Stentless pyeloplasty for ureteropelvic junction obstruction in children

Abstract

Introduction Stenting after pyeloplasty is an established practice and helps in  ensuring a patent anastomosis until healing has completed. Stents, however, may cause complications such as infection and displacement and increase the cost of management; therefore, stentless pyeloplasty is now considered as feasible  alternative.
Patients and methods From August 2008 to October 2010, we retrospectively analyzed the results of stentless surgery in patients with ureteropelvic junction  (UPJ) obstruction. In all, 42 patients with UPJ obstruction were managed. Nine patients who were treated conservatively, one who underwent nephrectomy, and one pyelostomy for pyonephrosis in solitary kidney were excluded. Age range at surgery was 14 days–12 years with a mean age of 12.7 months.
Results There were 23 male patients and eight female patients with a male-to-female ratio of 3 : 1. Fourteen patients had left, 12 right, and five had bilateral UPJ obstruction. A total of 34 pyeloplasties were performed in 31 patients. Of the
five patients with bilateral UPJ obstruction, three underwent bilateral pyeloplasty and remaining two underwent unilateral pyeloplasty with conservative management on the opposite sides. Two patients underwent laparoscopic pyeloplasties and
32 pyeloplasties by open technique. Double J stent was placed at initial surgery in three patients and 31 stentless pyeloplasties were performed. The mean operative time was 75 min. The mean perinephric drain removal time was 2 days. None of the patients had persistent urinary leak. The mean hospital stay was 3.2 days. Reduction in anteroposterior diameter was noticed in 91% cases on 12 weeks  follow-up scan. Complications included persistent or increase in hydronephrosis in three (9%) patients. In all the three patients, cystoscopic stenting was attempted. In two patients, size 4 Fr double J stent was passed easily into the renal pelvis. One
patient improved, whereas other still has a dilated pelvis with static anteroposterior diameter after removal of stent at 6 weeks; patient is kept on close surveillance on regular ultrasonography. Re-exploration was performed in one patient, which showed kinking at the anastomosis site. Pyeloplasty was revised and patient improved. Other complications included lumbar hernia in one patient, which improved at 6-month follow-up, and stitch granuloma in one patient, which improved after removal of residual stitch.
Conclusion Stentless surgery for UPJ obstruction is a safe and feasible technique; it reduces the cost of surgery and avoids multiple procedures.

Keywords: management, pyeloplasty, stentless, ureteropelvic junction obstruction