Ureteroneocystostomy with and without the use of an intravesical catheter.
PURPOSE: Assessment of postoperative pain, analgesic requirements, bladder spasms, nosocomial urinary tract infections, length of hospital stay and outcome of "no catheter" versus catheterized intravesical ureteric reimplantation. MATERIALS AND METHODS: Over a 1 year period, 33 patients (24F, 9M) aged 3-14 years with surgical indications for ureteroneocystostomy were randomly assigned to a "no catheter" or "catheter" group. Intravesical ureteric reimplantation was performed in all patients. Post-operatively patients were given intravenous morphine for pain control and pain was assessed by a pain scale and by interviewing patients and parents regarding pain control. Urine cultures were performed on the day of surgery, and first and third postoperative days. Patients were followed post-operatively at 6 weeks with a renal ultrasound and at 3 months with a voiding or nuclear cystogram. Postoperative analgesic requirements, occurrence of bladder spasms, urinary tract infection rate, length of hospital stay and outcome as regards cure of vesicoureteric reflux were recorded. Student's paired t test was used for evaluation of statistical difference between groups. RESULTS: There was no difference in sex distribution, mean age or body weight, or nosocomial urinary tract infection rate between the 2 groups. Post-operative intravenous morphine requirement was significantly lower (p<0.05) in the "no catheter" group (mean +/- Standard Error of Mean (SEM) 0.51 +/- 0.4 mg/kg) versus the "catheter" group (0.89 +/- 0.5 mg/kg). Bladder spasms occurred in 80% of catheterized patients and 30% of non-catheterized patients. Length of hospital stay was significantly shorter (p<0.05) in the "no catheter" group (87.2+/- 19.4 hours) versus the "catheter" group (109.1 +/- 20.9 hours). All patients had stable kidneys by renal ultrasound at 6 weeks and cure of reflux by cystogram at 3 months, regardless of catheter status. CONCLUSION: Intravesical ureteroneocystostomy without a catheter is safe, well tolerated, and associated with significantly lower postoperative intravenous analgesic requirements, shorter hospital stay and fewer bladder spasms than the use of bladder catheters post-reimplantation. "No-catheter" reimplantation did not alter the expected outcome as regards cure of reflux.
Al-Shammari
A.
A
Children's Hospital, University of Manitoba, Winnipeg, Manitoba.
Bhatti
A.
A
Kupchak
J.
J
Mix
L. W.
LW
Decter
A.
A
Leonard
M. P.
MP