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Eur J Pediatr Surg 2019; 29(01): 033-038
DOI: 10.1055/s-0038-1668149
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Surgery for Pediatric Ureteropelvic Junction Obstruction—Comparison of Outcomes in Relation to Surgical Technique and Operating Discipline in Germany

G. Goetz   *
1   Department of Pediatric Surgery, University of Leipzig, Leipzig, Germany
,
M. Klora   *
2   Center for Health Economics Research Hannover, Leibniz University Hannover, Hannover, Germany
,
J. Zeidler
2   Center for Health Economics Research Hannover, Leibniz University Hannover, Hannover, Germany
,
S. Eberhard
3   AOK Niedersachsen, Statutory Health Insurance of Lower Saxony, Hannover, Germany
,
S. Bassler
4   AOK PLUS, The Health Insurance Company for Saxony and Thuringia, Dresden, Germany
,
S. Mayer
1   Department of Pediatric Surgery, University of Leipzig, Leipzig, Germany
,
J.-H. Gosemann
1   Department of Pediatric Surgery, University of Leipzig, Leipzig, Germany
,
M. Lacher
1   Department of Pediatric Surgery, University of Leipzig, Leipzig, Germany
› Author Affiliations
Further Information

Publication History

15 May 2018

27 June 2018

Publication Date:
15 August 2018 (online)

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Abstract

Introduction Surgery for ureteropelvic junction obstruction (UPJO) is performed by both pediatric surgeons (PS) and urologists (URO). The aim of this study was to analyze treatment modalities for UPJO and results in relation to the surgical technique and the operating discipline in Germany.

Materials and Methods Data of patients aged 0 to 18 years were extracted from a major public health insurance (covering ∼5.7 million clients) during 2009 to 2016 and were analyzed for sociodemographic variables, surgical technique, and treating discipline. Logistic regression analysis was performed for the risk of a complication within the first postoperative year.

Results A total of 229 children (31.0% female) were included. Laparoscopic pyeloplasty (LP) was performed in 58 (25.3%) patients (8.6 ± 6.4 years), and open pyeloplasty (OP) was applied in 171 (74.7%; 4.6 ± 5.9 years). LP was the dominant technique in females (p < 0.02); males preferentially underwent OP (p < 0.02). Length of hospital stay was 4.3 days (p = 0.0005) shorter in LP compared with that in OP, especially in children ≤ 2 years (6.7 days, p = 0.007). PS operated on 162 children (70.7%), and URO performed surgery on 67 patients (29.3%). The mean age of children operated by PS (3.5 ± 4.7 years) was significantly younger compared with that operated by URO (10.8 ± 6.5 years, p < 0.0001). Complication rates were independent of surgical technique or treating specialty.

Conclusion In Germany, UPJO was treated by LP in 25.3% of patients, which was associated with a shorter length of stay, especially in children ≤ 2 years. Complication rates were independent of the operating specialty and surgical technique. Therefore, LP should be further promoted for the treatment of UPJO in small children.

Keywords

pyeloplasty - laparoscopy - children - open surgery - ureteropelvic junction obstruction

* G. Goetz and M. Klora contributed equally to the study.


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