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Febrile urinary tract infection after Double-J stent removal is associated with restenosis after laparoscopic pyeloplasty: A propensity score matched analysis of 503 children

  • Author Footnotes
    1 Co-first authors: Pei Liu and Jiayi Li have contributed equally and should be considered as co-first authors.
    Pei Liu
    Footnotes
    1 Co-first authors: Pei Liu and Jiayi Li have contributed equally and should be considered as co-first authors.
    Affiliations
    Department of Surgical Urology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
    Search for articles by this author
  • Author Footnotes
    1 Co-first authors: Pei Liu and Jiayi Li have contributed equally and should be considered as co-first authors.
    Jiayi Li
    Footnotes
    1 Co-first authors: Pei Liu and Jiayi Li have contributed equally and should be considered as co-first authors.
    Affiliations
    Department of Surgical Urology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
    Search for articles by this author
  • Songqiao Fan
    Affiliations
    Department of Surgical Urology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
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  • Zonghan Li
    Affiliations
    Department of Surgical Urology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
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  • Zhenzhen Yang
    Affiliations
    Department of Surgical Urology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
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  • Xinyu Wang
    Affiliations
    Department of Surgical Urology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
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  • Hongcheng Song
    Affiliations
    Department of Surgical Urology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
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  • Weiping Zhang
    Correspondence
    Correspondence to: Weiping Zhang
    Affiliations
    Department of Surgical Urology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
    Search for articles by this author
  • Author Footnotes
    1 Co-first authors: Pei Liu and Jiayi Li have contributed equally and should be considered as co-first authors.
Published:December 21, 2022DOI:https://doi.org/10.1016/j.jpurol.2022.12.008

      Summary

      Objective

      To analyze the association between the febrile urinary tract infection (fUTI) after Double-J (DJ) stents removal and restenosis after laparoscopic pyeloplasty (LP).

      Study design

      We retrospectively reviewed the clinical data of patients who were treated with transperitoneal LP for ureteropelvic junction obstruction from 2016 to 2020. Patients were divided into two groups according to whether they developed fUTI after DJ stent removal within 48 h. The 1:3 Propensity Score Matched (PSM) method was used to balance confounding variables.

      Results

      503 patients were included in the study. 28 (5.57%) patients developed fUTI after DJ stent removal. Compared with the non-fUTI group, age was younger, and weight was lower (P < 0.05) in the fUTI group. Restenosis occurred in 11 (2.2%) patients, of which six patients developed fUTI after DJ stent removal. The revision surgery rate in the fUTI group was significantly higher than in the non-fUTI group (21.4% vs. 1.1%, P < 0.01). After PSM, the results remained consistent. For 492 patients without restenosis, 22 patients developed fUTI. Compared with the non-fUTI group, the larger anteroposterior diameter (APD) and higher APD/cortical thickness (P/C) ratio were observed in the fUTI group at three months and six months postoperatively (P < 0.05), but the difference vanished at 12 months and 24 months after surgery (Figure).

      Discussion

      FUTI after DJ stent removal is not uncommon after LP, and surgeons are often concerned about the possibility of restenosis. In the present study, although our results demonstrated a significant association between them, restenosis patients comprise only about 20% of fUTI patients. Based on our clinical observations, fUTI is often developed in children from 1 to 6 years of age, and the younger patients may be afraid of voiding because of the postoperative pain after DJ stent removal. Besides, intraoperative manipulation of DJ stent removal may lead to transient edema in the anastomotic site, causing the fUTI. For patients who develop fUTI after DJ stent removal but without persistent symptoms, the transient worsening of hydronephrosis during the early postoperative period may not impact long-term outcomes (As shown in Figure). Additional follow-up is needed to prevent the deterioration of renal function.

      Conclusions

      Our result demonstrated that fUTI after DJ stent removal is associated with restenosis after LP. For fUTI patients without restenosis, APD and P/C ratio exhibited transient worsening at three months and six months postoperatively, decreasing gradually during follow-up. Patients who develop fUTI after DJ stent removal should be monitored.

      Keywords

      Abbreviations:

      UPJO (Ureteropelvic junction obstruction), fUTI (febrile urinary tract infection), DJ (Double-J), LP (laparoscopic pyeloplasty), PSM (Propensity Score Matched), APD (anteroposterior diameter), P/C (APD/ cortical thickness)
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