Comparison of Drainage Methods After Pyeloplasty in Children: A 14-Year Study

Abstract

Objective: To summarize our experiences with drainage methods after laparoscopic pyeloplasty with a 14-year study.Methods: We reviewed the data of the 838 children operated on for hydronephrosis due to congenital ureteropelvic junction obstruction (UPJO) between July 2007 and July 2020. Patients' demographics, perioperative details, postoperative drainage stents [including double-J stent, percutaneous trans-anastomotic (PU) stent, and trans-uretero-cystic external urethral stent (TEUS)], complications, hospital stay, and long-term follow-up outcomes were analyzed. Long-term follow-up was performed by outpatient visits and telephone follow-up. Moreover, we reviewed the details of nine cases of recurrence after laparoscopic pyeloplasty.Results: Comparison of preoperative general data among the three groups indicated that there was no statistical difference in age, gender, and surgical side of the three groups. Statistical differences were found in the incidence of postoperative complications from the three postoperative drainage method groups, especially the incidence of reoperations (p < 0.01): there were six cases (3.19%) of recurrences in the TEUS group, two cases (0.36%) in the DJ group, and one case (0.93%) in the PU group. In the six recurrent cases from the TEUS group, four cases (44.4%) were found to have stenosis, and two cases (22.2%) have iatrogenic valvular formation.Conclusion: Not all three types of drainage methods are suitable for drainage after pyeloplasty. Based on our findings, TEUS is not recommended.

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

“…A total of 342 studies were identified, and eleven studies were eventually included in our meta-analysis (3,4,(8)(9)(10)(11)(18)(19)(20)(21)(22). The filtering process is shown in Figure 1.…”

“…Nine studies with 1,287 patients were related to operative time (3,4,(8)(9)(10)(19)(20)(21)(22). Due to the high heterogeneity (I 2 >50%), we used the random-effects model.…”

“…Eleven studies had been linked to complications (3,4,(8)(9)(10)(11)(18)(19)(20)(21)(22), concerning 1,758 patients. Because of the heterogeneous results (I 2 = 62.3%), a random effect model was applied.…”

Risk factors for adverse outcomes after pediatric pyeloplasty: A retrospective cohort study

“…While most authors agree on the necessity and effectiveness of transanastomotic urinary diversion, the type of diversion to be used is still controversial. [22][23][24][25] According to Lee et al, 6 urinary drainage after pediatric pyeloplasty would be necessary only if the preoperative DRF is greater than 60% since this criterion is associated with a higher rate of postoperative complications. Ceyhan et al 7 found that morbidity following surgical management of UPJ obstruction was lower in children with transanastomotic diversions.…”

“…In this study, multivariate analysis found no association between diversion type and postoperative negative outcomes. While most authors agree on the necessity and effectiveness of transanastomotic urinary diversion, the type of diversion to be used is still controversial 22–25 . According to Lee et al., 6 urinary drainage after pediatric pyeloplasty would be necessary only if the preoperative DRF is greater than 60% since this criterion is associated with a higher rate of postoperative complications.…”