Study of Effectiveness of Double J (D-J) Stent and Transanastomotic BMI Tube Stent in Anderson Hynes (A-H) Pyeloplasty for The Management of Unilateral Pelvi-Ureteric Junction (PUJ) Obstruction in Children

ABSTRACT

Background: Hydronephrosis is a major urological health problem in children. Pelviretic junction (PUJ) obstruction is common among the congenital causes of hydronephrosis. A-H pyeploplasty is the most popular and common technique. There are different modalities of using trans-anastomotic stent in A-H pyeloplasty. Some surgeons use external drainage like nephrostomy tube, pyelostomy tube or trans-anastomotic stent and others use internal drainage D-J stent. In this study, D-J stent and BMI feeding tube were used for trans anastomotic drainage. We analyzed the data to find out which method of stenting in A-H pyeloplasty is more effective and safer and also to reduce the morbidity by reducing stent related complications.Material & Methods:A prospective interventional study was conducted in the faculty of Paediatric Surgery inBangladesh Shishu Hospital and Institute during the period from January 2016 to December 2019. A total of 60 patients under 12 years of age were included in this study were diagnosed as uni-lateral hydronephrosis for PUJ obstruction. Patients were divided into two groups by random lottery method and all patients underwent A-H pyeloplasty under general anaesthesia (G-A). In group-A, A-H pyeloplasty were done with using Double (D-J) stent and in group-B, 5Fr or 6Fr BMI tube were used as trans-anastomotic drainage. Patients were followed up after 2 weeks of operation, at 3 months and them at 6 months. The variables of the post-operative follow up study were patency of anastomosis, urinary tract infection, (UTI), urinary leakage and post-operative hospital stay and statistical analysis were done.Results:In group-A (30 cases), Anderson-Hynes pyeloplasty were done using D-J stent and in group-B (30 cases) with using trans-anastomotic BMI tube. In group-A most (73.33%) patients were below 5 years and in group-B 48 patients (80%) were below 5 years. In group-A mean age was 3.57+ 3.11 years and in group-B mean age was 3.31+3.21 years. There is no statistically significant difference in age distribution. In group-A left kidney were involved 66.7% cases and in group B in 80% cases left kidney were involved. In the early post-operative period, no urinary obstruction in group-A, however in 20% cases developed urinary obstruction in group-B but that was not statistically significant. In group-B continuous urinary leakage through drain tube was for 0-15 days but in group-B leakage was only or 0-1 day. It was statistically significant (p=0.037). In group-A, range of time of removal of drain tube was 4 days but in group-B range was 8-27 days. It was statistically significant (p=0.0001). Hospital stay in group-A was 4-8 days and in group B 9-29 days. It was also statistically significant (p=0.0001).Conclusion: In A-H pyeloplasty, morbidity of the patients can be reduced by using D-J stent which is more effective and safer. We found definite statistically significant difference in terms of urinary leakage, post-operative UTI, and hospital stay.