Complications and length of hospital stay following stented and unstented paediatric pyeloplasties

OBJECTIVES: To ascertain the necessity for the use of nephrostomies and ureteric stents after paediatric pyeloplasties. PATIENTS AND METHODS: Seventy children with a pelvi-ureteric junction obstruction underwent a dismembered pyeloplasty between March 1983 and March 1991 at The Bristol Royal Hospital for Sick Children. A nephrostomy and stent were not used routinely except for the first few months of the survey. Indications for their use were: surgery on a single kidney, an inflamed renal pelvis or a revision pyeloplasty. Urinary catheters were only used for those patients with proven or suspected vesicoureteric reflux. RESULTS: Thirteen patients had a nephrostomy and stent inserted (Group 1) of whom three patients (23%) developed complications. Fifty-seven patients had only a wound drain inserted (Group 2) of whom nine (16%) developed complications. The hospital stay of 12.1 days for patients in Group 1 was significantly longer than the 5.4 days for Group 2 (P value < 0.05). Long-term radiological and/or radio-isotopic follow-up showed improvement in function and/or drainage in 95% of both groups. CONCLUSIONS: These findings support the concept that paediatric pyeloplasties can be safely performed at any age without the insertion of a nephrostomy tube or stent and that hospital stay is therefore significantly reduced.