Drainless Mini-Incision Pyeloplasty for Children, with One-Day Hospital Stay
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- Category: Vol. 82, September 2014
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Drainless Mini-Incision Pyeloplasty for Children, with One-Day Hospital Stay, ADEL A. ASSIRI and AHMED H. ALMATHAMI
Abstract
Objective: To evaluate the current status of mini-incision pyelpolasty in pediatric urology.
Patients and Methods: A total of 50 children with ure-teropelvic junction opstruction (UPJO) underwent mini-incision pyeloplasty. Preoperative diagnostic evaluation in-cluded serum biochemistry, urine analysis and culture, renal function tests, renal ultrasound, voiding cystourethrogram, MAG3 scan. Surgical indications included prolonged drainage time, with loss of relative renal function on diuretic renogram, worsening of hydronephrosis on repeated follow-up ultrasounds and high grade hydronephrosis or flank pain or recurrent urinary tract infections. A small incision was made from the tip of the 12th rib, followed by a muscle-splitting, peritoneal reflection then dissection to expose the ureteropelvic junction retroperitoneally, through Gerota’s fascia. After dissection and release of the ureter, the UPJO was accessed and pulled out from the incision for dismembered pyeloplasty. A 4.5-Fr double-J-ureteral stent was then placed into the ureter. Pyelo-plasty was completed with water-tight anastomosis using 6- 0 polydioxanone continuous suture. After completion of the pyeloplasty, the ureteropelvic junction was returned to the retroperitoneal cavity. The fascia and muscle layers were closed, with absorbable monofilament sutures. No perinephric drains were used. Patients were discharged within the 1st postoperative day.
Results: Patients’ age at operation ranged from 3 to 132 months (median=15.5 months). The main presenting symptom/ sign were antenatal hydronephrosis (68%) or recurrent urinary tract infection (22%). The affected side was the mainly the right side (58%). About three-fourths of children had a grade of 3-4 hydronephrosis. The pyeloplasty mini-incision length ranged from 2cm to 2.8cm with a mean±SD of 2.42±0.19cm. The operative time ranged from 80 to 110 minutes with a mean±SD of 90.6±8.3 minutes. Operative success rate for mini-incision pyeloplasty among our children was 100%. One case (2%) had a postoperative complication (i.e., prolonged abdominal pain, which was controlled by IM pethidine 1mg/Kg). None of the patients had postoperative fever, infec-tion, hemorrhage or urinary leak.
Conclusions: Mini-incision pyeloplasty among children is a safe, cosmetic and easy surgical procedure with minimal hospital stay and minimal complications, with a high success rate, compared with other open surgery and laparoscopic pyeloplasty techniques.