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Urinary Diversion during and after Pediatric Pyeloplasty: A Population Based Analysis of More than 2,000 Patients

2014; Lippincott Williams & Wilkins; Volume: 192; Issue: 1 Linguagem: Inglês

10.1016/j.juro.2014.01.089

1527-3792

Renea Sturm, Thenappan Chandrasekar, Blythe Durbin‐Johnson, Eric A. Kurzrock,

Urological Disorders and Treatments

No AccessJournal of UrologyPediatric Urology1 Jul 2014Urinary Diversion during and after Pediatric Pyeloplasty: A Population Based Analysis of More than 2,000 Patients Renea M. Sturm, Thenappan Chandrasekar, Blythe Durbin-Johnson, and Eric A. Kurzrock Renea M. SturmRenea M. Sturm More articles by this author , Thenappan ChandrasekarThenappan Chandrasekar More articles by this author , Blythe Durbin-JohnsonBlythe Durbin-Johnson More articles by this author , and Eric A. KurzrockEric A. Kurzrock More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.01.089AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We evaluated the use and efficacy of intraoperative urinary diversion with ureteral stent or nephrostomy tube during pyeloplasty in children. Materials and Methods: The Faculty Practice Solutions Center® national billing database was queried to identify all pediatric pyeloplasties performed from 2009 to 2012. Patient variables, surgical approach, use of intraoperative stent/nephrostomy tube and return for postoperative stent/nephrostomy tube or second pyeloplasty were obtained. Results: A total of 2,435 children underwent open (1,792) or laparoscopic/robotic (643) pyeloplasty, with intraoperative urinary diversion rates of 45% and 83%, respectively. Comparing patients with and without an intraoperative stent/nephrostomy tube, 5.6% and 7.4%, respectively, returned to the hospital for urinary diversion. Multivariable analysis revealed no association with surgical approach, but higher surgeon volume (p <0.01) and use of an intraoperative stent/nephrostomy tube (p <0.01) were associated with decreased odds of requiring postoperative urinary diversion. Second pyeloplasty rate was 3.8% and was not associated with surgical approach or use of intraoperative stent/nephrostomy tube. Conclusions: Intraoperative stent/nephrostomy tube use and increased surgeon volume were each independently associated with a significant but small decrease in risk of postoperative stent/nephrostomy tube placement. Use of an intraoperative stent/nephrostomy tube was not associated with rate of second (redo ipsilateral or contralateral metachronous) pyeloplasty. References 1 : Retrocaval ureter; a case diagnosed pre-operatively and treated successfully by a plastic operation. Br J Urol1949; 21: 209. Google Scholar 2 : Stented versus nonstented pediatric pyeloplasty: a modern series and review of the literature. J Urol2002; 168: 1127. Link, Google Scholar 3 : Transpelvic anastomotic stenting: a good option for diversion after pyeloplasty in children. J Pediatr Urol2011; 7: 363. 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Google Scholar © 2014 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byKurzrock E (2015) Editorial CommentJournal of Urology, VOL. 194, NO. 2, (511-511), Online publication date: 1-Aug-2015.Baskin L (2014) This Month in Pediatric UrologyJournal of Urology, VOL. 192, NO. 1, (3-4), Online publication date: 1-Jul-2014. Volume 192Issue 1July 2014Page: 214-220 Advertisement Copyright & Permissions© 2014 by American Urological Association Education and Research, Inc.Keywordsureteral obstructionureterurinary diversionstentsoutcome assessment (health care)Metrics Author Information Renea M. Sturm More articles by this author Thenappan Chandrasekar More articles by this author Blythe Durbin-Johnson More articles by this author Eric A. Kurzrock More articles by this author Expand All Advertisement PDF downloadLoading ...