Internal Ureteric Stenting following Pyeloplasty Reduces Length of Hospital Stay in Children

Abstract

The advent of totally internal ureteric stents has the potential to reduce hospital stay in paediatric pyeloplasty. Traditionally, discharge from hospital has followed removal of an external trans-anastomotic drain, usually 5 days to a week post-operatively. The use of totally internal catheters negates the need for nursing supervision by removing external attachments that a paediatric patient might inadvertently dislodge. The length of hospital stay for pyeloplasty using a Double-J ureteric stent was compared with our previous method of trans-anastomotic feeding tube nephrostomy drainage. The results show the use of Double-J stenting to be advantageous in paediatric pyeloplasty by decreasing considerably the length of hospital stay. This is clearly of benefit to the patient, who returns to the family setting much earlier. Despite the need for an outpatient endoscopic procedure to remove the stent, savings in treatment costs and improved efficiency of bed use are also achieved.

Double–J Ureteral Stents: An Alternative to External Urinary Stents in Orthotopic Bladder Substitution

“…McMullin et al [10]used double–J stents in children following pyeloplasty. They found the need for post–operative nursing supervision was significantly reduced as there were no external devices which the child might dislodge inadvertently.…”

“…They found the need for post–operative nursing supervision was significantly reduced as there were no external devices which the child might dislodge inadvertently. Moreover, the hospital stay was considerably decreased [10]. …”

“…Moreover, the use of indwelling ureteral stents has been reported following urological complications in renal transplantation [8, 9]and in paediatric urology [10]. …”

Sonographically guided removal of a double J ureteral stent in an infant

“…These methods include snaring the stent with a 3F flexible grasping or biopsy forceps that is passed through the working channel of a neonatal cystoscope (7F or 9F); snaring the stent between the electrode and the sheath of a 10F resectoscope 3 ; and grasping the stent with a biopsy forceps passed through the working channel of a 7.5F flexible pediatric cystoscope or by first passing a flexible biopsy forceps into the bladder, then introducing the neonatal cystoscope alongside the forceps and grasping the stent under cystoscopic vision. However, these procedures require specialized instruments and accessories, because the urethra of a male neonate or infant can accommodate only an 8F or 9F cystoscope.…”

“…1 The advantages of such stenting are that it prevents leakage of urine from the anastomotic site, maintains the patency of the anastomosis, and allows for early discharge of patients after surgery. 3,4 A limitation of the use of totally internal stents is that their removal usually requires a second procedure, cystoscopy. 5 However, the availability of new-generation dou- ble J stents (eg, ÔÔblue stent,ÕÕ Angiomed Urosoft pyeloplasty stent; Bard Ltd, Crawley, UK), which are removable without cystoscopy, has to some extent rendered this debate obsolete.…”