# Abstract

 

## Background: Anderson-Hynes dismembered pyeloplasty is the gold standard therapeutic approach to ureteropelvic junction obstruction (UPJO). Use of a drainage method to protect the suture line from leakage is a matter of controversy. 

## Objectives: We have compared the surgical outcome of Anderson-Hynes dismembered pyeloplasty for UPJO repair, with or without internal stenting. 

## Patients and Methods: Eighty-two patients with UPJO were evaluated from 1996 to 2002. Complicated or emergent cases were excluded. Classic standard dismembered pyeloplasty was performed. Internal drainage, with a double j catheter, was performed in several patients, randomly. Another drain was also placed in the retroperitoneal space. The follow-up of patients was planned weekly, with patient visits and urine analysis and intravenous pyelography (IVP) and diethylene-triamine-pentaacetate (DTPA) scan after one month. 

## Results: The study group consisted of 51 male and 31 female patients, who were mostly in the age range of 20 - 40 years. Comparing the two techniques of pyeloplasty with or without internal drainage, there was no significant difference between groups regarding extravasation and anastomosis complications, such as leakage, stenosis, urinoma formation or evidence of obstruction on postoperative IVP or DTPA scan. However, a higher incidence of catheter related urinary symptoms and flank pain was reported among those with internal stent. 

## Conclusions: Pyeloplasty, with adequate spatulation, hemostasis and a watertight anastomosis, represents the mainstay of successful pyeloplasty and there may be no significant benefit for urethral stenting, especially in non-complicated cases. # 4. Results Double stenting was used in 30 cases and pyeloplasty without internal drainage was performed in 52 patients. Both groups were similar in age and sex distribution. The most common symptom was severe flank pain, which was present in 69% of patients. History of urinary tract infection was detected in 47% and 51% reported associated gastrointestinal symptoms. Pyuria was seen in 58% and only 36% of patients had positive urine culture, with *Escherichia coli* (*E. coli*) as the most common pathogen (60%). The preoperative sonographic evaluation and IVP results are shown in [Table 1](#). Intraoperative assessments showed ureteropelvic junction segmental atresia in 45 cases and aberrant vessels in 25 patients. The postoperative course was compared in two groups of patients, with and without internal drainage ([Table 2](#)). Among patients with extravasation in DTPA scan in the stent free group, retrograde DJ stent was inserted in four cases that had unacceptable drainage due to inflammation. One patient had distal ureter obstruction because of distal ureter stone, that was treated by Trans-ureteral lithotripsy (TULP) and stent support. Three other cases had no anatomical abnormality, and they were followed and extravasation resolved spontaneously at control IVP after one month. Removal of DJ stent was planned in one month after operation. However, eight cases missed the time and late stent removal was accompanied with several complications, such as stone formation on the tip of catheter in the bladder of a patient that needed TULP before stent removal. ::::table-wrap

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## Results of Preoperative Ultrasonography and Intravenous Pyelography Evaluation ^[a](#), [b](#)^

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Imaging Method Right Kidney Left Kidney

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**Sonography**\
Severe hydronephrosis 28 (34.6) 35 (43.2)
Moderate hydronephrosis 8 (9.9) 9 (11.1)
Mild hydronephrosis 6 (7.4) 3 (3.7)
Without hydronephrosis 39 (48) 34 (42)
**IVP**\
No secretion 6 (7.3) 9 (11)
Delayed secretion 33 (40.2) 38 (46.3)
Normal secretion 43 (52.4) 35 (42.7)

^a^Abbreviation: IVP, intravenous pyelography

^b^Data are presented as No. (%).:::: ::::table-wrap
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## Comparing Postoperative Course Between Patients who Underwent Pyeloplasty With or Without Internal Drainage ^[a](#), [b](#)^

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Post-Operative Course With Stent (n = 30) Without Stent (n = 52) P Value

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**Drain removal**\
In 48 hours 12 (40) 17 (32.7) 0.583
After 2 days 18 (60) 34 (65.4) 0.632
**Mean hospital stay, d** 36 ± 1.74 3.4 ± 1.30 0.841
**Urine analysis** ^**[c](#)**^\
Hematuria 19/27 32/32 0.001
Pyuria 12/27 20/32 0.008
**Post-operative IVP (one month later)**\
Extravasation 2 (6.7) 8 (15.3) 0.209
Delayed secretion 19 (63.3) 25 (48.1) 0.124
Visible ureter 18 (60) 41 (78.8) 0.633
**DTPA scan**^**[d](#)**^\
Partial obstruction 8/20 13/44 0.716
**Urinary symptoms** 24 (80) 2 (3.8) 0.005
**Urinoma** 0 (0) 1 (1.9) 0.324
**Recurrence of stenosis**\
reoperation 0 (0) 1 (1.9) 0.324
**Stent remnants** 2 (6.7) 0 (0) 0.041
**Flank pain at voiding** 10 (33.3) 0 (0) 0.001

^a^Abbreviations: IVP, intravenous pyelography; DTPA,
diethylene-triamine-pentaacetate.

^b^Data are presented as No. (%).

^c^Urine analysis was done in 27 patients of the stent group and 32
cases of the stent free group.

^d^DTPA scan was done in 20 patients of stent group and 32 cases of
stent free group.::::


Extracted trial result:
Outcome: ureteropelvic junction obstruction (binary)
Intervention: internal drainage group
Comparator: stentless cases
Intervention events: 8
Intervention group size: 20
Comparator events: 13
Comparator group size: 44