

  • Higher rates of intraoperative urinary diversion were observed in laparoscopic/robotic pyeloplasty (83%) compared to open pyeloplasty (45%).
  • Patients undergoing intraoperative urinary diversion had a slightly lower rate of return for postoperative urinary diversion (5.6% vs. 7.4%).
  • Increased surgeon volume and intraoperative stent/nephrostomy tube use were independently associated with a decreased need for postoperative urinary diversion, though the effect was small.

Conclusions:

  • Intraoperative stent or nephrostomy tube placement during pediatric pyeloplasty is associated with a small but significant reduction in the requirement for postoperative urinary diversion.
  • Higher surgeon volume also independently contributes to a decreased risk of postoperative urinary diversion.
  • The use of intraoperative urinary diversion did not influence the rate of subsequent pyeloplasty procedures.
Abstract

Keywords:
outcome assessment (health care)stentsureterureteral obstructionurinary diversion

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