TITLE:
Interventional Radiology Procedures after Pediatric Pyeloplasty and Ureteral Reimplantation in Patients with Postoperative Obstruction
AUTHORS:
Brent W. Snow, M. Chad Wallis, G. Peter Feola, John W. Rampton, Teisha Shiozaki
KEYWORDS:
Interventional Radiology, Pediatrics, Ureteral Reimplantation, Pyeloplasty, Postoperative Obstruction
JOURNAL NAME:
Open Journal of Urology,
Vol.4 No.6,
June
18,
2014
ABSTRACT:
Introduction: Obstructive
complication after pyeloplasty or ureteral reimplant surgery is a rare though
worrisome problem in pediatric urology. These are often complex patients with
complicated post-operative courses that at times require interventional
radiology procedures. The current literature is lacking in guiding principles
to manage these complications. In this study we have reviewed these difficult
to manage patients at our children’s hospital over the past 15 years. Methods:
A list of patients who underwent interventional radiology procedures to place
nephrostomy tubes or internal double-J ureteral stents was compared a list of
patients undergoing pyeloplasty or reimplant procedures. These lists were
cross-referenced to a list of patients undergoing cystoscopic removal of
double-J stents. This small patient group does not represent all complications
but those with radiology intervention. Results: At our institution, during the
years 1998-2011 we performed 458 pyeloplasties and 3003 open ureteral reimplant
procedures. 14 (0.4%) met all of the inclusion criteria. The long term outcome
of these problems showed 11 of these patients went on to stability or
improvement with either percutaneous drainage or JJ stent placement alone, and
three of the reimplant patients ultimately required redo surgery. Of our
pyeloplasty patients only three required percutaneous nephrostomy tube, and one
went on to JJ stent placement (0.66% of pyeloplasties). No patients in the
pyeloplasty group needed surgical revision. Of patients how had undergone
ureteral reimplantation, with or without tapering, seven of them underwent
interventional radiology procedures (0.23% of reimplant patients). Conclusion:
Pediatric urology patients with persistent obstruction after pyeloplasties and
ureteral reimplantation surgery with or without tapering who needed
interventional radiology rescue procedure resolved or stabilized in 11 of 14 patients.
Surgical revision was performed in only 3 of our 14 patients after months of
conservative trial after interventional radiologic procedures.