Retrograde Percutaneous Access for Kidney Internal Splint Stent Catheter Placement in Pediatric Laparoscopic Pyeloplasty: Avoiding Stent Removal in the Operating Room

Abstract

A laparoscopic approach for KISS catheter placement is a technically feasible and advantageous technique when placing a stent for a pyeloplasty repair. This eliminates a trip back to the operating room for stent removal in the pediatric population and likely decreases bladder irritation.

Laparoscopically Guided External Transanastomotic Stenting in Dismembered Pyeloplasty: A Safe Technique

“…Stents were removed without anesthesia after a median time of 7 days (range, [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21]. No intraoperative complications (bleeding caused by stent placement or inability to insert the stent) occurred.…”

“…Various techniques for this purpose have been described in small case series. [14][15][16][17][18][19] We describe a simple method to introduce an external transanastomotic stent during laparoscopic transperitoneal dismembered pyeloplasty in a large cohort of pediatric patients of all age-groups. We assessed surgical outcome and analyzed stent-associated complications.…”

“…A retrograde percutaneous transrenal approach has been described by Hadley et al,17 who passed a STING needle through a calix under laparoscopic vision…”

A novel technique of stenting for laparoscopic pyeloplasty in children

“…In order to avoid the second anesthetic for JJ removal, Yucel et al [17] reported the use of a urethral dangler to remove the stent, although this required cystoscopy for placement. In addition, they Dissatisfaction with these techniques has led others to investigate antegrade, percutaneous nephro-ureteral stenting [18,19]. This approach obviates the need for a second anesthetic and time lost with cystoscopy while avoiding the difficulties of antegrade passage across the uretero-vesical junction.…”

“…The potential for renal parenchymal hemorrhage was acknowledged by the authors in this small series. To avoid the difficulties of the Tavares technique and inspired by the retrograde Lawson percutaneous access technique [20], Hadley et al [19] chose in nine children to penetrate the renal parenchyma in a retrograde fashion using a STING needle introduced through the epigastric port. Again, the possibility of bleeding cannot be avoided by this blind technique.…”