Complications of trans-anastomotic externalised stents in open pyeloplasty: influence of the method of placement, the duration of stenting, and the associated bladder drainage.
OBJECTIVE
To assess the influence of the method for stent placement, the duration of stenting, and the presence of bladder drainage on the complication rate of open pyeloplasty.


METHODS
Complications were, retrospectively, compared in 228 consecutive open pyeloplasties performed at institution A using a trans-pyelostomic 6-Fr splint/stent for 5 days and no bladder drainage, and 150 consecutive open pyeloplasties performed at institution B using a trans-nephrostomic 6-Fr splint/stent for 9 days plus bladder drainage.


RESULTS
Median age at surgery was comparable between groups. The overall complication rate was 13% and was comparable at the two institutions, but for the presence of perioperative bleeding that was more common when the stent was placed trans-nephrostomically (institution B) and the rate of stent dislodgements, which was lower at institution A, perhaps due to some technical details aiming to prevent any inadvertent traction on the stent. Additional procedures, such as double J internal stent insertion, were required in <2% of cases.


CONCLUSIONS
A 5-day period of stenting after open pyeloplasty is generally enough. Trans-nephrostomic and trans-pyelostomic stent placement is equally effective. However, the former can be associated with a slightly higher bleeding rate. Details during stent placement are keys to avoid postoperative dislodgement and malfunctioning. Systematic bladder drainage seems unnecessary.
Castagnetti
Marco
M
Section of Paediatric Urology, Urology Unit, Department of Oncological and Surgical Sciences, University Hospital of Padova, Monoblocco Ospedaliero, Via Giustiniani, 2, 35128, Padua, Italy. marcocastagnetti@hotmail.com
Berrettini
Alfredo
A
Cimador
Marcello
M
Sergio
Maria
M
Rigamonti
Waifro
W
DeGrazia
Enrico
E
D000293:Adolescent; D000714:Anastomosis, Surgical; D002648:Child; D002675:Child, Preschool; D004322:Drainage / Q000295:instrumentation; D004867:Equipment Design; D005260:Female; D006801:Humans; D007223:Infant; D007558:Italy / Q000453:epidemiology; D007674:Kidney Diseases / Q000601:surgery*; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology*; D015995:Prevalence; D012189:Retrospective Studies; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D014546:Urinary Catheterization / Q000295:instrumentation; D013520:Urologic Surgical Procedures / Q000295:instrumentation*; D055815:Young Adult