Pyeloplasty with ureteral stent placement in children: Do prophylactic antibiotics serve a purpose?

Vidovic, Sara; Hayes, Tristan; Fowke, Jay H.; Cline, Joseph K.; Cannon, Glenn M.; Colaco, Marc; Swords, Kelly; Cornwell, Laura B.; Villanueva, Carlos; Corbett, Sean T.; Maciolek, Kimberly A.; Lambert, Sarah M.; Beltran, Gemma; Vemulakonda, Vijaya M.; Giel, Dana W.

doi:10.1016/j.jpurol.2022.03.022

Cited by 8 publications

(5 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…After removing the DJ stent within 2 weeks after surgery, no further UTIs have occurred. Therefore, we agree with Vidovic et al who reported that a routine administration of prophylactic antibiotics after pyeloplasty does not appear to be beneficial [ 25 ].…”

Section: Discussionsupporting

confidence: 92%

A Comparative Analysis of Robot-Assisted Laparoscopic Pyeloplasty in Pediatric and Adult Patients: Does Age Matter?

Kang

Suh

Lim

et al. 2022

JCM

View full text Add to dashboard Cite

We investigated factors that affect the surgical outcomes of robotic pyeloplasty by comparing the surgical results of pediatric and adult patients with ureteropelvic junction stricture (UPJO). We retrospectively reviewed patients who underwent robotic pyeloplasty for UPJO between January 2013 and February 2022. The patients were categorized into two groups: the pediatric (≤18 years) and adult (>18 years) groups. The perioperative and postoperative outcomes and surgical complications were comparatively analyzed. Prognostic factors for predicting surgical failure were analyzed with multivariable logistic regression analysis. The pediatric group showed longer total operation and console times. The mean pain score was lower in the pediatric group than in the adult group on days 1 and 2 after surgery. The average amount of morphine used in the pediatric group was lower during postoperative days 0–2. No differences in the length of hospital stay, incidence of surgical failure, and incidence of urolithiasis requiring treatment after robotic pyeloplasty were observed between the groups. The only factor that predicted surgical failure was a history of urolithiasis before surgery. The results showed that age did not affect the surgical outcome.

show abstract

Section: Discussionsupporting

confidence: 92%

A Comparative Analysis of Robot-Assisted Laparoscopic Pyeloplasty in Pediatric and Adult Patients: Does Age Matter?

Kang

Suh

Lim

et al. 2022

JCM

View full text Add to dashboard Cite

show abstract

“…Among children undergoing routine pyeloplasty, the incidence of postoperative fUTI in our cohort was relatively low (5%), consistent with current reported rates of 1–3% [ 6 , 7 ]. When evaluating potential risk factors for development of fUTI in the initial 30-day postoperative period, we did not identify an association between the use of pAbx, surgical approach, or urinary stent placement.…”

Section: Discussionsupporting

confidence: 91%

Does prophylactic antibiotics post pediatric pyeloplasty reduce the incidence of febrile UTIs?

et al. 2023

View full text Add to dashboard Cite

Purpose The use of postoperative prophylactic antibiotics in pediatric upper urinary tract reconstruction remains controversial. In this study, we examined whether low dose antibiotics administered following pediatric pyeloplasty reduce the incidence of febrile urinary tract infections at our institution. As a secondary outcome, in those patients with infection, additional analysis was performed to better quantify which patient population benefits the most from low dose prophylactic antibiotics. Methods Institutional review board approval (IRB) was obtained. All methods were carried out in accordance with relevant guidelines and regulations. A retrospective study was performed in patients who underwent pyeloplasty (2011–2017) at our institution. Surgical approach (laparoscopic versus robotic assisted versus open, with or without internal JJ ureteral stent) were based on surgeon preference. Patients of 8 fellowship trained pediatric urologists were included in the study period. Patients with prior history of urologic interventions or other congenital genitourinary tract abnormalities were excluded. Demographics (age, gender, ethnicity, insurance status), prior history of culture proven urinary tract infection, surgical details (administration of perioperative antibiotics), and postoperative outcomes including; 1) re-admission 30 days post-surgery, 2) any urine cultures collected due to suspected urinary tract infection. Results A total of 209 patients (149 boys, 60 girls) met our inclusion criteria with 55/209 (26%) receiving postoperative prophylactic antibiotics. The average age was 6 years (range: 2 months-18 years). Indwelling ureteral stent was used in 176 (84%) patients. Eleven patients (5%) had a culture-proven urinary tract infection within 30-days postoperatively. No significant differences were seen in postoperative complications or incidence of urinary tract infection when comparing surgical approaches, +/- ureteral stent, or the use of antibiotics. Secondary analysis noted statistically significant increase in post-operative urinary tract infection in younger children (2.8 v. 6.2 years, p = 0.02), those patients who had a positive preoperative urine culture (8/11, p = 0.01) and those with public health insurance (p = 0.038). Conclusion The incidence of postoperative urinary tract infection following pyeloplasty in our cohort was relatively low. There was a higher incidence of urinary tract infection in patients less than 3 years old. The use of antibiotics in patients post pyeloplasty did not appear to affect the incidence of post-operative urinary tract infection, however, they may have a role in children who have not yet potty trained and in patients with positive preoperative urine culture.

show abstract

Section: Resultsmentioning

confidence: 99%

“…Two of the included studies enrolled more than 800 children undergoing pyeloplasty, and all of these children had a stent placed after surgery [ 69 , 70 ]. According to Vidovic et al, only female gender, diaper use, and positive intraoperative urine culture were significant risk factors for stent UTI [ 69 ]. An RCT aimed to analyze the effect of CAP in children with urinary stents after surgery, including pyeloplasty.…”

Section: Resultsmentioning

confidence: 99%

“…Pooled results from three observational studies showed no significant benefits from continuing antibiotic prophylaxis after pyeloplasty in terms of recurrent UTIs (pooled RR: 1.22; 95% CI: 0.74-2.00) [69][70][71] [Table 11]. Two of the included studies enrolled more than 800 children undergoing pyeloplasty, and all of these children had a stent placed after surgery [69,70].…”

Section: Which Dosage Should Be Preferred For Continuous Antibiotic P...mentioning

confidence: 99%

See 1 more Smart Citation

Antibiotic Prophylaxis for the Prevention of Urinary Tract Infections in Children: Guideline and Recommendations from the Emilia-Romagna Pediatric Urinary Tract Infections (UTI-Ped-ER) Study Group

Autore,

Bernardi,

Ghidini

et al. 2023

Antibiotics

View full text Add to dashboard Cite

Background: Urinary tract infection (UTI) represents one of the most common infectious diseases and a major cause of antibiotic prescription in children. To prevent recurrent infections and long-term complications, low-dose continuous antibiotic prophylaxis (CAP) has been used. However, the efficacy of CAP is controversial. The aim of this document was to develop updated guidelines on the efficacy and safety of CAP to prevent pediatric UTIs. Methods: A panel of experts on pediatric infectious diseases, pediatric nephrology, pediatric urology, and primary care was asked clinical questions concerning the role of CAP in preventing UTIs in children. Overall, 15 clinical questions were addressed, and the search strategy included accessing electronic databases and a manual search of gray literature published in the last 25 years. After data extraction and narrative synthesis of results, recommendations were developed using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) methodology. Results: The use of CAP is not recommended in children with a previous UTI, with recurrent UTIs, with vesicoureteral reflux (VUR) of any grade, with isolated hydronephrosis, and with neurogenic bladder. CAP is suggested in children with significant obstructive uropathies until surgical correction. Close surveillance based on early diagnosis of UTI episodes and prompt antibiotic therapy is proposed for conditions in which CAP is not recommended. Conclusions: Our systematic review shows that CAP plays a limited role in preventing recurrences of UTI in children and has no effect on its complications. On the other hand, the emergence of new antimicrobial resistances is a proven risk.

show abstract

Pyeloplasty with ureteral stent placement in children: Do prophylactic antibiotics serve a purpose?

Cited by 8 publications

References 21 publications

A Comparative Analysis of Robot-Assisted Laparoscopic Pyeloplasty in Pediatric and Adult Patients: Does Age Matter?

A Comparative Analysis of Robot-Assisted Laparoscopic Pyeloplasty in Pediatric and Adult Patients: Does Age Matter?

Does prophylactic antibiotics post pediatric pyeloplasty reduce the incidence of febrile UTIs?

Antibiotic Prophylaxis for the Prevention of Urinary Tract Infections in Children: Guideline and Recommendations from the Emilia-Romagna Pediatric Urinary Tract Infections (UTI-Ped-ER) Study Group

Contact Info

Product

Resources

About