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Priorities in urinary diversion following pyeloplasty

M Wollin1, P G Duffy, D A Diamond

  • 1University of Massachusetts Medical Center, Worcester.

The Journal of Urology
|August 1, 1989
PubMed

Insights

Optimal pyeloplasty drainage remains debated. This study found that routine nephrostomy tubes and transanastomotic stents in pyeloplasty offer no significant benefit and may prolong hospitalization, suggesting selective use for specific cases.

Area of Science:

  • Urology
  • Pediatric Surgery

Background:

  • The optimal method for drainage after pyeloplasty, a surgical procedure to correct a blockage in the kidney's drainage system, is a subject of ongoing discussion.
  • Different drainage techniques, including the use of nephrostomy tubes and transanastomotic stents, have been employed with varying outcomes.

Purpose of the Study:

  • To compare the outcomes and complication rates of pyeloplasty performed with and without routine upper tract drainage (nephrostomy tube and transanastomotic stent).

Main Methods:

  • A retrospective review of 100 consecutive dismembered pyeloplasties performed between 1983 and 1987.
  • Patients were divided into two groups: Group 1 (20%) received a nephrostomy tube and transanastomotic stent, while Group 2 (80%) underwent a nonintubated procedure.
  • Catheter use varied between groups, with 20% in Group 1 and 90% in Group 2 using a urethral bladder catheter.

Main Results:

  • Overall complication rates and long-term results were similar between the intubated (Group 1) and nonintubated (Group 2) pyeloplasty groups.
  • The intubated group experienced a 10.5% incidence of urinary tract infections.
  • The nonintubated group showed an 8.6% incidence of postoperative anastomotic leakage.

Conclusions:

  • Routine use of nephrostomy tubes and transanastomotic stents in pyeloplasty appears unnecessary and may lead to prolonged hospital stays.
  • Selective use of upper tract drainage could potentially reduce the incidence of postoperative anastomotic leakage in specific patient cases.

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