Comparison of Drainage Methods After Pyeloplasty in Children: A 14-Year Study

Objective: To summarize our experiences with drainage methods after laparoscopic pyeloplasty with a 14-year study.Methods: We reviewed the data of the 838 children operated on for hydronephrosis due to congenital ureteropelvic junction obstruction (UPJO) between July 2007 and July 2020. Patients' demographics, perioperative details, postoperative drainage stents [including double-J stent, percutaneous trans-anastomotic (PU) stent, and trans-uretero-cystic external urethral stent (TEUS)], complications, hospital stay, and long-term follow-up outcomes were analyzed. Long-term follow-up was performed by outpatient visits and telephone follow-up. Moreover, we reviewed the details of nine cases of recurrence after laparoscopic pyeloplasty.Results: Comparison of preoperative general data among the three groups indicated that there was no statistical difference in age, gender, and surgical side of the three groups. Statistical differences were found in the incidence of postoperative complications from the three postoperative drainage method groups, especially the incidence of reoperations (p < 0.01): there were six cases (3.19%) of recurrences in the TEUS group, two cases (0.36%) in the DJ group, and one case (0.93%) in the PU group. In the six recurrent cases from the TEUS group, four cases (44.4%) were found to have stenosis, and two cases (22.2%) have iatrogenic valvular formation.Conclusion: Not all three types of drainage methods are suitable for drainage after pyeloplasty. Based on our findings, TEUS is not recommended.

Initial Experience with the Comprehensive Modified Laparoscopic Pyeloplasty Technique Based on Membrane Anatomy for Treating Ureteropelvic Junction Obstruction

Objective: The aim of the objective was to present our initial experience and evaluate the feasibility of the novel comprehensive modified laparoscopic pyeloplasty (CMLP) technique based on membrane anatomy. Materials and Methods: Forty-eight patients underwent CMLP from February 2016 to October 2020. CMLP involves the following: dissection of the ureter was based on the fascia or fusion fascia formed by embryonic development. The ureter was separated from the ureteral sheath, and the pelvis and ureter were incised with incomplete amputation. The first stitch was placed between the lower point of the spatulated ureter and the lowest corner of the renal pelvis to ensure correct orientation of the anastomosis; anastomosis of the renal pelvis and ureter was performed using the touchless technique. Results: All CMLPs were completed successfully without conversion. The mean overall operating time was 230.96 min. The median estimated blood loss was 50.00 (interquartile range 20.00–57.50) mL. The average postoperative hospital stay was 9.31 days. The average follow-up time was 24.73 months. No major complications occurred. In 1 case, revision laparoscopic pyeloplasty was performed, but the obstruction persisted after double J stent removal, so ultimately, the double J stent required regular replacement. Another asymptomatic patient with hydronephrosis experienced failed treatment and is still under follow-up. The overall success rate was 95.83% (46/48). The success rate in patients with recurrent ureteropelvic junction obstruction (UPJO) was 87.5% (7/8). Conclusions: CMLP is a practical and effective treatment option for UPJO with a high success rate. An advantage of CMLP is the clear surgical field.

EP.TH.670Antibiotic Prophylaxis Use In Paediatric Robotic-Assisted Laparoscopic Pyeloplasty: A Systematic Review

Aim A systematic review was conducted to evaluate the current evidence for prophylactic antibiotic use in paediatric robotic-assisted laparoscopic pyeloplasty (RALP). As pyeloplasties are ‘clean contaminated’ procedures, prophylactic antibiotics are recommended, however, recent evidence suggests that antibiotics may be unnecessary. Prophylactic antibiotics are often either under or over prescribed in paediatric surgery, which increases the risk of developing antibiotic resistance. In general, minimally invasive surgery is associated with less postoperative infections, however, it is not yet clear how RALP compares with other approaches. Recent reviews have indicated prophylactic antibiotics may not decrease postoperative infections, however, there are no clear guidelines. Methods A systematic review was conducted of the following electronic databases: Pubmed, Medline Ovid, The Cochrane Library, TRIP Database, NICE Evidence Search, and EMBASE. The search terms used were: paediatric, pyeloplasty, robotic, antibiotic and were used as keywords as well as in combination as MeSH terms. Results Forty-one articles were retrieved, and after screening for relevance and redundancy, 2 articles remained including a total of 315 pyeloplasties. Prophylactic antibiotics did not reduce the incidence of postoperative UTIs in RALP. Conclusion Prophylactic antibiotics for RALP is not associated with lower rates of UTIs and therefore, may be reserved for patients with risk factors. However, due to the limited data and confounding factors, further research is required to optimise antibiotic stewardship and infection prevention.