URETERONEOCYSTOSTOMY - TO DRAIN OR NOT TO DRAIN

Purpose: Indications for the use of external abdominal drains after ur eteral reimplantation are not well defined. We determine the nature of the drainage fluid as well as the current use of drains by pediatric urologists. Materials and Methods: We prospectively evaluated 15 conse cutive patients 7 months to 19 years old who underwent unilateral or b ilateral intravesical ureteroneocystostomy for primary vesicoureteral reflux. All patients were treated with a urethral Foley catheter and c losed suction Jackson-Pratt abdominal drain. Fluid from the Jackson-Pr att drain and Foley catheter was analyzed for urea and creatinine on p ostoperative day 1, and compared to serum values. The Foley catheter w as removed after the urine became clear, and the Jackson-Pratt drain w as removed after drainage was 5 ml. or less for 12 hours. In addition, a questionnaire was distributed to 268 pediatric urologists to determ ine current practice regarding the use of routine postoperative drains . Results: Urea and creatinine from the Jackson-Pratt drains in all 15 patients were consistent with serum values. The Foley catheter and Ja ckson-Pratt drain were removed an average of 3 and 4 days postoperativ ely, respectively. There were 186 responses from the 268 questionnaire s distributed (69.4%). Of the pediatric urologists surveyed 70.4% perf ormed intravesical ureteral reimplantation exclusively, 5.9% extravesi cal reimplantation exclusively and 23.7% both techniques. Of the group surveyed 73.1% placed external abdominal Jackson-Pratt or Penrose dra ins, although 26.5% of those who routinely used external drains believ ed that they were probably unnecessary. Of the physicians who placed d rains 53.7% believed that the drainage fluid had some component of uri ne. Conclusions: In our small prospective study group we demonstrated that external abdominal drainage fluid is consistent with serum despit e the popular belief that it may have some component of urine. The gyn ecological literature has shown repeatedly that there is no increase i n morbidity after radical hysterectomy and pelvic lymph node dissectio n when no external abdominal drains are used. Although to our knowledg e there are no previous reports of drain use after ureteral reimplanta tion, 26.9% of pediatric urologists currently do not place external ab dominal drains with no apparent increase in morbidity. Larger prospect ive cohorts with long-term followup are needed to address adequately t he issue of whether drains are needed after uncomplicated ureteral rei mplantation.