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Is peri-operative urethral catheter drainage enough? The case for stentless pediatric robotic pyeloplasty
Mark V. Silva, M.D., Julia B. Finkelstein, M.D., Jason P. Van Batavia, M.D., Pasquale Casale, M.D..
Columbia University, New York, NY, USA.

Open pyeloplasty has been the standard of care for the correction of utereropelvic junction obstruction in the pediatric population. However, recently the robotic approach has demonstrated similar surgical outcomes with a high success rate and a low incidence of complications. The procedure, as originally described, utilizes a ureteral stent to ensure patency of the pelvic-ureteral anastomosis. In the pediatric population, this requires a second procedure and anesthesia for stent removal.
We retrospectively reviewed a prospective database of all patients undergoing robotic pyeloplasty from July 2012 to February 2014. Either the “bypass pyeloplasty” or Anderson-Hynes dismembered pyeloplasty (DP) technique was performed. A ureteral stent was not utilized and no abdominal drainage catheter was placed. Complications such as postoperative pain, bladder spasms, fever, and urinary tract infections (UTI) were recorded. Resolution of hydronephrosis on follow-up ultrasound was reviewed.
Twenty-seven patients (17 male, mean age 32 months, range 6-157) underwent ureteral stentless pyeloplasty. The bypass pyeloplasty technique was used in 19 patients (70.3%). Mean length of stay was 22.1 hours (range 8-46). No significant postoperative complications were reported. One patient stayed for 46 hours due to abdominal pain which subsided on post-operative day 2. All the other patients stay was under 24 hours. Median follow up was 6.2 months (range 4-21). On 3-month renal ultrasound, hydronephrosis resolved in 8 patients (29.6%), improved in 14 patients (51.9%) and was unchanged in 5 patients (18.5%). Those 5 patients who had unchanged ultrasounds compared to their pre-operative ones underwent either Mag3 scans or MR Urography (3 and 2 patients, respectively) depending on their pre-operative study. All 5 studies showed non-obstructive parameters compared to their pre-operative obstructive studies. Overall success rate was 100% in the follow up period.
Stentless pyeloplasty is a feasible alternative to conventional methods with similar success rates and without the need for a second procedure and risks of anesthesia.

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