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Re: Ureteral Stents Do Not Cause Bacterial Infections in Children After Ureteral Reimplantation
PEDIATRIC UROLOGY
683
Editorial Comment: When surgery is done inappropriately or poorly, bad results occur. In this case report a 2-year-old girl with localized Wilms tumor underwent laparoscopic nephron sparing surgery with incomplete resection and seeding of the peritoneal cavity. Extensive peritoneal cancer resulted with studding of tumor nodules throughout the omentum, peritoneal surface of the bowel and mesentery liver surface, splenic surface and diaphragm, along with recurrence of the initial mass. This case reminds us why our current approach to Wilms tumor, limiting nephron sparing surgery to solitary kidneys, bilateral tumors and children with syndromes predisposing to recurrence, remains the standard of care. While successful laparoscopic total nephrectomy for Wilms tumor has been reported, for now open surgery remains the standard for partial nephrectomy. Douglas A. Canning, M.D.
Re: Ureteral Stents Do Not Cause Bacterial Infections in Children After Ureteral Reimplantation P. Uvin, A. Van Baelen, J. Verhaegen and G. Bogaert Department of Urology, University Hospitals, Leuven, Belgium Urology 2011; 78: 154 –158.
Objectives: To determine, in a prospective study, the incidence of bacterial colonization and the risk of bacterial infection of indwelling double-J stents in children undergoing ureteral reimplantation. In a balance between the safety and comfort of the child, the need for postoperative stenting of the reimplanted ureters has been discussed. It is unknown whether an indwelling double-J stent after ureteral reimplantation would be a risk factor for postoperative urinary tract infection. Methods: From 2005 to 2010, 209 children (138 girls and 71 boys; median age 3.8 years) with vesicoureteral reflux underwent unilateral or bilateral cross-trigonal ureteral reimplantation (352 ureters). All children received a single dose of gentamicin (2 mg/kg body weight) and a preoperative bladder rinse with 10% polividone-saline solution. A transurethral catheter was also left postoperatively for 2 (unilateral) or 3 (bilateral) days. The ureter was stented with a 8 –22 cm multilength catheter. At 3 weeks postoperatively, the ureteral catheters were removed and investigated for bacterial colonization. Results: Of the 209 children, 10 (4.8%) developed a urinary tract infection within the first 6 weeks after ureteral reimplantation. Of the remaining 199 children without any symptoms, 13 (6.5%) had a positive urine culture at removal of the catheters. Of the 199 children without any symptoms, 90 (45.2%) had a positive culture of one or more segments of the double-J catheter. Conclusions: Although the colonization rate of ureteral stents in our study was 42.9%, the rate of urinary tract infection during the first 6 weeks after ureteral reimplantation using indwelling ureteral stents was only 4.6%. We have concluded that the clinical significance of bacterial colonization of an indwelling ureteral stent is low, and therefore, ureteral stents can be used safely. Editorial Comment: Stents are frequently used following ureteral surgery to reduce the risk of obstruction postoperatively. In this study although nearly half of the patients who had indwelling Double-J® stents following reimplant for vesicoureteral reflux were colonized, symptomatic urinary tract infection developed in only 10 of 209 children (febrile in 6, nonfebrile in 4). None of the additional 22 children who had undergone pyeloplasty had urinary tract infections during the 6-week postoperative period despite 9 of 22 positive cultures. Although the authors did not study a cohort of children who did not have stents placed, from these data I agree that ureteral stents pose little risk to children following ureteral surgery as long as they are draining properly. Douglas A. Canning, M.D.
683
Editorial Comment: When surgery is done inappropriately or poorly, bad results occur. In this case report a 2-year-old girl with localized Wilms tumor underwent laparoscopic nephron sparing surgery with incomplete resection and seeding of the peritoneal cavity. Extensive peritoneal cancer resulted with studding of tumor nodules throughout the omentum, peritoneal surface of the bowel and mesentery liver surface, splenic surface and diaphragm, along with recurrence of the initial mass. This case reminds us why our current approach to Wilms tumor, limiting nephron sparing surgery to solitary kidneys, bilateral tumors and children with syndromes predisposing to recurrence, remains the standard of care. While successful laparoscopic total nephrectomy for Wilms tumor has been reported, for now open surgery remains the standard for partial nephrectomy. Douglas A. Canning, M.D.
Re: Ureteral Stents Do Not Cause Bacterial Infections in Children After Ureteral Reimplantation P. Uvin, A. Van Baelen, J. Verhaegen and G. Bogaert Department of Urology, University Hospitals, Leuven, Belgium Urology 2011; 78: 154 –158.
Objectives: To determine, in a prospective study, the incidence of bacterial colonization and the risk of bacterial infection of indwelling double-J stents in children undergoing ureteral reimplantation. In a balance between the safety and comfort of the child, the need for postoperative stenting of the reimplanted ureters has been discussed. It is unknown whether an indwelling double-J stent after ureteral reimplantation would be a risk factor for postoperative urinary tract infection. Methods: From 2005 to 2010, 209 children (138 girls and 71 boys; median age 3.8 years) with vesicoureteral reflux underwent unilateral or bilateral cross-trigonal ureteral reimplantation (352 ureters). All children received a single dose of gentamicin (2 mg/kg body weight) and a preoperative bladder rinse with 10% polividone-saline solution. A transurethral catheter was also left postoperatively for 2 (unilateral) or 3 (bilateral) days. The ureter was stented with a 8 –22 cm multilength catheter. At 3 weeks postoperatively, the ureteral catheters were removed and investigated for bacterial colonization. Results: Of the 209 children, 10 (4.8%) developed a urinary tract infection within the first 6 weeks after ureteral reimplantation. Of the remaining 199 children without any symptoms, 13 (6.5%) had a positive urine culture at removal of the catheters. Of the 199 children without any symptoms, 90 (45.2%) had a positive culture of one or more segments of the double-J catheter. Conclusions: Although the colonization rate of ureteral stents in our study was 42.9%, the rate of urinary tract infection during the first 6 weeks after ureteral reimplantation using indwelling ureteral stents was only 4.6%. We have concluded that the clinical significance of bacterial colonization of an indwelling ureteral stent is low, and therefore, ureteral stents can be used safely. Editorial Comment: Stents are frequently used following ureteral surgery to reduce the risk of obstruction postoperatively. In this study although nearly half of the patients who had indwelling Double-J® stents following reimplant for vesicoureteral reflux were colonized, symptomatic urinary tract infection developed in only 10 of 209 children (febrile in 6, nonfebrile in 4). None of the additional 22 children who had undergone pyeloplasty had urinary tract infections during the 6-week postoperative period despite 9 of 22 positive cultures. Although the authors did not study a cohort of children who did not have stents placed, from these data I agree that ureteral stents pose little risk to children following ureteral surgery as long as they are draining properly. Douglas A. Canning, M.D.