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Published on: January 7, 2019
Short-term Complications After Pyeloplasty in Children With Lower Urinary Tract Anomalies
Rafal Chrzan1, Wojciech Panek2, Caroline F Kuijper1
1Department of Pediatric Urology, University Children's Hospital AMC/EKZ, Amsterdam, The Netherlands; Department of Pediatric Urology, UMC/WKZ, Utrecht, The Netherlands.
Insights
Children with lower urinary tract anomalies undergoing laparoscopic pyeloplasty with a double-J catheter (JJC) face increased risks of postoperative complications. Careful patient selection and monitoring are crucial for managing these risks.
Area of Science:
- Pediatric Urology
- Surgical Complications
- Lower Urinary Tract Anomalies
Background:
- Laparoscopic pyeloplasty is a common procedure for ureteropelvic junction obstruction in children.
- The use of double-J catheters (JJC) is standard for stenting during this procedure.
- The impact of pre-existing lower urinary tract (LUT) anomalies on postoperative outcomes is not well-defined.
Purpose of the Study:
- To determine if children with lower urinary tract (LUT) anomalies have a higher risk of complications after laparoscopic pyeloplasty stented with a double-J catheter (JJC).
- To identify specific LUT anomalies that may increase surgical risk.
Main Methods:
- Prospective analysis of data from laparoscopic pyeloplasty (LP) performed between 2006 and 2015.
- Inclusion criteria: toilet-trained children undergoing unilateral dismembered pyeloplasty with JJC.
- Patients were categorized based on infravesical LUT anomalies (a-LUTA) or history of LUT symptoms (LUTS); complications were graded using Clavien-Dindo classification.
Main Results:
- A total of 54 children were analyzed; 10 had LUTS and 11 had accidental urethral anomalies (a-LUTA).
- The overall complication rate was 14% (8/54).
- Patients with LUTS (1/10) and a-LUTA (3/11) experienced significantly higher rates of grade 3 complications compared to the control group (1/33) (P < .05).
Conclusions:
- Children with lower urinary tract anomalies are at a significantly increased risk for postoperative complications following laparoscopic pyeloplasty with JJC stenting.
- Thorough patient history and pre-operative evaluation for infravesical abnormalities are essential.
- Consideration should be given to avoiding internal diversion in patients with infravesical anomalies and close monitoring of bladder function postoperatively.
Objective:
To investigate whether children with lower urinary tract (LUT) anomalies are at greater risk for postoperative complications after laparoscopic pyeloplasty stented with a double-J catheter (JJC).
Materials And Methods:
Prospectively collected data of laparoscopic pyeloplasty (LP) performed between 2006 and 2015 were analyzed. Inclusion criteria are (1) toilet-trained child and (2) unilateral dismembered pyeloplasty stented with a JJC done by the same surgeon. Our pyeloplasty protocol includes cystoscopy and retrograde pyelography. JJC is left in for 3weeks. Asymptomatic patients with infravesical LUT anomalies (a-LUTA) and those with history of LUT symptoms (LUTS) were identified. Any short-term complication was classified according to Clavien-Dindo. Fisher's exact test was used for statistical analysis.
Results:
Fifty-four children (mean 9.8 years) were included. Ten of 54 patients had LUTS. In 4 of those 10, anatomical infravesical anomaly was found during cystoscopy. Accidental urethral anomaly was found in 11 patients (a-LUTA). The control group (CG) consisted of 33 patients. Postoperative hospital stay ranged from 1 to 8 days (mean 2 days). Overall complication rate was 8 of 54 (14%). Grade 1 complications occurred in 3 patients in the CG. Five patients had grade 3 complications (2 needed replacement of bladder catheter, and 3 had diversion of the upper tract). Those problems occurred in 1 of 10 patients with LUTS and 3 of 11 patients with a-LUTA compared to 1 of 33 in the CG. This difference was statistically significant (P < .05).
Conclusion:
Careful history should be taken in toilet-trained children before pyeloplasty. If any infravesical abnormality is discovered, internal diversion should probably be avoided. Special attention must be paid to bladder function in the postoperative period.
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