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LETTER TO EDITOR
Year : 2006  |  Volume : 22  |  Issue : 2  |  Page : 159
 

Intubated versus non-intubated pyeloplasty


Department of Urology, Jaslok Hospital, Mumbai, India

Correspondence Address:
Shriram Joshi
Kamala Kunj, 212, Lady Jehangir Road, Matunga, Mumbai
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-1591.26579

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How to cite this article:
Joshi S. Intubated versus non-intubated pyeloplasty. Indian J Urol 2006;22:159

How to cite this URL:
Joshi S. Intubated versus non-intubated pyeloplasty. Indian J Urol [serial online] 2006 [cited 2019 Nov 17];22:159. Available from: http://www.indianjurol.com/text.asp?2006/22/2/159/26579


Dear Sir,

This is a comment on the article written by Prof. Sarin on paediatric pyeloplasty.[1]

I have by and large, not done an intubated pyeloplasty in children in the last 30 years of my practice. I agree with Prof. Sarin that, if he/she has a functioning kidney, the urinary bolus will keep the anastomosis patent without any leak. Steps that he has mentioned in his article have to be meticulously followed, the important ones being- the 6/0 suture material and the limited mobilization of the upper ureter. The only variation from the classical anterolateral, extraperitoneal approach, which I have recently being following, is splitting of abdominal muscles with injection of sensorcaine in the muscles. The postoperative pain is certainly very much less. The patient can go home as soon as the extrarenal drain is removed.

Special indications for stented pyeloplasty in my opinion are:

1. Redopyeloplasty- fibrosis from previous surgery and urinary leak creates an element of poorer blood supply to the upper ureter and pelvic flap. It is safer to use a stent. In the article, Prof Sarin has done one redopyeloplasty without a stent, but I would be reluctant to do so.

2. PUJ obstruction with secondary stones, commonly seen in adolescents. The stones produce local low grade infection and edema. Chances of prolonged drainage is higher in such cases. Also water tight suturing can be difficult due to edema.

3. Giant hydronephrosis with poor function of the kidney: due to long- standing obstruction and poor function, the urinary bolus is not strong enough to keep the anastomosis open and chances of cross union exists in such cases. It will take many months for this kidney to function optimally - if it ever recovers the function!

 
   References Top

1.Sarin YK. Paediatric pyeloplasty: Intubated vs nonintubated. Indian J Urol 2006;22:35-8.  Back to cited text no. 1    




 

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