An updated comparison of early post-operative outcomes from stentless and stented pyeloplasty: A single-institution experience
Thomas M. FitzGibbon, Jr., MD, MSc1, Andrew Strine, MD, MPH1, Michael Daugherty, MD1, Joonsue Lee, BS2, Marion Schulte, RN1, Eugene Minevich, MD1, Brian A. VanderBrink, MD1, Pramod P. Reddy, MD1, William R. DeFoor, Jr., MD, MPH1.
1Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA, 2University of Cincinnati School of Medicine, Cincinnati, OH, USA.
BACKGROUND: Performing robotic-assisted laparoscopic pyeloplasty (RALP) without the use of ureteral stent may spare the patient an additional anesthetic and thus potential additional risk and morbidity. Stentless RALP has been shown to be safe and successful in several small series. In this study, we aim to present our institution's updated experience with stentless pyeloplasty. METHODS: We retrospectively reviewed patients from January 2015 to June 2021 who underwent RALP at our institution. Patients were separated based on whether they had a ureteral stent, nephroureteral catheter, or ureteral catheter placed (stented) versus no nephroureteral drainage (stentless). Demographic and perioperative data were compared. RESULTS: A total of 224 RALPs were performed during the study period, of which 122 were performed stentless. Demographic and perioperative data are presented in Table 1. Patients who underwent stentless pyeloplasty were significantly younger and weighed less than stented patients (p <0.005 and =0.001 respectively). Operative time and post-operative length of stay was significantly shorter among patients who underwent stentless RALP (p =0.02 and <0.005 respectively). Overall complication rates did not differ between the two groups. After controlling for age, stent status still significantly predicted decreased length of stay on linear regression. CONCLUSIONS: Stentless RALP is a safe and feasible operation to perform. Stentless RALP was performed in younger patients and smaller patients. Operative time and post-operative length of stay were shorter for stentless pyeloplasty, with many patients who underwent stentless RALP able to be discharged the same day. There was no significant difference in overall complication rates between the two groups.
|Number of patients||123||101|
|Median age in months (range)||19.9 (1.7 - 212.7)||47 (1.3 - 279)||<0.005|
|No. gender (%) Male Female||92 (74.8) 31 (25.2)||66 (65.3) 35 (34.7)||0.19|
|Mean weight in kg (range)||17.8 (4.6 - 79.5)||27.6 (4.2 - 113.4)||0.001|
|No. laterality (%) Right Left||43 (35.0) 80 (65.0)||49 (48.5) 52 (51.5)||0.04|
|Mean operative time in minutes (range)||192.3 (84 - 340)||211.2 (125 - 497)||0.02|
|Median length of post-operative hospitalization in days (range)||0 (0 - 3)||1 (0 - 5)||<0.005|
|Complications (%)||8 (6.5)||9 (8.9)||0.7|
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