Outcome analysis and cost comparison between externalized pyeloureteral and standard stents in 470 consecutive open pyeloplasties

Abstract

Purpose: Despite the widespread use of ureteral stents for pyeloplasty by pediatric urologists there is ongoing controversy regarding the most advantageous type of transanastomotic drainage. We compared patients who underwent placement of an externalized pyeloureteral Salle intraoperative pyeloplasty stent (Cook Urological, Spencer, Indiana) to those who had a standard Double-J ureteral stent placed to assess the benefits, drawbacks and costs of each modality during open pyeloplasty.

Materials and methods: Our study sample comprised 470 age matched children who underwent primary open pyeloplasty in an 11-year period. A total of 242 patients (51.5%) underwent Double-J ureteral stent insertion and 228 (48.5%) underwent placement of a Salle intraoperative pyeloplasty stent at surgery. Operative time, hospital stay, overall complication and success rates, type of complications and hospital costs were compared between the 2 groups.

Results: Median age was 18 months and median followup was 39 months. Mean hospital stay was 3.0 and 3.1 days in children with a Double-J ureteral and a Salle intraoperative pyeloplasty stent, respectively (p = 0.7). The overall complication rate was 9.9% (24 of 242 patients) for the Double-J ureteral stent vs 8.3% (19 of 228) for the Salle intraoperative pyeloplasty stent (p = 0.6). Complications in patients with a Double-J ureteral stent consisted of urinoma in 3, return visits due to bladder spasms in 7 or catheter obstruction in 6 and readmission due to pyelonephritis in 5. Complications in children with a Salle intraoperative pyeloplasty stent involved urinoma in 1, prolonged drainage through the Penrose drain in 5 and readmission due to pyelonephritis in 1. Recurrent ureteropelvic junction obstruction developed in 12 cases per group. The success rate was 95.0% (230 of 242 cases) and 94.7% (216 of 228) for the Double-J ureteral and the Salle intraoperative pyeloplasty stent, respectively (p = 0.2). Hospital charges, including the surgical procedure, postoperative hospitalization and cystoscopy or a clinical visit for catheter removal, in patients with a Double-J ureteral and a Salle intraoperative pyeloplasty stent were $9,825 and $9,260, respectively.

Conclusions: The 2 ureteral stents are equivalent in regard to overall complication and success rates after pyeloplasty. However, Salle intraoperative pyeloplasty stent insertion was associated with a Canadian $565 cost decrease per patient and most importantly the preclusion of a second general anesthesia for catheter removal.