ESPU Congress 2018 - Abstract Book

119

11–14 APRIL, 2018, HELSINKI, FINLAND

09:22–09:25

S14-6 (PP)

RETROPERITONEOSCOPIC PYELOPLASTY DRAINAGE,

TRANSPELVIC IS THE WAY!

Joana LOPES

, Oliver SANCHEZ

, Andrew ROBB

, Liam MCCARTHY

, Karan

PARASHAR

and Harish CHANDRAN

1) Birmingham Children's Hospital, Paediatric Surgery and Urology, Birmingham, UNITED KINGDOM - 2) Centre

Hospitalier Universitaire Vaudois, Department of Pediatric Surgery, Lausanne, SWITZERLAND

PURPOSE

There is a wide variety in post-operative pyeloplasty drainage practices. Our previous practice con-

sisted of cystoscopy for JJ stent insertion, followed by patient repositioning for retroperitoneoscopic

pyeloplasty (RPP), and stent removal at 6 weeks under general anaesthetic. We have recently

changed to a simplified percutaneous drainage (PD), by transanastomotic stenting with a shortened

Salle intraoperative pyeloplasty stent (Cook® Medical) introduced through the pelvis.

MATERIAL AND METHODS

We analysed the short-term results of our first 32 PD cases (Group 2) versus the previous 32 in-

ternally drained (ID) patients (Group 1) with a retrospective review of case notes collecting demo-

graphic data, operative details, post-operative course including re-admissions, symptomatic leak

and urinoma, early recurrence, reoperation, drainage malfunction or problem during stent retrieval.

Comparisons were made by Mann-Whitney test, p<0.05 taken as significant.

RESULTS

64 consecutive retroperitoneoscopic pyeloplasties were analysed, performed between August

2014 and October 2017. Mean age in our cohort was 8,1 +/- 5,5 years, 1F : 1.6M. Mean operative

time in Group 2 was 144 +/- 6,5 min while it was 181 +/- 8,2 min in Group 1 (p = 0.001). The

post-operative median length of stay was 2 days in both groups. 2 patients needed reoperations

in PD Group - one stent retrieval failure, and one for JJ stent insertion. In the ID Group - 2 patients

needed reoperations for drainage of urinoma; one patient needed a cystotomy at time of JJ removal

due to failure to retrieve stent. In each group there was one readmission due to pain, without further

interventions.

CONCLUSIONS

The percutaneous drainage has significantly shortened the overall procedure time, avoided lower

urinary tract instrumentation in 97 % of patients and avoided an additional general anaesthetic in

94 %. There was no increase in early complications or readmissions and no symptomatic urine

leaks. We will further analyse the mid and long term results.