Can standard open pediatric urological procedures be performed on an outpatient basis?

Purpose: We questioned whether it is feasible in the current era of cost consciousness to perform standard open pediatric urological procedures on an outpatient basis while maintaining patient safety and satisfaction. Materials and Methods: We report on 51 consecutive patients 2 months to 13 years old (mean age 4 years 3 months) who underwent a standard open pediatric urological procedure between August 1999 and June 2000. The procedures included ureteral reimplantation in 22 cases (tapered in 2), pyeloplasty in 20, partial nephrectomy in 2, nephrectomy in 2, complete ureterocele reconstruction in 1 and other in 4. The expectation that the procedure would be performed on an outpatient basis was discussed with parents preoperatively. We excluded only cases requiring bowel for reconstruction. A caudal block was administered at the start of the procedure using 0.25% bupivacaine with 1:200,000 epinephrine at a dose of 1 cc/kg. The wound was infiltrated with 1 cc/kg. 0.25% bupivacaine and 0.5 mg./kg. ketorolac was administered at the end of the procedure. As soon as the child awakened, an age appropriate diet was started and 0.5 to 1 mg./kg. codeine with acetaminophen was given every 4 hours. Results: Of the 51 children 44 (86%) were discharged home the day of surgery. Average postoperative hospitalization was 7 hours. One of the 44 children discharged home required a single catheterization elsewhere. There were no other complications or repeat hospitalizations. Conclusions: Our experience shows that standard open pediatric urological procedures may be performed safely and comfortably on an outpatient basis.