Early Hospital Discharge for Intravesical Ureteroneocystostomy

Miller, O. Fred; Bloom, Tammy L.; Smith, Loren J.; Aleer, Irene M. M c; Kaplan, George W.; Kolon, Thomas F.

doi:10.1016/s0022-5347(05)65036-7

Cited by 34 publications

(15 citation statements)

References 13 publications

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“…The surgery related complication rate and contralateral reflux development in our series were 2% and 8.9% respectively, which were consistent with the literature (2,(28)(29)(30). Complications were as follows: bleeding required blood transfusion in 1 patient, hematoma under incision in 3 and prolonged hospitalization secondary to UTI in 4 patients.…”

Section: Discussionsupporting

confidence: 90%

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Ureteroneocystostomy in primary vesicoureteral reflux: critical retrospective analysis of factors affecting the postoperative urinary tract infection rates

et al. 2014

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ARTICLE INFO ______________________________________________________________ ______________________Introduction: To determine the parameters affecting the outcome of ureteroneocystostomy (UNC) procedure for vesicoureteral reflux (VUR). Materials and Methods:Data of 398 patients who underwent UNC procedure from 2001 to 2012 were analyzed retrospectively. Different UNC techniques were used according to laterality of reflux and ureteral orifice configuration. Effects of several parameters on outcome were examined. Disappearance of reflux on control VCUG or absence of any kind of UTI/symptoms in patients without control VCUG was considered as clinical improvement.Results: Mean age at operation was 59.2 ± 39.8 months and follow-up was 25.6 ± 23.3 months. Grade of VUR was 1-2, 3 and 4-5 in 17, 79, 302 patients, respectively. Male to female ratio was 163/235. UNC was performed bilaterally in 235 patients and intravesical approach was used in 373 patients. The frequency of voiding dysfunction, scar on preoperative DMSA, breakthrough infection and previous surgery was 28.4%, 70.7%, 49.3% and 22.4%, respectively. Twelve patients (8.9%) with postoperative contralateral reflux were excluded from the analysis. Overall clinical improvement rate for UNC was 92%. Gender, age at diagnosis and operation, laterality and grade of reflux, mode of presentation, breakthrough infections (BTI) under antibiotic prophylaxis, presence of voiding dysfunction and renal scar, and operation technique did not affect the surgical outcome. However, the clinical improvement rate was lower in patients with a history of previous endoscopic intervention (83.9% vs. 94%). Postoperative UTI rate was 27.2% and factors affecting the occurrence of postoperative UTI were previous failed endoscopic injection on univariate analysis and gender, preoperative BTI, postoperative VUR state, voiding dysfunction on multivariate analysis. Surgery related complication rate was 2% (8/398). These were all low grade complications (blood transfusion in 1, hematoma under incision in 3 and prolonged hospitalization secondary to UTI in 4 patients).In long term, 12 patients are under nephrologic follow-up because of hypertension in 5, increased serum creatinine in 5, proteinuria in 1 and hematuria in 1 patient and all these patients had preoperative scarred kidneys. Conclusions: Despite its invasive nature, UNC has a very high success rate with a negligible percent of complications. In our cohort, the only factor that negatively affected the clinical improvement rate was the history of previous antireflux interventions where the predictive factors for postoperative UTI were previous failed endoscopic injection, female gender, preoperative BTI, persistent VUR and voiding dysfunction.

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Section: Discussionsupporting

confidence: 90%

“…There is an increasing effort to minimize the invasiveness of this open surgery. Apart from the laparoscopic technique, contemporary series report open UNC without or with 1-day catheter technique, or via inguinal incision, or bilateral extravesical with minimal ureteral dissection with no postoperative urinary retention (28,29,31,32).…”

Section: Discussionmentioning

confidence: 99%

Ureteroneocystostomy in primary vesicoureteral reflux: critical retrospective analysis of factors affecting the postoperative urinary tract infection rates

et al. 2014

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“…They found that patients who were "stentless" had advantages of shortened hospital stay and decreased postoperative discomfort, while no complications or failures were observed during follow-up. Miller et al [11] reviewed 113 patients who underwent OUR without ureteral stenting, and reported similar results. It is worth noticing that both studies included only simple cases, and any patient requiring ureteral tapering, bladder augmentation, a redo procedure, and so on was excluded.…”

Section: Discussionmentioning

confidence: 79%

A Modified Transurethral Stenting Technique for (Robot-Assisted) Laparoscopic Ureteral Reimplantation

Teng

Jia

et al. 2019

Urol Int

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Background: Ureteral stenting is a technique-demanding procedure performed during robot-assisted laparoscopic ureteral reimplantation (RALUR). Many stenting techniques have been reported; however, none of them could be accepted as an ideal way. Objectives: The aim of the study was to report our initial results of a modified stenting technique for RALUR. Methods: Consecutive 4 patients undergoing RALUR were prospectively enrolled into our study. Our ureteral stenting technique included the following steps: catheterize a head-cut Foley catheter at the beginning of the operation, drag out the Foley catheter from the ureterovesical stoma after finishing posterior anatomosis, insert a guide wire through the catheter to the ureter lumen, and place the double-J (DJ) stent over the guide wire with a pusher. Results: All surgeries were successfully performed without severe complications. The mean stenting time was 1.6 min. No submucosa pseudocanal was found during stenting. DJ stent was removed 4 weeks after surgery. During the 3-month follow-up, it was observed that no vesicoureteral reflux or ureter stricture was found. Conclusions: Our ureteral stenting technique is an effective, simple, and safe procedure in RALUR, and could also be performed in laparoscopic ureteral reimplantation.

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“…Ureteral reimplantation may be required to treat vesicoureteral reflux that is high-grade or does not resolve. This procedure is the most common pediatric urologic procedure requiring hospitalization and is usually associated with a brief LOS and few complications [2][3][4][5][6]. Various perioperative management techniques have been recommended to further reduce LOS and lower hospital costs of children undergoing ureteral reimplantation.…”

Section: Introductionmentioning

confidence: 99%

“…Various perioperative management techniques have been recommended to further reduce LOS and lower hospital costs of children undergoing ureteral reimplantation. These modifications include early removal of the urethral catheter, elimination of the use of drains, extravesicle ureteral reimplantation techniques, continuous epidural anesthesia, and the use of non-steroidal anti-inflammatory medications to reduce narcotic use [3,4,[6][7][8].…”

Section: Introductionmentioning

confidence: 99%

The effect of surgeon volume and hospital characteristics on in-hospital outcome after ureteral reimplantation in children

Dickstein

Barone

Liao³

et al. 2006

Ped Surgery Int

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The aim of this study was to examine the association between surgeon and hospital characteristics on in-hospital outcome after ureteral reimplantation in children. Patients<18 years undergoing vesicoureteral reimplantation (n=3,109) were identified in Kids' Inpatient Database, an administrative database containing discharge records from 27 states during 2000 in the US. Based on patient volume in 2000, surgeons were designated as low volume (<11 procedures), medium volume (11-20 procedures) and high volume (>20 procedures) surgeons. Length of stay and hospital charges were analyzed using multivariate linear regression analysis. A significant association between shorter length of stay and higher surgeon volume (p=0.02) was observed that was independent of children's hospital status, hospital volume and other hospital characteristics. Length of stay was 20% shorter when the procedure was performed by the highest volume surgeons compared to when performed by the lowest. No significant effect of surgeon volume on hospital charges, however, was observed. Higher surgeon volume was associated with shorter length of stay but no difference in hospital charges among children undergoing vesicoureteral reimplantation.

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Early Hospital Discharge for Intravesical Ureteroneocystostomy

Cited by 34 publications

References 13 publications

Ureteroneocystostomy in primary vesicoureteral reflux: critical retrospective analysis of factors affecting the postoperative urinary tract infection rates

Ureteroneocystostomy in primary vesicoureteral reflux: critical retrospective analysis of factors affecting the postoperative urinary tract infection rates

A Modified Transurethral Stenting Technique for (Robot-Assisted) Laparoscopic Ureteral Reimplantation

The effect of surgeon volume and hospital characteristics on in-hospital outcome after ureteral reimplantation in children

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