PURPOSE: The goal of this study was to evaluate the utilization and efficacy of intraoperative urine diversion with ureteral stent or nephrostomy tube (NT) during pediatric pyeloplasty.
MATERIALS AND METHODS: The FPSC national billing database was queried to identify all pediatric pyeloplasties performed from 2009 to 2012. Patient variables, surgical approach, use of intraoperative stent/NT and return for postoperative stent/NT or second pyeloplasty were obtained.
RESULTS: 2,435 children underwent open (1,792) or laparoscopic/robotic (643) pyeloplasty with an intraoperative urine diversion rate of 45% and 83%, respectively. Comparing patients with and without an intraoperative stent/NT, return to the hospital for urine diversion occurred in 5.6% and 7.4%, respectively. Multivariable analysis showed no association with surgical approach, but higher surgeon-volume (p< 0.01) and use of an intraoperative stent/NT (p< 0.01) were associated with decreased odds of requiring postoperative urine diversion. Second pyeloplasty rate was 3.8% and not associated with surgical approach or use of intraoperative stent/NT.
CONCLUSION: Intraoperative stent/NT use and increased surgeon-volume were each independently associated with a significant, but small decrease in risk of postoperative stent/NT. Use of an intraoperative stent/NT was not associated with rate of second (redo ipsilateral or contralateral metachronous) pyeloplasty.
Written by:
Sturm RM, Chandrasekar T, Durbin-Johnson B, Kurzrock EA. Are you the author?
Department of Urology, University of California Davis, 4860 Y Street, Sacramento, CA 95817; Division of Biostatistics, University of California Davis, Davis, CA 95616.
Reference: J Urol. 2014 Feb 8. pii: S0022-5347(14)00123-2.
doi: 10.1016/j.juro.2014.01.089
PubMed Abstract
PMID: 24518773
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