Variants for upper urinary tract drainage after laparoscopic pyeloplasty in children

Rudin Yu.E., Maruhnenko D.V., Lagutin G.V.

Rudin, D.V. Maruhnenko, G.V. Lagutin

Introduction. Scientific papers, which deal with laparoscopic pyeloplasty in children with hydronephrosis, pay attention to the difficulties of renal drainage during the postoperative period and the associated complications. The aim of this study is to demonstrate the variants of temporary urine diversion in children after laparoscopic pyeloplasty, depending on the degree of hydronephrosis and patient’s age.

Materials and methods. 98 children (62 males and 49 females), aged from 9 months to 17 years (mean age was 3.48 years) underwent surgery in the pediatric uroandrological department of N. Lopatkin Research Institute of Urology and Interventional Radiology (Moscow, Russia) during the period of 2010-2016.

96 patients received surgery with laparoscopic access; two patients underwent retroperitoneoscopic surgery. Surgery of the pyeloureteral segment was performed according to Anderson-Hynes method; in two patients, the operation was combined with lithoextraction. 5 patients underwent antevasal pyelo-pyelo anastomosis.

The duration of the surgery varied from 90 to 370 min (mean 155±15.2 min). According to the way of drainage, the patients were distributed as follows: 72 patients had internal stenting, 9 patients (aged 10-24 months) received internal stenting combined with nephrostomy, nephrostomy was performed in 2 patients. 65 patients had antegrade drainage; 7 infants had retrograde drainage.

Results. Among intraoperative complications, one patient (1%) had bleeding from the abdominal wall, where a trocar was placed. In addition, one patient (1%), who previously underwent three surgical interventions, had conversion.

Depending on the type of renal drainage, the following complications were recorded. Among those with the JJ stent, urinous infiltration was found in 4 patients (4.1%) with grade IV hydronephrosis, two patients (2%) had impairment of drainage function combined with the dilation of the pelvicalyceal system and acute pyelonephritis, one patient (1%) had reflux, one had impaired function of pyelostomy stenting, one had its withdrawal, and one child (1%) had a nephrostomy loss.

The mean duration of post-operative drainage was 34.6±2.4 days. However, stent withdrawal was performed 6-7 weeks after the surgery in case of 4 grade hydronephrosis and constriction of the prevesical ureter.

A good outcome of treatment, without complications, was in 88 patients (89.7%), who had one surgery. We managed to perform successful laparoscopic pyeloplasty in 93 patients (94.9%) after the first surgery of the pyeloureteral segment. The second surgical intervention brought successful results in 100% of the patients.

Conclusion. It is preferable to perform internal stenting combined with nephrostomy for treating babies (aged 10-24 months), who undergo endovideosurgical pyeloplasty. For patients with grades III-IV hydronephrosis, who have significant dilation of the pelvicalyceal system and impairment of renal function, it is advisable to apply double drainage: the JJ stent combined with nephrostomy or pyelostomy. Nondrainage methods of endovideosurgical plasty of the pelvicalyceal system are not recommended for wide application, especially in babies. The optimal method of post-operative renal drainage after laparoscopic pyeloplasty helps to increase the results of surgical treatment and reduce the incidence of post-operative complications.

Authors declare lack of the possible conflicts of interests.

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hydronephrosis, drainage of the upper urinary tract, laparoscopic pyeloplasty, children