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Research Update: Pyeloplasty, Antibiotic, and Ureteral Stent Usage

October 26, 2020

UPMC Children’s Hospital of Pittsburgh Division of Pediatric Urology fellow Marc A. Colaco, MD, MBA, is leading the Division's efforts in a multicenter collaborative study called “Is There an Indication for Prophylactic Antibiotics in Children After Pyeloplasty With Ureteral Stent Placement?”

The University of Memphis is the lead site coordinating the study to investigate the use of pre- and postoperative antibiotics and their impact on postoperative urinary tract infection outcomes in cases of pyeloplasty for the correction of ureteropelvic junction obstruction (UPJO), and also the effect on outcomes of pyeloplasty with and without the use of ureteral stents. UPJO is one of the causes of hydronephrosis, which can lead to permanent kidney damage if left untreated. Vesicoureteral reflux also can be a cause of hydronephrosis in pediatric patients.

Historically, clinical practice has entailed using antibiotics immediately before surgery and in the post-procedural period until the removal of the patient’s stent (if a stent is used) several weeks after surgery. However, with the continued push toward more judicious use of antibiotics, in part to combat the development and spread of antibiotic resistant bacteria, this pathway needs to be studied to ensure patients are receiving only the antibiotics they need when it is most effective to do so in order to achieve optimal surgical outcomes. The same is true for the use of ureteral stents during pyeloplasty.

The purpose of this multicenter study is to determine if the use or non-use of antibiotics has any effect on postoperative infection rates. The participating centers in the study all use varying protocols for prophylactic antibiotic use in cases of pyeloplasty. The use of ureteral stents also differs from one institution to the next. By combining data from multiple institutions that use varying protocols for their pyeloplasty cases, outcomes can be compared to assess which protocols and standards of care perform better. This research may contribute to future clinical guidelines and standards of care for pyeloplasty in pediatric patients.

“There’s a bit of an old dogma in place when it comes to the use of antibiotics with pyeloplasty, and there isn’t a lot of data available in the literature to guide clinical practice or inform changes that may be beneficial to patients and institutions alike. Since these cases are not that common, it is very difficult for a single institution to have enough case volume to power a study on their own. Hence the need for a collaborative multi-institution trial such as this one,” says Dr. Colaco.

More About Dr. Colaco

Dr. Colaco is a second-year fellow in the Department of Pediatric Urology at UPMC Children’s. He earned a dual MD/MBA degree from the University of Medicine and Dentistry of New Jersey – Robert Wood Johnson Medical School and The State University of New Jersey – Rutgers Business School. Dr. Colaco then completed his residency training at Wake Forest Baptist Health prior to beginning his pediatric urology fellowship at UPMC Children’s.