Outcomes and costs analysis of Externalized PyeloUreteral versus internal Double-J ureteral stents after paediatric laparoscopic Anderson-Hynes pyeloplasty

Paraboschi, Irene; Jannello, Letizia Maria Ippolita; Mantica, Guglielmo; Roberts, Luke; Olubajo, Seyi; Paul, Anu; Mishra, Pankaj; Taghizadeh, Arash; Garriboli, Massimo

doi:10.1016/j.jpurol.2020.12.006

Cited by 7 publications

(14 citation statements)

References 30 publications

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“…Compared with other reported literature (5,8,(13)(14)(15)(16), the advantages of our study lie in the long follow-up time and importantly in the number of patients. To our knowledge, this is the first long-term follow-up of TEUS and study of the results.…”

Section: Discussionmentioning

confidence: 82%

“…DJ stent insertion provides a shorter hospital stay, but a second operating room visit and anesthesia for removal are unavoidable. Similarly, in the study of Irene et al (8), they also compared the costs incurred by the two drainage methods, and they believed that the DJ and PU stents were equivalent in terms of overall complications and success rate. Moreover, PU stents can avoid the need for additional general anesthesia and reduce overall hospital costs.…”

Section: Discussionmentioning

confidence: 99%

“…After LP, the choice of stent type has always been the focus of debate. For now, double-J (DJ) stent and percutaneous transanastomotic (PU) are widely used due to their reliable efficacy, but their disadvantages are also obvious, such as displacement and secondary anesthesia in the DJ stent (5)(6)(7)(8) and urine leakage, kinks, and obstruction in the PU stent (5,9,10). Therefore, the ideal drainage method should be effective while being minimally invasive and safe.…”

Section: Introductionmentioning

confidence: 99%

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

Kong

et al. 2021

Front. Pediatr.

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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.

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Section: Discussionmentioning

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Kong

et al. 2021

Front. Pediatr.

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“…In addition, such factors as high insertion of the ureter, ureteral calculi, ureteral polyps, ureteral valves, reduced peristaltic function of the ureteropelvic junction and upper ureter, abnormal fibrous cord and nerve vascular compression outside the ureter, and retrocaval ureter can also induce hydronephrosis. The Anderson-Hynes operation, which is regarded as the gold standard for the treatment of UPJ obstruction ( 1 ), can be categorized into four types according to different surgical approaches: open dismembered pyeloplasty, laparoscopic dismembered pyeloplasty, robot-assisted laparoscopic pyeloplasty, and endoscopic incision of or balloon dilatation in ureteral stenosis. As surgical operations have continuously developed in refinement, mechanization, and visualization, open dismembered pyeloplasty has usually use infants and after repeated failures of laparoscopic surgery ( 12 – 14 ).…”

Section: Discussionmentioning

confidence: 99%

“…Pediatric hydronephrosis mainly resulting from ureteropelvic junction (UPJ) obstruction can be treated by the Anderson-Hynes operation, which is viewed as the gold standard ( 1 ). Currently, laparoscopic surgery has become the preferred way to treat UPJ obstruction, which is principally categorized into retroperitoneal laparoscopic pyeloplasty (RPLP) and transperitoneal laparoscopic pyeloplasty (TLP) ( 2 – 6 ).…”

Section: Introductionmentioning

confidence: 99%

Comparative study of different surgical approaches for treatment of UPJ obstruction according to the degree/severity of hydronephrosis factor

et al. 2022

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ObjectiveTo compare the efficacy of two different surgical approaches during and after pyeloplasty according to the degree/severity of hydronephrosis factor.Materials and methodsSixty child patients with UPJ obstruction admitted to our hospital from August 2019 to October 2021 were collected. Patients who underwent retroperitoneal laparoscopic pyeloplasty (RPLP) were enrolled into Group A (n = 20), while those who received transperitoneal laparoscopic pyeloplasty (TLP) were selected as Group B (n = 40). Clinical parameters, including gender, age, laterality of UPJ obstruction, degree/severity of hydronephrosis, body weight, operation time, drainage tube indwelling time, complete oral feeding time, and length of hospital stay, were compared between the two groups.ResultsAll 60 child patients were operated upon successfully without conversion to open surgery. There were no statistically significant differences in gender, age, laterality of UPJ obstruction, and body weight between the two groups, while the operation time of TLP was shorter than that of RPLP, indicating a statistically significant difference (P < 0.001). The differences in complete oral feeding time, drainage tube indwelling time, and length of hospital stay were statistically significant between the two groups, and RPLP was superior to TLP in terms of postoperative recovery time (P < 0.001). A stratified comparison showed that there were no statistically significant differences in anteroposterior diameter ≤ 20 mm, while there were statistically significant differences in anteroposterior diameter >20 mm. Hydronephrosis is reviewed after 3 months of the operation, degree/severity of hydronephrosis have been reduced.ConclusionBoth RPLP and TLP are safe and feasible in the treatment of UPJ obstruction, and their overall surgical effects are equivalent. For child patients with anteroposterior diameter ≤ 20 mm, RPLP is available, while patients with anteroposterior diameter >20 mm, TLP is recommended.

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