Category: Reconstruction: Benign
Introduction & Objective : Ureteral stent is routinely placed after pyeloplasty for the treatment of ureteropelvic junction obstruction in adults. However, little is known about the stent placement time after pyeloplasty in real practice. We examined the trend of indwelling time of ureteral stent after pyeloplasty through a nationwide population-based data.
Methods : We performed a retrospective cohort study in adults who underwent pyeloplasty from 2007 to 2015 by using the Truven Health MarketScan database. Patients who are 18 years old or higher, who had both CPT codes of pyeloplasty (50400, 50405, 50544) and ureteral stent removal after pyeloplasty were included. Trends of ureteral stent indwelling time were investigated and clinical factors that affected stent indwelling time were evaluated by using Log-rank test and Cox proportional hazard model.
Results : A total of 4,997 patients were included in this study. The mean age was 31.5 years, and M/F ratio was 0.98. Charlson comorbidity index (CCI) was 0 or 1 in 82.3% and 2 or greater in 17.7%. Open pyeloplasty was performed in 34.1%, and laparoscopic (including robot-assisted) pyeloplasty was done in 65.9%. Primary pyeloplasty was in 91.6%, and salvage pyeloplasty was in 8.4%. Most patients (89.2%) had ureteral stents for 8 weeks or shorter. Most common stent indwelling time group was ‘5<and≤6 weeks’ (21.6%) followed by ‘4<and≤5 weeks' (20.8%), and ‘6<and≤7 weeks' (20.0%).
Stent indwelling time was significantly shorter in laparoscopic pyeloplasty group than open group (5.4 vs. 5.9 weeks, HR 1.24 (95% CI 1.16-1.31)) and primary group than salvage group (5.6 vs. 6.0 weeks, HR 1.24 (95% CI 1.12-1.37)). Patients with shorter hospital stay, lower CCI, younger age, and female gender had significant shorter stent indwelling time.
Conclusions : In real practice, ureteral stent indwelling time after pyeloplasty was varied in the United States. And there was no significant difference in indwelling time of ureteral stent over time. Patients with primary pyeloplasty and minimally invasive pyeloplasty had shorter stent indwelling time.
Deok Hyun Han– Associate professor, Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Seoul-t'ukpyolsi, Republic of Korea
Kyung Jin Chung– Associate Professor, Department of Urology, Gachon University Gil Hospital, Incheon, Inch'on-jikhalsi, Republic of Korea
Jae Heon Kim– Associate Professor, Department of Urology, Soon Chun Hyang University Seoul Hospital, Soon Chun Hyang University College of Medicine, Seoul, Seoul-t'ukpyolsi, Republic of Korea
Shufeng Li– Stanford University, Stanford, California
Benjamin Chung– Associate Professor of Urology, Stanford University, Stanford, California
Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine
Seoul, Seoul-t'ukpyolsi, Republic of Korea
Dr. Deok Hyun Han is an associate professor in the Department of Urology at Samsung Medical Center that is located in Seoul, South Korea. He earned his Medical Degree at the Seoul National University and completed the internship at the Seoul National University Hospital for one year. Then he moved to Samsung Medical Center to complete his urological residency and was certified by the Korean Board of Urology. During his fellowship at the Samsung Medical Center, he focused on advanced endourology and minimally invasive surgery.
He has performed many cases of therapeutic and diagnostic flexible ureteroscopies and percutaneous nephrolithotomies with his own primary access. He also has performed various kinds of laparoscopic surgeries including conventional, single-port, and robot-assisted laparoscopy. He is interested in novel devices and techniques in the field of minimally invasive surgery. He has been a board member of the Korean Endourological Society since 2010 and is the current General Secretary in this society.
Contact information: email@example.com
Department of Urology, Gachon University Gil Hospital
Incheon, Inch'on-jikhalsi, Republic of Korea
Department of Urology, Soon Chun Hyang University Seoul Hospital, Soon Chun Hyang University College of Medicine
Seoul, Seoul-t'ukpyolsi, Republic of Korea