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Risk Of Postoperative UTI And Complications With Ureteral Stents With Extraction Strings In Pediatric Robotic Pyeloplasty
Hannah Dillon, BS, Nikhil Batra, MD, Rosalia Misseri, MD, Pankaj Dangle, MD, Joshua D. Roth, MD, Kirstan K. Meldrum, MD, Martin Kaefer, MD, Richard C. Rink, MD, Konrad M. Szymanski, MD, Benjamin M. Whittam, MD.
Riley Hospital for Children at Indiana University School of Medicine, Indianapolis, IN, USA.


Background: The use of ureteral stents with extraction strings in robotic pyeloplasty obviates the need for a secondary procedure and anesthetic for ureteral stent removal but are thought to increase risk for postoperative UTI. We sought to review our experience with robotic pyeloplasty in a large series of patients managed with ureteral stents with and without extraction strings.Methods: All robotic pyeloplasty at our institution from 2012 - present were retrospectively reviewed. Patients with less than 60 days of follow-up were excluded. Patient demographics, perioperative details, and complications within 60 days were evaluated. Statistical analysis was performed with Fisher’s exact testing.Results: A total of 218 patients underwent robotic pyeloplasty during the study period: 188 (86%) patients had ureteral stents with extraction strings and 30 (14%) patients had internalized stents. Study groups were similarly weighted with regards to demographics, presenting symptoms, functional parameters prior to surgery, and length of stay.A total of 13 (6%) patients in our series required treatment for UTI following discharge: 4 patients were treated on an outpatient basis (3 string (1.6%) vs 1 non-string (3.4%), p=0.45) and 9 patients were admitted for inpatient treatment (9 string (4.8%) vs 0 non-string (0%), p=0.61). In subgroup analysis of patients with extraction strings, 67% (2/3) of patients requiring outpatient treatment for UTI and 78% (7/9) requiring inpatient treatment for UTI were female. Gender was not associated with an increased risk of complications (p=0.19) or UTI (p=0.59) on subgroup analysis.Complications were similar between the two groups (22 vs. 4, p=0.50). A total of 11 (5.8%) Clavien 3 complications were noted in the group with extraction strings. Among this group, 5 patients underwent percutaneous nephrostomy tube placement (2 for clot obstruction, 2 for urinoma, 1 for ureteral stent dislodgement) and 5 underwent ureteral stent replacement (2 due to distal ureteral edema, 2 due to stent fracture during removal, and one due to urine leak). No Clavien 3 complications were noted in the internal stent group. A total of 7 (3.7%) extraction string patients required stent removal in the operating room under anesthesia. Fourteen (7.4%) patients came to the office for ureteral stent removal. All patients in the internal stent group required removal under anesthesia in the operating room.Conclusions: Ureteral stents with extraction strings were not associated with an increased risk of complications or postoperative UTI in our series.

OutcomesExtraction string(N=188)Internal stent(N=30)Total(N=236)p-value
Any complication within 60 daysp = 0.33
Number (%)22 (12%)4 (13%)26 (12%)
Outpatient Treatment for UTI within 60 daysp = 0.45
Number (%)3 (2%)1 (3%)4 (2%)
Inpatient Treatment for UTI within 60 daysp = 0.61
Number (%)9 (5%)0 (0%)9 (4%)
Any Treatment for UTI within 60 daysp = 1.00
Number (%)12 (6%)1 (3%)13 (6%)
Clavien-Dindo IIIb complications
Number (%)11 (6%)0 (0%)11 (5%)p = 0.37

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