Dismembered pyeloplasty in infants under the age of 12 months

Objective To assess the impact of internal ureteric stenting on the surgical outcome of dismembered pyeloplasty in infants under the age of 12 months. Patients and methods The case records of 53 of 55 infants with the diagnosis of congenital pelvi-ureteric junction obstruction who underwent dismembered pyeloplasty over a 6-year period were available for review. A total of 63 renal units were treated surgically. The policy for urinary drainage changed during this period from predominantly nephrostomy or no drainage to that of internal ureteric stenting. Results The post-operative mean (SD) length of stay for stented and non-stented cases was 5.9 (1.8) and 12.4 (5.4) days, respectively (P<0.001). The mean length of stay for patients with bilateral and unilateral pyeloplasty was 9.7 (4.9) and 8.0 (4.7) days, respectively (P=0.19). Urinary leaks occurred in non-stented anastomoses and not in stented anastomoses. All three cases which later required revision pyeloplasty had had significant complications associated with urinary leaks, With a minimum follow-up of 24 months, a favourable outcome, as determined by radio-isotope imaging, was achieved in 48 of 51 infants (34%) for whom follow-up data were available. Conclusion The use of internal ureteric stenting in dismembered pyeloplasty performed in infants <12 months old has, in our hands, led to a dramatic reduction in operative morbidity. The routine use of internal ureteric stents at the time of pyeloplasty is justified.