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)To read this article in full you will need to make a payment
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References
- The Society for Fetal Urology consensus statement on the evaluation and management of antenatal hydronephrosis.J Pediatr Urol. 2010; 6: 212-231https://doi.org/10.1016/j.jpurol.2010.02.205
- Laparoscopic versus open pyeloplasty in children: preliminary report of a prospective randomized trial.J Urol. 2010; 184: 690-695https://doi.org/10.1016/j.juro.2010.03.062
- Comparison of DJ stented, external stented and stent-less procedures for pediatric pyeloplasty: a network meta-analysis.Int J Surg. 2019; 68: 126-133https://doi.org/10.1016/j.ijsu.2019.07.001
- Comparison of drainage methods after pyeloplasty in children: a 14-year study.Front Pediatr. 2021; 9779614https://doi.org/10.3389/fped.2021.779614
- Primary laparoscopic pyeloplasty in children: a single-center experience of 279 patients and analysis of possible factors affecting complications.J Pediatr Urol. 2020; 16: 331.e1-331.e11https://doi.org/10.1016/j.jpurol.2020.03.028
- Systematic review and meta-analysis of ureteral stent for risk factors of restenosis after laparoscopic pyeloplasty.Ann Palliat Med. 2021; 10: 10527-10534https://doi.org/10.21037/apm-21-2228
- Guidelines for standard and diuretic renogram in children.Eur J Nucl Med Mol Imag. 2011; 38: 1175-1188https://doi.org/10.1007/s00259-011-1811-3
- Laparoscopic versus open pyeloplasty for ureteropelvic junction obstruction in children: a systematic review and meta-analysis.J Endourol. 2011; 25: 727-736https://doi.org/10.1089/end.2010.0544
- Effect of continuous antibiotic prophylaxis in children with postoperative JJ stents: a prospective randomized study.J Pediatr Urol. 2021; 17: 89-94https://doi.org/10.1016/j.jpurol.2020.10.004
- Managing ureteropelvic junction obstruction in the young infant.Front Pediatr. 2020; 8: 242https://doi.org/10.3389/fped.2020.00242
- Ureteropelvic junction obstruction: diagnosis and management.Curr Opin Pediatr. 2021; 33: 227-234https://doi.org/10.1097/MOP.0000000000000994
- Patterns and predictors of laparoscopic complications in pediatric urology: the role of ongoing surgical volume and access techniques.J Urol. 2008; 180: 681-685https://doi.org/10.1016/j.juro.2008.04.042
- One week stenting after pediatric laparoscopic pyeloplasty; is it enough?.J Pediatr Urol. 2020; 16: 98.e1-98.e6https://doi.org/10.1016/j.jpurol.2019.10.016
- Ureteric stenting 25 years on: routine or risky?.ANZ J Surg. 2004; 74: 243-247https://doi.org/10.1111/j.1445-2197.2004.02947.x
- Ureteric stents in pyeloplasty: a help or a hindrance?.J Pediatr Urol. 2008; 4: 275-279https://doi.org/10.1016/j.jpurol.2008.01.205
- Urinary tract infection after robot-assisted laparoscopic pyeloplasty: are urine cultures and antibiotics helpful?.Urology. 2021; 148: 235-242https://doi.org/10.1016/j.urology.2020.09.054
- Probability of urinary tract infection in infants with ureteropelvic junction obstruction: is antibacterial prophylaxis really needed?.Pediatr Nephrol. 2011; 26: 1837-1841https://doi.org/10.1007/s00467-011-1889-7
- Failure after laparoscopic pyeloplasty: prevention and management.J Endourol. 2011; 25: 1457-1462https://doi.org/10.1089/end.2010.0647
- Renal ultrasound changes after pyeloplasty in children with ureteropelvic junction obstruction: long-term outcome in 47 renal units.J Urol. 1996; 156: 2020-2024https://doi.org/10.1016/S0022-5347(01)65424-7
- Renal ultrasound changes after internal double-J stented pyeloplasty for ureteropelvic junction obstruction.Tech Urol. 2001; 7: 276-280
- Early postoperative ultrasound after open pyeloplasty in children with prenatal hydronephrosis helps identify low risk of recurrent obstruction.J Urol. 2012; 188: 2347-2353https://doi.org/10.1016/j.juro.2012.08.036
- Screening ultrasound in follow-up after pediatric pyeloplasty.Urology. 2010; 76: 175-179https://doi.org/10.1016/j.urology.2009.09.092
- Radiation-free monitoring in the long-term follow-up of pyeloplasty: are ultrasound new parameters good enough to evaluate a successful procedure?.J Pediatr Urol. 2016; 12 (e1-7. https://doi.org/10.1016/j.jpurol.2016.04.026): 230
Article info
Publication history
Published online: December 21, 2022
Accepted:
December 17,
2022
Received in revised form:
December 2,
2022
Received:
August 26,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.
