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One week stenting after pediatric laparoscopic pyeloplasty; is it enough?
M Abdelwahab1, A Abdelaziz1, W Aboulela1
1Urology Department, Faculty of Medicine, Cairo University, Egypt.
Insights
Short-term ureteric stenting after pediatric laparoscopic pyeloplasty is safe and effective. This approach avoids complications associated with longer stent durations, offering a better patient experience.
Area of Science:
- Pediatric Urology
- Minimally Invasive Surgery
- Urologic Oncology
Background:
- The optimal duration of ureteric stent placement after pediatric pyeloplasty is debated.
- Standard 4-6 week stenting can lead to complications and requires general anesthesia for removal in children.
- Laparoscopic pyeloplasty is a common procedure for ureteropelvic junction obstruction (UPJO) in pediatric patients.
Purpose of the Study:
- To evaluate the outcomes of short-term ureteric stenting following laparoscopic pyeloplasty in pediatric patients.
- To compare the safety and efficacy of 1-week stenting versus 4-week stenting.
Main Methods:
- A prospective randomized study included 37 children under 16 with UPJO undergoing laparoscopic pyeloplasty.
- Group A (18 patients) had stents removed after 4 weeks under general anesthesia.
- Group B (19 patients) had stents removed after 1 week with the urethral catheter in an outpatient setting.
Main Results:
- No significant differences in operative time, leakage, hospital stay, or early complications between groups.
- Both groups showed similar improvements in symptoms, ultrasound, and renal scans.
- Group A had a significantly higher incidence of irritative voiding symptoms and urinary tract infections post-removal.
Conclusions:
- Short-term ureteric stenting (1 week) is a safe and effective alternative to standard 4-week stenting after pediatric laparoscopic pyeloplasty.
- This approach reduces stent-related morbidity, including lower rates of infection and voiding dysfunction.
- Outpatient removal without anesthesia is a significant advantage for pediatric patients.
Introduction:
The use of ureteric stents for urinary diversion after pediatric dismembered pyeloplasty and its duration remain debatable. Classically, an indwelling Double J ureteric stent has to be left for 4-6 weeks. However, such a duration is not free of stent-related complications, in addition to the need to remove it under general anesthesia in the pediatric age group.
Objectives:
This study aims to evaluate the outcome of short-term stenting after laparoscopic pyeloplasty in pediatric sector.
Methods:
A prospective randomized study of 37 children (less than 16 years-old) with pelvi-ureteric junction obstruction (PUJO) were managed by laparoscopic pyeloplasty by the same surgeon in the period between April 2015 and September 2017. In group A (18 patients), the DJ was removed after 4 weeks under general anesthesia, while in group B (19 patients), the DJ was fixed to the urethral catheter by a stitch, and it was removed with the urethral catheter after one week in the outpatient office. All patients were followed regularly for symptomatic improvement. Urine culture and sensitivity was done 1 month postoperatively. Abdominal ultrasound was done at 3, 6, 12 months and annually thereafter, while renal isotope scanning was done after 6 months.
Results:
There were no significant differences between both groups regarding operative duration, postoperative leakage, hospital stay, early postoperative complications. Both groups improved after pyeloplasty with no significant differences regarding symptoms, follow-up ultrasound, and renal scanning. The incidence of irritative symptoms and need for anticholinergics after catheter removal as well as urinary tract infection after 1 month were significantly higher in group A (P-value: 0.004 and 0.029, respectively) (Table).
Discussion:
To the authors knowledge, this is the first prospective controlled randomized study comparing short-term stenting with the classic 4 weeks stenting after laparoscopic pyeloplasty in the pediatric age group. In addition, the used technique of stenting not only allows stent removal on outpatient basis without anesthesia but also benefits from the pre-operative retrograde study so as not to miss any associated pathology in the ureter.
Conclusion:
Short-term ureteric stenting after laparoscopic pyeloplasty in pediatric age group is safe and not inferior to the standard 4-week stenting. It also avoids the stent-related complications.
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