DISMEMBERED PYELOPLASTY IN INFANTS UNDER THE AGE OF 12 MONTHS

Objective To assess the impact of internal ureteric stenting on the su rgical outcome of dismembered pyeloplasty in infants under the age of 12 months. Patients and methods The case records of 53 of 55 infants w ith the diagnosis of congenital pelvi-ureteric junction obstruction wh o underwent dismembered pyeloplasty over a 6-year period were availabl e for review. A total of 63 renal units were treated surgically. The p olicy for urinary drainage changed during this period from predominant ly nephrostomy or no drainage to that of internal ureteric stenting. R esults The post-operative mean (SD) length of stay for stented and non -stented cases was 5.9 (1.8) and 12.4 (5.4) days, respectively (P<0.00 1). The mean length of stay for patients with bilateral and unilateral pyeloplasty was 9.7 (4.9) and 8.0 (4.7) days, respectively (P=0.19). Urinary leaks occurred in non-stented anastomoses and not in stented a nastomoses. All three cases which later required revision pyeloplasty had had significant complications associated with urinary leaks, With a minimum follow-up of 24 months, a favourable outcome, as determined by radio-isotope imaging, was achieved in 48 of 51 infants (34%) for w hom follow-up data were available. Conclusion The use of internal uret eric stenting in dismembered pyeloplasty performed in infants <12 mont hs old has, in our hands, led to a dramatic reduction in operative mor bidity. The routine use of internal ureteric stents at the time of pye loplasty is justified.