P D Anderson1, P A Dewan. 1. Department of Paediatrics, Urology Unit, Royal Children's Hospital, Flemington Road, Parkville, Victoria 3052, Australia.
Abstract
OBJECTIVE: To review the profile and outcome of patients in whom it was elected not to insert a bladder catheter as part of the management of Cohen transtrigonal ureteric reimplantation surgery. PATIENTS AND METHODS: Between April 2000 and April 2001, 37 patients underwent ureteric reimplantation by the senior author, using the Cohen transtrigonal technique. The use of the catheter-less protocol began after the blockage of a suprapubic catheter soon after surgery; the catheter was removed with no adverse event. Subsequently, 27 of those undergoing ureteric reimplantation were selected not to have a bladder catheter. Later in the study a greater proportion of patients had no catheter inserted, as confidence with the catheter-less technique increased. Caudal anaesthetic, oral analgesia and a single dose of intravesical bupivacaine were used for pain relief. The children were monitored closely after surgery and a urethral catheter inserted in the one patient who had not voided after 6 h. RESULTS: The patients generally tolerated the lack of a bladder catheter well. Of the 27 patients who did not have a catheter inserted at surgery, one required catheterization (a girl with bilateral duplex systems and large ureteroceles). Two children stayed in hospital for 2 days after surgery, one was discharged on the day of surgery, and the remainder went home on oral analgesia on the first day after surgery. Since starting the catheter-less approach, 10 patients have had a suprapubic catheter because they had more complex surgery, were older or because the approach had not developed sufficiently at the time of surgery. CONCLUSIONS: Intravesical ureteric reimplantation is not only safe when omitting a bladder catheter but, if used selectively, there appears to be a significant decrease in the hospital stay and discomfort after surgery.
OBJECTIVE: To review the profile and outcome of patients in whom it was elected not to insert a bladder catheter as part of the management of Cohen transtrigonal ureteric reimplantation surgery. PATIENTS AND METHODS: Between April 2000 and April 2001, 37 patients underwent ureteric reimplantation by the senior author, using the Cohen transtrigonal technique. The use of the catheter-less protocol began after the blockage of a suprapubic catheter soon after surgery; the catheter was removed with no adverse event. Subsequently, 27 of those undergoing ureteric reimplantation were selected not to have a bladder catheter. Later in the study a greater proportion of patients had no catheter inserted, as confidence with the catheter-less technique increased. Caudal anaesthetic, oral analgesia and a single dose of intravesical bupivacaine were used for pain relief. The children were monitored closely after surgery and a urethral catheter inserted in the one patient who had not voided after 6 h. RESULTS: The patients generally tolerated the lack of a bladder catheter well. Of the 27 patients who did not have a catheter inserted at surgery, one required catheterization (a girl with bilateral duplex systems and large ureteroceles). Two children stayed in hospital for 2 days after surgery, one was discharged on the day of surgery, and the remainder went home on oral analgesia on the first day after surgery. Since starting the catheter-less approach, 10 patients have had a suprapubic catheter because they had more complex surgery, were older or because the approach had not developed sufficiently at the time of surgery. CONCLUSIONS: Intravesical ureteric reimplantation is not only safe when omitting a bladder catheter but, if used selectively, there appears to be a significant decrease in the hospital stay and discomfort after surgery.