A randomized control trial comparing outcome after stented and nonstented Anderson-Hynes dismembered pyeloplasty

Nagdeve, Nilesh; Bhingare, Pravin; Sarawade, Prashant

doi:10.4103/jiaps.jiaps_58_17

Cited by 9 publications

(5 citation statements)

References 17 publications

(31 reference statements)

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“…A randomized controlled trial of stented versus non-stented OP in 42 pediatric patients demonstrated no differences in surgical outcomes at 3-month nuclear renal scan. As expected, they noted significantly increased levels of post-operative pain and dysuria in the stented cohort which resolved upon stent removal (11). Similar level of evidence is lacking in the adult population.…”

Section: Discussionsupporting

confidence: 58%

Robot-assisted laparoscopic transperitoneal pyeloplasty case report

Davaro¹,

Roberts²,

Lombardo³

2022

J Vis Surg

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Ureteropelvic junction obstruction (UPJO) can be caused by various anatomic abnormalities impairing drainage of urine from the kidney to the ureter. Patients often develop hydronephrosis and caliectasis which can lead to decreased function and eventually failure of the ipsilateral renal unit. Our patient presented with right sided abdominal pain and associated nausea. Classically, these symptoms are colicky in nature, can progress to emesis, and are often provoked by episodes of diuresis. Diagnosis involves a nuclear medicine renal scan with administration of Lasix to ascertain renal function and presence of obstruction. Indications for intervention are nuanced but T1/2 greater than 20 minutes and decreased function of the affected side less than 40% are typical. Our patient demonstrated a T1/2 of 23 minutes with preserved renal function. Robotic dismembered pyeloplasty is becoming the standard of care for urologists given its minimally invasive approach, faster recovery time and superior success to endoscopic approach and comparative success to open surgery. This case adds a visual walk-through of a robotic pyeloplasty to the scientific literature and addresses debated perioperative management strategies such as comparison of surgical approaches and length of trans-anastomotic drainage. Post-operative imaging with repeat nuclear medicine renal scan with Lasix administration to confirm resolution of obstruction is typically performed.Our case concluded with patient becoming symptom free and a Lasix renal scan demonstrating no evidence of post-renal obstruction.

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Section: Discussionsupporting

confidence: 58%

Robot-assisted laparoscopic transperitoneal pyeloplasty case report

Davaro¹,

Roberts²,

Lombardo³

2022

J Vis Surg

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“…This could help to release the stress on the newly formed anastomosis ( 23 ). The DJ stent and external stent were the main management of anastomosis drainage after pyeloplasty, and each measure had its advantages and disadvantages ( 24 , 25 ). The major shortcoming of the DJ stent was that patients, especially infants, needed to undergo second general anesthesia when withdrawing it.…”

Section: Discussionmentioning

confidence: 99%

Comparison of external stents and DJ stents techniques for pediatric pyeloplasty: A systematic review and meta-analysis

Meng

Gan

et al. 2022

Front. Pediatr.

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ObjectiveTo evaluate and compare the efficacy and safety between an external stent and a Double J stent for pediatric Pyeloplasty.MethodsThrough a systematical search of multiple scientific databases in July 2022, we performed a systematic review and meta-analysis of the primary outcomes of interest according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses), whose protocol was registered with PROSPERO(CRD42021274087).ResultsEleven studies involving 1,758 patients were included. No significant differences were observed in operative time (MD: 2.26; 95% CI −9.62 to 14.14; P = 0.79), operative success rate (OR: 1.10; 95% CI 0.57 to 2.10; P = 0.780), length of hospital stay (MD: 0.65; 95% CI −0.04 to 1.34; P = 0.063), or complications (OR: 0.87; 95%CI 0.48 to 1.56; P = 0.630) between external stents and DJ stents in pediatric pyeloplasty. According to the subgroup analysis, we found the external stent group had a shorter operative time than the DJ stent group in terms of robot-assisted laparoscopic pyeloplasty (MD: −17.13; 95% CI −32.8 to −1.45; P = 0.032).ConclusionsThere were no significant differences in operative time, operative success rate, length of hospital stay, or complications between external stents and DJ stents in pediatric pyeloplasty. The external stented procedure seemed to have less operative time when using robot-assisted laparoscopic pyeloplasty. However, due to the limitations of our analysis, more studies are still required to support our conclusion.Systematic review registrationThis systematic review has been registered on PROSPERO, the registration ID is CRD42021274087.

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“…However, several studies have reported positive results that are consistent with our results. [21][22][23][24][25] Recently, Nagdeve et al 26 concluded that double-Jstented patients were more symptomatic than unstented patients in the postoperative period, but no significant difference was identified. Considering the relatively low expense and advantages in follow-up for double-J stents, we still suggest double-J stent placement during LP in pediatric patients with UPJO as a safe, feasible, and beneficial method.…”

Section: Discussionmentioning

confidence: 99%

Use of double-J ureteric stents post-laparoscopic pyeloplasty to treat ureteropelvic junction obstruction in hydronephrosis for pediatric patients: a single-center experience

et al. 2020

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Objectives We aimed to investigate the safety concerns associated with placing double-J ureteric stents post-laparoscopic pyeloplasty surgery for congenital ureteropelvic junction obstruction (UPJO) and hydronephrosis. Methods A total of 1349 patients with postoperative double-J stent placement at our center were included. Clinical variables for enrolled patients were collected by two independent authors. We compared clinical variables and the efficacy of stenting post-laparoscopic pyeloplasty. Results The mean age of the patients was 4.23 ± 2.39 years. A total of 58.49% of patients were diagnosed with left UPJO with hydronephrosis and 33.95% were diagnosed with right UPJO. Furthermore, 7.56% of patients had bilateral UPJO. In all cases, 96.96% of indwelling double-J stents were successfully removed 4 weeks post-surgery. A total of 3.04% of the patients still required further management, including stent migration to the renal pelvis (0.37%), stent migration to the bladder (0.30%), prolapse of the stent through the ureter (0.15%), blockage of stents (1.85%), and fouling of stents (0.37%). Conclusions Double-J ureteric stents used after laparoscopic pyeloplasty for treating UPJO in hydronephrosis for pediatric patients is a safe, feasible, and beneficial method, which can be recommended for routine procedures. However, caution should be practiced for follow-up and removal using this method.

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A randomized control trial comparing outcome after stented and nonstented Anderson-Hynes dismembered pyeloplasty

Cited by 9 publications

References 17 publications

Robot-assisted laparoscopic transperitoneal pyeloplasty case report

Robot-assisted laparoscopic transperitoneal pyeloplasty case report

Comparison of external stents and DJ stents techniques for pediatric pyeloplasty: A systematic review and meta-analysis

Use of double-J ureteric stents post-laparoscopic pyeloplasty to treat ureteropelvic junction obstruction in hydronephrosis for pediatric patients: a single-center experience

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