title: Urinary diversion during and after pediatric pyeloplasty: a population based analysis of more than 2,000 patients.
abstract: OBJECTIVE
  We evaluated the use and efficacy of intraoperative urinary diversion with ureteral stent or nephrostomy tube during pyeloplasty in children.
  
  
  METHODS
  The Faculty Practice Solutions Center® national billing database was queried to identify all pediatric pyeloplasties performed from 2009 to 2012. Patient variables, surgical approach, use of intraoperative stent/nephrostomy tube and return for postoperative stent/nephrostomy tube or second pyeloplasty were obtained.
  
  
  RESULTS
  A total of 2,435 children underwent open (1,792) or laparoscopic/robotic (643) pyeloplasty, with intraoperative urinary diversion rates of 45% and 83%, respectively. Comparing patients with and without an intraoperative stent/nephrostomy tube, 5.6% and 7.4%, respectively, returned to the hospital for urinary diversion. Multivariable analysis revealed no association with surgical approach, but higher surgeon volume (p <0.01) and use of an intraoperative stent/nephrostomy tube (p <0.01) were associated with decreased odds of requiring postoperative urinary diversion. Second pyeloplasty rate was 3.8% and was not associated with surgical approach or use of intraoperative stent/nephrostomy tube.
  
  
  CONCLUSIONS
  Intraoperative stent/nephrostomy tube use and increased surgeon volume were each independently associated with a significant but small decrease in risk of postoperative stent/nephrostomy tube placement. Use of an intraoperative stent/nephrostomy tube was not associated with rate of second (redo ipsilateral or contralateral metachronous) pyeloplasty.
authors: Department of Urology, University of California Davis, Sacramento and Division of Biostatistics, University of California Davis, Davis (BD-J), California.
authors: Renea M
authors: RM
authors: Sturm
authors: Department of Urology, University of California Davis, Sacramento and Division of Biostatistics, University of California Davis, Davis (BD-J), California.
authors: Thenappan
authors: T
authors: Chandrasekar
authors: Department of Urology, University of California Davis, Sacramento and Division of Biostatistics, University of California Davis, Davis (BD-J), California.
authors: Blythe
authors: B
authors: Durbin-Johnson
authors: Department of Urology, University of California Davis, Sacramento and Division of Biostatistics, University of California Davis, Davis (BD-J), California.
authors: Eric A
authors: EA
authors: Kurzrock
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007432:Intraoperative Period; D007682:Kidney Pelvis / Q000601:surgery*; D010535:Laparoscopy; D008297:Male; D009403:Nephrostomy, Percutaneous / Q000295:instrumentation; D011184:Postoperative Period; D015607:Stents; D014517:Ureteral Obstruction / Q000601:surgery*; D014547:Urinary Diversion / Q000295:instrumentation / Q000379:methods*
keywords: outcome assessment (health care); stents; ureter; ureteral obstruction; urinary diversion