The use of pyelostomy during laparoscopic pyeloplasty in children

Abstract

The selection of surgical options for hydronephrosis correction and urinary diversion methods remains a relevant problem nowadays despite the widespread use of minimally invasive procedures. This paper summarizes our own long-term experience of using various drainage methods during ureteropelvic junction endoscopic surgery in children. Objective. To investigate the safety problems and assess the effiсacy of using pyelostomy during laparoscopic pyeloplasty in children. Patients and methods. Between 2011 and 2021, we performed Anderson–Hynes–Kucera laparoscopic pyeloplasty with partial resection of the renal pelvis and affected ureter area in 109 patients aged 3 months to 18 years. Among those, 15 children had grade 2 hydronephrosis, 59 children had grade 3 hydronephrosis, and 35 patients had grade 4 hydronephrosis. Only patients with primary ureteropelvic junction stricture causing hydronephrosis were included in the study. Children in whom hydronephrosis aroused due to other reasons (aberrant vessel, ureteric calculi, etc.) were not included in the statistics. The follow-up period ranged from 6 months to 2 years after surgery. Results. Pyelostomy as a method of renal pelvis drainage was performed in 77 patients. The mean duration of pyelostomy was 5 minutes. The mean duration of pyeloplasty with the use of pyelostomy was 90 minutes. Retrograde and antegrade double J stent (JJ/DJ stent) insertion took significantly more time. The mean surgery duration with the use of those methods was 115 and 120 minutes, respectively. Pyelostomy was successfully performed in all patients (100%). Retrograde stent insertion was unsuccessful in 3 patients (14%), and antegrade stent insertion – in 2 patients (18%). In the long-term follow-up period, 2 patients (2.6%) after pyelostomy and 1 patient (4.8%) after retrograde stenting developed ureteropelvic junction stricture, which required repeated pyeloplasty. Conclusion. Pyelostomy is an effective, sparing, and relatively easy to perform method of renal pelvis drainage during laparoscopic pyeloplasty. It allows to significantly reduce the time of surgical intervention, as well complication rate. The presence of pyelostoma in patients does not affect the length of hospital stay. Key words: hydronephrosis, children, laparoscopic pyeloplasty, pyelostomy, urinary tract drainage, DJ stent / JJ stent.