title: Is peri-operative urethral catheter drainage enough? The case for stentless pediatric robotic pyeloplasty.
abstract: BACKGROUND
  The necessity for urinary diversion with trans-anastomotic ureteral stenting during pyeloplasty is currently under debate. Performing a stentless repair could eliminate stent-related morbidity, including: stent migration, urinary tract infection, flank pain, and bladder spasms. In addition, there would be no need for a second procedure and associated anesthesia required for stent removal. This study describes the outcomes of robotic-assisted laparoscopic pyeloplasty without use of a ureteral stent.
  
  
  METHODS
  An IRB-approved prospective database of all pediatric patients undergoing robotic pyeloplasty from July 2012 to July 2014 at a single institution was reviewed. The 'bypass pyeloplasty' or Anderson-Hynes dismembered pyeloplasty (DP) technique was performed. In both groups, neither a ureteral stent nor an abdominal drainage catheter was utilized. Complications were recorded, including: postoperative pain, bladder spasms, fever, and urinary tract infections. Follow-up renal ultrasound was reviewed for hydronephrosis.
  
  
  RESULTS
  Twenty-seven children (17 male, 10 female) with a mean age of 25 months (range 6-157 months) underwent robotic ureteral stentless pyeloplasty during the study time period. The bypass pyeloplasty technique was performed on 19 children (70%). Mean length of stay was 20.2 hours (range 11-46). No fever, urinary tract infections, or hematuria requiring intervention were experienced. Additionally, there were no reports of bladder spasms or pain requiring pharmacotherapy. The mean follow-up was 8 months (range 4-21). Pre-operative Society of Fetal Urology grading was 3.5 and 3.4 for the dismembered and bypass cohort, respectively, with improvements to 1.1 for both groups at 3 months. Postoperative renal ultrasound hydronephrosis resolved in eight children (29.6%), improved in 14 (51.9%), and was stable in five (18.5%). The overall success rate was 100%.
  
  
  CONCLUSIONS
  This study was limited by its small cohort and short follow-up, which may not thoroughly describe the efficacy of the stentless repair as it has been shown that stricture and re-obstruction can occur several years after surgery.
  
  
  CONCLUSIONS
  Robotic stentless pyeloplasty is a feasible alternative to conventional methods, with excellent success rates and minimal complications. Importantly, this technique circumvents the need for a second procedure and the associated risks of anesthesia.
authors.affiliation: Department of Urology, Columbia University Medical Center, 161 Fort Washington Avenue - Herbert Irving Pavilion, 11th Floor, New York, NY 10032, USA. Electronic address: mvs2125@columbia.edu.
authors.forename: Mark V
authors.initials: MV
authors.lastname: Silva
authors.affiliation: Department of Urology, Columbia University Medical Center, 161 Fort Washington Avenue - Herbert Irving Pavilion, 11th Floor, New York, NY 10032, USA.
authors.forename: Alison C
authors.initials: AC
authors.lastname: Levy
authors.affiliation: Department of Urology, Columbia University Medical Center, 161 Fort Washington Avenue - Herbert Irving Pavilion, 11th Floor, New York, NY 10032, USA.
authors.forename: Julia B
authors.initials: JB
authors.lastname: Finkelstein
authors.affiliation: Department of Urology, Columbia University Medical Center, 161 Fort Washington Avenue - Herbert Irving Pavilion, 11th Floor, New York, NY 10032, USA.
authors.forename: Jason P
authors.initials: JP
authors.lastname: Van Batavia
authors.affiliation: Department of Urology, Columbia University Medical Center, 161 Fort Washington Avenue - Herbert Irving Pavilion, 11th Floor, New York, NY 10032, USA.
authors.forename: Pasquale
authors.initials: P
authors.lastname: Casale
mesh_terms: D002675:Child, Preschool; D004322:Drainage / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D010535:Laparoscopy / Q000379:methods; D008297:Male; D019990:Perioperative Care / Q000379:methods*; D011446:Prospective Studies; D019651:Plastic Surgery Procedures / Q000379:methods*; D012371:Robotics / Q000379:methods*; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D014517:Ureteral Obstruction / Q000601:surgery*; D014546:Urinary Catheterization / Q000379:methods*; D013520:Urologic Surgical Procedures / Q000379:methods*
keywords: Adolescent Urology; Laparoscopic surgery; Robotic surgery; UPJ obstruction