Ureteroneocystostomy without urethral catheterization shortens hospital stay without compromising postoperative success

Purpose: We determine whether routinely performing catheterless ureteroneocystostomy would minimize hospital stays without compromising postoperative outcomes. Materials and Methods: Between May 1996 and February 2002 patients who underwent ureteroneocystostomy at a single major tertiary care institution were identified. Patients who underwent additional, simultaneous surgical procedures were excluded from the study. Data recorded included patient demographics, reflux grade, use of a bladder catheter, length of hospital stay, medication use, postoperative complications and subsequent rehospitalization. Results: Of the 300 patients included in the study 266 were girls and 34 were boys, with a median age of 4 years (range 3 months to 19 years). Reimplantation was bilateral in 215 cases and unilateral in 85. Reflux was grade I in 1% of cases, grade II in 18%, grade III in 47%, grade IV in 25% and grade V in 9%. Similar distributions were observed among the 76 patients who received bladder catheters and the 224 who did not. The average length of postoperative hospitalization for patients who received catheters compared to those who did not was 2.1 versus 1.4 days (p <0.001), and the rate of prolonged hospitalization are 18% versus 5%, respectively (p <0.01). Postoperative complication rates were 17% versus 8% (p <0.05) for patients who received catheters compared to those who did not. There was no statistically significant difference in the rate of rehospitalization whether urethral catheters were used (1.3% vs 4.9%, respectively, p = 0.07). Furthermore, there was no statistically significant difference in the amount of either ketorolac or oxybutynin used by patients who received catheters compared to those who did not. Conclusions: Surgical repair of vesicoureteral reflux via catheterless ureteroneocystostomy can reduce hospital stay without adversely affecting complication rates, rehospitalization rates and the amount of medications needed postoperatively.