One‐ vs 4‐week stent placement after laparoscopic and robot‐assisted pyeloplasty: results of a prospective randomised single‐centre study

Abstract

ObjectivesTo determine whether 1-week stenting of the pelvi-ureteric anastomosis of laparoscopic or robot-assisted pyeloplasty is as effective as 4-week stenting, based on their respective success rates. Patients and MethodsA total of 100 patients with pelvi-ureteric junction obstruction were treated by Anderson-Hynes pyeloplasty and the anastomosis was stented using a 6-F JJ catheter for either 1 week (1W series) or 4 weeks (4W series), based on a randomisation protocol. Postoperative follow-up was performed at 3 months using intravenous urography (IVU), at 6 months using diuretic renography and at 1, 3 and 5 years using ultrasonography. Statistical analysis was performed using a one-sided Z-test, Pearsons's chi-squared test and a Wilcoxon rank sum test. ResultsThe primary outcome measure, success rate, which was defined as no obstruction on IVU and diuretic renography, was 100% in the 1W series and not inferior to the success rate of 98% in the 4W series (P = 0.006). The following secondary outcome measures were not significantly different between the 1W and the 4W series with regard to residual symptoms (10 vs 6%; P = 0.48), rate of complications (4 vs 6%; P = 0.65), need for synchronous robot-assisted pyelolithotomy (4 vs 8%; P = 0.47), improvement in split renal function (1 vs 0%; P = 0.59) and duration of surgery (200 vs 192 min; P = 0.87). Only length of hospital stay was significantly different; this was shorter in the 1W series (5 vs 6 days; P = 0.01). ConclusionsStenting of the pelvi-ureteric anastomosis after laparoscopic or robot-assisted pyeloplasty for 1 week is as effective as stenting for 4 weeks. Both procedures, laparoscopic or robot-assisted pyeloplasty have an excellent success rate.

Peri‐operative outcomes and complications after laparoscopic vs robot‐assisted dismembered pyeloplasty: a systematic review and meta‐analysis

“…All 17 were observational studies . Thirteen studies had a retrospective design [], three were prospective , and one used both retrospective and prospective data collection . Two studies reported patient matching .…”

“…). Ten studies reported similar complication rates between approaches []. Four studies reported complication rates of 0% for both groups .…”

“…). Moreover, although one author provided us with unpublished data , we were unable to identify any further unpublished data. This included contacting corresponding authors of included studies for missing or incomplete data.…”

“…Other sources of bias include centres and surgeons with an existing but unexplained preference towards one approach , using multiple surgeons [], and variations in clinical practice. Furthermore, five studies were at centres that switched from LP to RAP once robotics became available . Some of the differences we report may therefore be attributable to both the greater experience of surgeons when commencing RAP having previously performed LP, and changes in clinical practice at that centre over time.…”

Use of fibrin glue as a sealant at the anastomotic line in laparoscopic pyeloplasty: A randomised controlled trial

“…Recently, laparoscopic pyeloplasty (LPP) has become the standard treatment for PUJ obstruction (PUJO), Open pyeloplasty should only be performed after failed LPP [1]. The success rates of LPP vary between 87% and 100% and are comparable to open pyeloplasty success rates, but with the requisite advantages of being minimally invasive [2].…”