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Ureteroneocystostomy: to drain or not to drain
S H Chow1, M D LaSalle, J A Stock
1Children's Hospital of New Jersey-Saint Barnabas Health Care System, Department of Surgery, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, Newark, USA.
Insights
External abdominal drains after ureteral reimplantation showed fluid consistent with serum, not urine. Many pediatric urologists question the necessity of these drains, suggesting potential for reduced morbidity in ureteral reimplantation surgery.
Area of Science:
- Pediatric Urology
- Surgical Drainage
- Urologic Surgery
Background:
- The indications for external abdominal drains post-ureteral reimplantation are not well-established.
- Current practices among pediatric urologists regarding drain use vary significantly.
Purpose of the Study:
- To analyze the composition of drainage fluid following ureteral reimplantation.
- To assess the current utilization of external abdominal drains by pediatric urologists.
Main Methods:
- Prospective analysis of drainage fluid (urea, creatinine) in 15 patients undergoing ureteroneocystostomy.
- Comparison of drainage fluid composition to serum values.
- Survey of 268 pediatric urologists on their drain placement practices.
Main Results:
- Drainage fluid urea and creatinine levels were consistent with serum values in all patients.
- The Foley catheter and Jackson-Pratt drains were removed within an average of 3 and 4 days, respectively.
- 73.1% of surveyed urologists use external drains, but 26.5% consider them potentially unnecessary.
Conclusions:
- External abdominal drainage fluid after ureteral reimplantation is serum-consistent, contrary to the belief that it contains urine.
- A significant percentage of pediatric urologists do not routinely use external drains without apparent increased morbidity.
- Further large-scale studies are needed to confirm the necessity of drains in uncomplicated ureteral reimplantation.
Purpose:
Indications for the use of external abdominal drains after ureteral reimplantation are not well defined. We determine the nature of the drainage fluid as well as the current use of drains by pediatric urologists.
Materials And Methods:
We prospectively evaluated 15 consecutive patients 7 months to 19 years old who underwent unilateral or bilateral intravesical ureteroneocystostomy for primary vesicoureteral reflux. All patients were treated with a urethral Foley catheter and closed suction Jackson-Pratt abdominal drain. Fluid from the Jackson-Pratt drain and Foley catheter was analyzed for urea and creatinine on postoperative day 1, and compared to serum values. The Foley catheter was removed after the urine became clear, and the Jackson-Pratt drain was removed after drainage was 5 ml. or less for 12 hours. In addition, a questionnaire was distributed to 268 pediatric urologists to determine current practice regarding the use of routine postoperative drains.
Results:
Urea and creatinine from the Jackson-Pratt drains in all 15 patients were consistent with serum values. The Foley catheter and Jackson-Pratt drain were removed an average of 3 and 4 days postoperatively, respectively. There were 186 responses from the 268 questionnaires distributed (69.4%). Of the pediatric urologists surveyed 70.4% performed intravesical ureteral reimplantation exclusively, 5.9% extravesical reimplantation exclusively and 23.7% both techniques. Of the group surveyed 73.1% placed external abdominal Jackson-Pratt or Penrose drains, although 26.5% of those who routinely used external drains believed that they were probably unnecessary. Of the physicians who placed drains 53.7% believed that the drainage fluid had some component of urine.
Conclusions:
In our small prospective study group we demonstrated that external abdominal drainage fluid is consistent with serum despite the popular belief that it may have some component of urine. The gynecological literature has shown repeatedly that there is no increase in morbidity after radical hysterectomy and pelvic lymph node dissection when no external abdominal drains are used. Although to our knowledge there are no previous reports of drain use after ureteral reimplantation, 26.9% of pediatric urologists currently do not place external abdominal drains with no apparent increase in morbidity. Larger prospective cohorts with long-term followup are needed to address adequately the issue of whether drains are needed after uncomplicated ureteral reimplantation.