A Randomized Control Trial Comparing Outcome after Stented and Nonstented Anderson-Hynes Dismembered Pyeloplasty

Area of Science:

• Pediatric Urology
• Surgical Innovation
• Clinical Trials

Background:

• Ureteropelvic junction obstruction (UPJO) is a common cause of hydronephrosis in children.
• Open dismembered pyeloplasty is a standard surgical treatment for UPJO.
• The use of double "J" (DJ) stents in pediatric pyeloplasty is debated due to potential complications.

Purpose of the Study:

• To compare the efficacy and postoperative complications of stented versus nonstented open pediatric dismembered pyeloplasty.
• To evaluate the impact of DJ stents on patient symptoms and surgical outcomes in UPJO repair.

Main Methods:

• A prospective, randomized controlled trial was conducted with 42 children undergoing Anderson-Hynes dismembered pyeloplasty for UPJO.
• Patients were randomized into two groups: one receiving a DJ stent and the other not.
• Outcomes assessed included surgical duration, hospital stay, and postoperative complications like dysuria, pain, hematuria, and urinary tract infections.

Main Results:

• Surgical duration was significantly shorter in the nonstented group (60.4 min) compared to the stented group (78.9 min).
• Patients with DJ stents reported significantly higher rates of dysuria, loin pain, lower abdominal pain, and urinary frequency.
• Resolution of hydronephrosis was similar in both groups, with no statistically significant difference in fever, hematuria, or urinary tract infections.

Conclusions:

• Nonstented dismembered pyeloplasty is associated with a shorter operative time and reduced postoperative symptoms in children with UPJO.
• While both stented and nonstented pyeloplasty effectively resolve hydronephrosis, stenting leads to increased patient morbidity.
• The findings suggest that omitting DJ stents may be a preferable approach in select pediatric UPJO cases.