Use of internal-external diversion stent in open pyeloplasty in patients under one year of age
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Published on: November 30, 2010
C M Gálvez Estévez1, M P Valdivieso Castro1, A Galbarriatu Gutiérrez1
1Pediatric Surgery Department. Hospital Universitario de Cruces. Barakaldo (Spain).
Insights
An internal-external diversion stent is a safe and effective option for pediatric pyeloplasty patients under one year old. This method allows for early discharge and avoids a second anesthesia for stent removal.
Area of Science:
- Pediatric Urology
- Surgical Innovation
- Nephrology
Background:
- Pyeloplasty often requires renal pelvis drainage post-surgery.
- Internal-external diversion stents offer an alternative drainage method.
- Current protocols involve early stent knotting and outpatient removal.
Purpose of the Study:
- To evaluate the outcomes of open pyeloplasty in infants under one year.
- To assess the efficacy of outpatient internal-external diversion stents in this cohort.
Main Methods:
- Retrospective analysis of 28 patients (31 renal units) from 2011-2021.
- Assessment of diagnostic methods, surgical techniques (Anderson-Hynes, Culp-DeWeerd), and postoperative course.
- Standardized use of internal-external diversion stents.
Main Results:
- Median age at pyeloplasty was 3 months for hydronephrosis cases.
- Mean hospital stay was 3.5 days, with good postoperative progression.
- Two complications occurred: urinary infection and pyonephrosis requiring re-operation.
Conclusions:
- Internal-external diversion stents are a simple, safe option for pediatric pyeloplasty.
- This approach facilitates early discharge and outpatient management.
- It eliminates the need for a second general anesthesia for stent removal.
Introduction:
There are various alternatives available for renal pelvis drainage following pyeloplasty. One of them is the use of an internal-external diversion stent, which according to our protocol, is knotted 48 hours following surgery, prior to discharge, and removed 7 days later on an outpatient consultation basis, with no sedation or analgesia required.
Objective:
To analyze the results of patients under one year of age who underwent open pyeloplasty associated with an outpatient internal-external diversion stent.
Materials And Methods:
A retrospective, descriptive analysis of 28 patients (31 renal units) undergoing surgery from 2011 to 2021 was carried out. Diagnostic methods, indications, surgical approach, and postoperative progression were assessed.
Results:
28 patients (23 male) prenatally diagnosed with hydronephrosis confirmed by ultrasonography and/or renogram underwent pyeloplasty at a median age of 3 months (15 days-11 months). Pyeloplasty was conducted according to the Anderson-Hynes technique or dismembered pyeloplasty in 28 renal units, and according to the Culp-DeWeerd technique or spiral flap in 3. In all cases, an internal-external diversion stent was used according to our protocol. Mean hospital stay was 3.5 days (2-7 days), with a good postoperative progression. 2 patients had complications (urinary infection requiring intravenous antibiotics, and pyonephrosis requiring re-pyeloplasty).
Conclusions:
Using an internal-external diversion stent following pyeloplasty in patients under 1 year of age with ureteropelvic junction obstruction is a simple and safe option that allows for early discharge with outpatient management. It also avoids a second general anesthesia for drainage catheter removal purposes.
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