Risk of Postoperative Urinary Tract Infection and Complications With Ureteral Stents With and Without Extraction Strings in Pediatric Robotic Pyeloplasty.

Abstract

We sought to review our experience with the postoperative use of ureteral stents with and without extraction strings in a large series of pediatric patients following robotic-assisted laparoscopic pyeloplasty (RALP). All RALP at our institution from 2012 to present were retrospectively reviewed. Patients with < 60 days of follow-up, preoperative nephrostomy tubes, and redo pyeloplasty were excluded. Statistical analysis was performed. A total of 245 patients underwent RALP: 179 (73%) patients had ureteral stents with extraction strings (SWES) and 66 (27%) had internalized stents. Groups were similar with regards to demographics and perioperative characteristics, except for longer operative times in the internalized stent group (<i>P</i> = .01). No statistically significant difference in postoperative complications (OR 0.77, 95% CI 0.35-1.68, <i>P</i> = .5) and UTIs (OR 0.72, 95% CI 0.24-2.20, <i>P</i> = .6) were observed between SWES compared with internalized stents. No difference in Clavien-Dindo Grade 3 complications were seen between groups (OR 1.78, 95% CI 0.49-6.41, <i>P</i> = .4). Subgroup analysis did not reveal an increased risk of postoperative complications or UTI with female sex, UTI history, or circumcision status (<i>P</i> ≥ .16). Nonuse of antibiotic prophylaxis was associated with an increased risk of postoperative UTI in the SWES group (<i>P</i> = .02). Of patients with SWES, 21 (12%) required stent removal in the office setting, 3 (1.7%) required removal in the operating room under anesthesia, and 153 (86%) were able to remove at home. Ureteral SWES were not associated with an increased risk of postoperative UTI or complications in our series.