Ureteral stent in ureteroneocystostomy for vesicoureteral reflux
Analysis of the data from National Surgical Quality Improvement Program-Pediatrics
DOI:
https://doi.org/10.5489/cuaj.9242Keywords:
Ureteral Stent, ureteroneocystostomy, Ureteral Reimplant, Vesicoureteral reflux, NSQIPAbstract
INTRODUCTION: We aimed to assess the association between stent placement during ureteral reimplantation for vesicoureteral reflux (VUR) and short-term postoperative outcomes.
METHODS: We conducted a retrospective analysis of National Surgical Quality Improvement Program-Pediatrics (NSQIP-P). Independent variables included stent placement, age, sex, urologic comorbidity, prior VUR procedures, severity of reflux, preoperative urinary tract infections (UTIs), American Society of Anesthesiologists (ASA) classification, and operative approach. Outcomes of interest were emergency department (ED) visits, operative time, readmissions, unplanned operations, length of hospital stay (LOS), and postoperative UTIs. Descriptive statistics were performed, and Chi-squared and Mann-Whitney U tests were used for univariate analysis. For multivariate analyses, logistic regression, linear regression, and negative binomial models were applied.
RESULTS: A total of 4550 patients were identified (median age 47.36 months, 68.7% female, 48.8% stented). In multivariate analyses, ureteral stenting was significantly associated with higher rates of ED visits (p=0.0019), related readmissions (p<0.0001), and postoperative UTIs (p<0.0001). The expected length of hospitalization for the stent group was 37% longer than for the non-stent group (p<0.0001), and the operative time was, on average, 31 minutes longer (p<0.0001).
CONCLUSIONS: This study reveals an association between ureteral stenting and short-term adverse postoperative outcomes following ureteral reimplantation for VUR. Consideration should be given to the selective use of stents at the time of ureteral reimplantation for VUR. There are limitations to the study due to the absence of some surgical data in the database, such as type of reimplant, long-term success rate, and type of stent used.
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