title: Postoperative outcome following pyeloplasty in children using miniflank incision and transanastomotic stent: a prospective observational study.
abstract: OBJECTIVE
  To assess the postoperative outcome in children undergoing pyeloplasty, using a single transanastomotic indigenized stent.
  
  
  METHODS
  329 pyeloplasties were performed by small miniflank incision (3-5 cm) with lateral position for unilateral cases and prone position for bilateral cases during 1993-2009. The procedure involved decompression of the hydronephrotic sac, single layer anastomosis at the PUJ using 5/6-0 suture (reduction of the pelvis if required). An indigenized # 6, Teflon transanastomotic stent (TAS) with multiple holes (modified recently to a self-retaining loop in pelvis) was placed and taken out through the renal pelvis and the main skin incision. The stent served both as a nephrostomy and a stent. The kidney was not mobilized during the procedure. Postoperative results were assessed for early complications.
  
  
  RESULTS
  The mean age of the patients was 3.4 years (1 month-14 years). Bilateral simultaneous pyeloplasties were done in 16 cases with a mean age of 5.6 months (2-12). The stent was removed after 4-5 days in most cases after confirming distal flow on clamping. The post-operative complications included slippage of stent (11), blockage/nondrainage (7), difficult retrieval (4), urine leak (4), urinoma (3) and post-operative infection (1). DTPA scan at 3 months follow-up depicted improved drainage in 271 units, preserved renal function in 58 units and improved renal function more than 5% in 246 units.
  
  
  CONCLUSIONS
  Pyeloplasty using a single Teflon TAS is helpful not only in achieving effective drainage in children undergoing pyeloplasty, but also avoids the complications usually encountered with the use of nephrostomies, or double J stents.
authors.affiliation: Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, 110029, India. profdkgupta@gmail.com
authors.forename: Devendra K
authors.initials: DK
authors.lastname: Gupta
authors.forename: Shilpa
authors.initials: S
authors.lastname: Sharma
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D006869:Hydronephrosis / Q000601:surgery; D007223:Infant; D007682:Kidney Pelvis / Q000601:surgery*; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D011446:Prospective Studies; D015607:Stents; D014517:Ureteral Obstruction / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods*