Dismembered Pyeloplasty in Infants 6 Months Old or Younger With and Without External Trans-anastomotic Nephrostent: A Prospective Randomized Study.
OBJECTIVE
To compare the outcome of dismembered pyeloplasty in infants with and without external nephro-ureteric stent (ENUS) for treatment of congenital ureteropelvic junction obstruction.


METHODS
This is a parallel, randomized comparative study between October 2013 and September 2014. Thirty infants ≤6 months old with ureteropelvic junction obstruction indicated for dismembered pyeloplasty were randomly assigned (block randomization, closed envelope method) into two groups: group A (stentless) and group B (ENUS). Infants with solitary kidney, gross pyuria, huge pelvis, vesicoureteric reflux, or other renal anomalies were excluded. Operative data, complications, and ultrasonographic and nuclear scintigraphy criteria were compared after at least 18 months of follow-up using Student t, Mann-Whitney U, Kruskal-Wallis, chi-square, and Fisher exact tests when appropriate. Occurrence of urinary leakage was the primary outcome.


RESULTS
Included patients completed the study with intention-to-treat analysis. All children had normal renal function. The mean operative time was 85.3 ± 6.3 (60-90) minutes in group A and 92.6 ± 15.3 (70-120) minutes in group B (P = .2). Although there was a significant postoperative improvement in each group in split renal function and anterior-posterior renal pelvis diameter, there was no significant difference between both groups. The mean hospital stay for group A and group B was 5.9 ± 2 (4-10) days versus 3.5 ± 0.8 (2-5) days, respectively (P < .001). Postoperative urinary leakage was reported only in group A (40%). All complications were managed by double J insertion. Auxiliary interventions were higher in group A. The overall success rate was 93.4%. Redo pyeloplasty was performed in one case in each group.


CONCLUSIONS
ENUS significantly reduces hospital stay and complications. It saves the infant hazards of auxiliary interventions under general anesthesia for management of leakage or double J removal if placed at time of pyeloplasty.
Urology Department, Aboul-Riche Children's Hospital, Cairo University, Cairo, Egypt.
Farouk M
FM
Nasser
Urology Department, Aboul-Riche Children's Hospital, Cairo University, Cairo, Egypt.
Ahmed M
AM
Shouman
Urology Department, Aboul-Riche Children's Hospital, Cairo University, Cairo, Egypt. Electronic address: mohammedshemy@yahoo.com.
Mohammed S
MS
ElSheemy
Urology Department, Aboul-Riche Children's Hospital, Cairo University, Cairo, Egypt.
Mohammed A
MA
Lotfi
Urology Department, Aboul-Riche Children's Hospital, Cairo University, Cairo, Egypt.
Waseem
W
Aboulela
Urology Department, Aboul-Riche Children's Hospital, Cairo University, Cairo, Egypt.
Mohamed
M
El Ghoneimy
Urology Department, Aboul-Riche Children's Hospital, Cairo University, Cairo, Egypt.
Mohammad
M
Abdelwahhab
Urology Department, Aboul-Riche Children's Hospital, Cairo University, Cairo, Egypt.
Ahmed I
AI
Shoukry
Urology Department, Aboul-Riche Children's Hospital, Cairo University, Cairo, Egypt.
Waleed
W
Ghoneima
Urology Department, Aboul-Riche Children's Hospital, Cairo University, Cairo, Egypt.
Hany
H
Morsi
Urology Department, Aboul-Riche Children's Hospital, Cairo University, Cairo, Egypt.
Hesham
H
Badawy
D000714:Anastomosis, Surgical / Q000379:methods; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007668:Kidney / Q000601:surgery*; D007682:Kidney Pelvis / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods; D007902:Length of Stay / Q000639:trends; D008297:Male; D061646:Operative Time; D011183:Postoperative Complications; D011446:Prospective Studies; D011877:Radionuclide Imaging / Q000379:methods; D019651:Plastic Surgery Procedures / Q000379:methods*; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography; D014513:Ureter / Q000601:surgery*; D014517:Ureteral Obstruction / Q000151:congenital / Q000175:diagnosis / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods*