Summary
Background
The gold standard treatment for Uretero-Pelvic Junction Obstruction (UPJO) is laparoscopic
dismembered pyeloplasty according to the Anderson-Hynes technique. The internal Double-J
ureteral (DJ) and the Externalized PyeloUreteral (EPU) stents are usually the drainage
of choice. Only a few articles have compared the clinical impact of the different
drainage techniques on the perioperative morbidity and none presented a cost analysis
of the incurred hospital stay.
Objective
To present the clinical outcome and financial analysis of a cohort of children who
underwent a laparoscopic pyeloplasty comparing the use of the DJ versus EPU stent.
Study design
Retrospective study of consecutives children who underwent laparoscopic Anderson-Hynes
pyeloplasty in a single tertiary paediatric referral centre from January 2017 to March
2020. Patients were grouped according to the type of stent used: DJ stent vs EPU stent.
Results
Fifty-three laparoscopic pyeloplasties were performed on 51 patients: 27 (50.9%) had
an EPU stent and 26 (49.1%) a DJ stent. There was no statistically significant difference
between the two patient groups with regards to surgical time, hospital stay, stent-related
complications or the need for re-do surgery. All the EPU stents were removed with
an outpatient admission 8.1 days ± 3.1 after surgery while the DJ stents were removed
with a cystoscopy 61.6 days ± 30.2 after surgery (p value < 0.001). On a financial
analysis (Figure), the hospital costs for stent removal were significantly lower for
the EPU stent group (£ 686.7 ± 263.4 vs £ 1425 ± 299.5, p value < 0.01).
Discussion
Both drainage methods have some disadvantages. Possible complications associated with
DJ stents include migration and artificial vesicoureteral reflux which may lead to
higher incidence of Urinary Tract Infections. Possible disadvantages of the EPU stent
insertion are related to the damage of the renal parenchyma and to the risk of developing
skin site infections and urinary leaks. However, in our series the EPU stent has not
been associated with a higher incidence of bleeding, leakage or discomfort. In addition
to clinical considerations, there is a financial implication to be considered. With
this regard, the EPU stent was associated with a significant reduction in the incurred
hospital costs.
Conclusions
Graphical AbstractComparison of incurred hospital costs (British pounds sterling) between DJ stent and
EPU stent for pyeloplasty (A) and stent removal (B).
Keywords
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Article info
Publication history
Published online: December 08, 2020
Accepted:
December 3,
2020
Received in revised form:
December 2,
2020
Received:
October 19,
2020
Identification
Copyright
© 2020 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.
