Unstented laparoscopic pyeloplasty in young children (1-5 years old): a comparison with a repair using double-J stent or transanastomotic externalized stent.

Abstract

OBJECTIVE:

To evaluate feasibility of unstented laparoscopic pyeloplasty in young children to prevent pyelonephritis and second anaesthesia.

PATIENTS AND METHODS:

During 2006-2013, 70 children (1-5 years old) underwent laparoscopic pyeloplasty for high grade hydronephrosis. Unstented repair was indicated in 34 children (GroupL1), double-J stent was placed in 21 patients (Group L2) and uretero-pyelostomy stent (Cook) in 15 patients (Group L3). Stenting was preferred in large thin-walled pelvis, thin ureter, kidney malrotation, and unfavourable course of crossing vessels. The outcome was compared with age-matched group of 52 children who had open surgery during 1996-2006 (Groups O1, O3).

RESULTS:

Operation times were significantly shorter in Groups L1 and L2 than in Group L3; the times were shorter in open repairs. Three patients with crossing vessels from Group L1 had urine leakage and one had obstruction (11.4%). In Group L2, one patient had obstruction, one incorrect placement of the stent, and one girl had serious pyelonephritis (14.3%). In Group L3, displacement of uretero-pyelostomy occurred in one patient (6.7%). There is no statistical difference between laparoscopic groups and between laparoscopic and open groups.

CONCLUSION:

Unstented laparoscopic pyeloplasty is a safe procedure in selected young children with favourable anatomical conditions preventing additional anaesthesia and stent-related complications.

• Authors: Radim Kočvara, Josef Sedláček, Marcel Drlík, Zdeněk Dítě, Jaromír Běláček, Vojtěch Fiala
• Journal: Journal of pediatric urology (J Pediatr Urol) Vol. 10 Issue 6 Pg. 1153-9 (Dec 2014) ISSN: 1873-4898 [Electronic] England
• PMID: 24957464 (Publication Type: Comparative Study, Journal Article)
• Copyright: Copyright © 2014 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

Topics

• Child
• Child, Preschool
• Female
• Humans
• Hydronephrosis (surgery)
• Infant
• Kidney Pelvis (surgery)
• Laparoscopy
• Length of Stay
• Male
• Prosthesis Design
• Pyelonephritis (prevention & control)
• Stents
• Ureteral Obstruction (surgery)
• Urologic Surgical Procedures (methods)