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Dismembered pyeloplasty in infants under the age of 12 months
1Department of Urology, Prince Henry Hospital, Little Bay, New South Wales, Australia.
Insights
Internal ureteric stenting significantly reduces complications and hospital stays for infants undergoing pyeloplasty. This approach improves surgical outcomes for congenital pelvi-ureteric junction obstruction, making routine stenting advisable.
Area of Science:
- Pediatric Urology
- Surgical Outcomes
- Medical Device Impact
Background:
- Congenital pelvi-ureteric junction obstruction is a common cause of hydronephrosis in infants.
- Dismembered pyeloplasty is the gold standard surgical treatment.
- Urinary drainage methods post-pyeloplasty have varied, impacting outcomes.
Purpose of the Study:
- To evaluate the effect of internal ureteric stenting on surgical results of dismembered pyeloplasty.
- To compare outcomes between stented and non-stented infant pyeloplasty cases.
- To assess the impact on post-operative morbidity and recovery.
Main Methods:
- Retrospective review of 63 infant renal units undergoing dismembered pyeloplasty over 6 years.
- Comparison of outcomes between infants who received internal ureteric stents versus those who did not.
- Analysis of post-operative length of stay, urinary leaks, and need for revision surgery.
Main Results:
- Stented cases had a significantly shorter mean post-operative stay (5.9 days) vs. non-stented (12.4 days).
- Urinary leaks occurred only in non-stented anastomoses, with associated complications in revision cases.
- A favorable outcome was achieved in 94% of infants with a minimum 24-month follow-up.
Conclusions:
- Internal ureteric stenting dramatically reduces operative morbidity in infant pyeloplasty.
- The routine use of internal ureteric stents is justified for dismembered pyeloplasty in infants.
- Stenting simplifies post-operative management and improves patient recovery.
Objective:
To assess the impact of internal ureteric stenting on the surgical outcome of dismembered pyeloplasty in infants under the age of 12 months.
Patients And Methods:
The case records of 53 of 55 infants with the diagnosis of congenital pelvi-ureteric junction obstruction who underwent dismembered pyeloplasty over a 6-year period were available for review. A total of 63 renal units were treated surgically. The policy for urinary drainage changed during this period from predominantly nephrostomy or no drainage to that of internal ureteric stenting.
Results:
The post-operative mean (SD) length of stay for stented and non-stented cases was 5.9 (1.8) and 12.4 (5.4) days, respectively (P < 0.001). The mean length of stay for patients with bilateral and unilateral pyeloplasty was 9.7 (4.9) and 8.0 (4.7) days, respectively (P = 0.19). Urinary leaks occurred in non-stented anastomoses and not in stented anastomoses. All three cases which later required revision pyeloplasty had had significant complications associated with urinary leaks. With a minimum follow-up of 24 months, a favourable outcome, as determined by radio-isotope imaging, was achieved in 48 of 51 infants (94%) for whom follow-up data were available.
Conclusion:
The use of internal ureteric stenting in dismembered pyeloplasty performed in infants < 12 months old has, in our hands, led to a dramatic reduction in operative morbidity. The routine use of internal ureteric stents at the time of pyeloplasty is justified.
