H H Woo1, R H Farnsworth. 1. Department of Urology, Prince Henry Hospital, Little Bay, New South Wales, Australia.
Abstract
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.
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.
Authors: C William Schwab; Grace Hyun; Francisco Garibay-Gonzalez; Douglas A Canning; Richard W Grady; Pasquale Casale Journal: JSLS Date: 2006 Jul-Sep Impact factor: 2.172