Comparison of Surgical Outcomes between Dismembered Pyeloplasty with or without Ureteral Stenting in Children with Ureteropelvic Junction Obstruction

Abstract

PurposeTo evaluate the impact of temporary internal ureteral stents on the surgical outcomes of dismembered pyeloplasty in children.Materials and MethodsThe medical records of 70 children (76 renal units) who underwent dismembered pyeloplasty for ureteropelvic junction (UPJ) obstruction at at Asan Medical Center between January 2005 and December 2010 were retrospectively reviewed. We classified the renal units into the stented group (22 renal units) and the nonstented group (54 renal units). Fifty-four of 70 patients were male and their mean age was 2.2±3.8 years old. The mean follow-up period was 29.6±16.8 months.ResultsSixty-four children had unilateral UPJ obstruction. The mean stent duration was 31.9 days. As shown by evaluation of radiologic images, there were no significant differences between the stented group and the nonstented group during the follow-up period (p>0.05). The mean preoperative and postoperative anteroposterior pelvic diameters (APPDs) of the nonstented group were 31.3 mm and 15.1 mm, respectively (p<0.001). The preoperative and postoperative grades of hydronephrosis were 3.9 and 2.9, respectively (p=0.037). The mean preoperative and postoperative APPDs of the stented group were 36.4 mm and 15.6 mm, respectively (p<0.001). The preoperative and postoperative grades of hydronephrosis were 4 and 3.1, respectively (p<0.001). Repeat obstruction was shown in 4 subjects as a postoperative complication (5.7%). Two children from each group had recurrent UPJ obstruction, with percentages of 3.7% and 9%, respectively (p=0.575).ConclusionsIn a comparison of nonstented and stented groups during pediatric dismembered pyeloplasty for UPJ obstruction, no significant differences were found in the resolution of hydronephrosis or overall postoperative complications.

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

“…There are many studies which have compared the outcome following stented and nonstented pyeloplasty. [ 3 4 6 14 15 16 17 ] Most of these pediatric pyeloplasty series have not observed any significant difference on improvement in hydronephrosis after stented pyeloplasty compared to nonstented group. We too found no significant difference between the nonstented group and the stented group in terms of improvement of hydronephrosis.…”

Comparison of outcomes between 2 week versus 4 week stenting in pediatric pyeloplasty—A single centre observational study

“…The hospital stay was also more in the stented group. In another study of 70 children, the overall resolution of hydronephrosis and complication rates were similar in the stented and the unstented groups [ 6 ]. Kumar and Mandhani [ 7 ] in their limited series of 16 laparoscopic stentless pyeloplasties had 50% urinary leak in the pediatric population requiring restenting in the postoperative period.…”

Noncystoscopic removal of retained ureteral stents in children

“…It is reported that retaining double J ureteral stent can reduce hospitalization time, postoperative complication, and the additional treatments, and make earlier improvement compared with nonstented pyeloplasty. [ 6 , 7 ] There are, however, some crucial shortages of double J ureteral stent such as a necessary second operation for stent removal. The traditional method to remove the stent with cystoscope needs a second hospitalization and general anesthesia.…”