Use of double-J ureteric stents post-laparoscopic pyeloplasty to treat ureteropelvic junction obstruction in hydronephrosis for pediatric patients: a single-center experience

Abstract

Objectives We aimed to investigate the safety concerns associated with placing double-J ureteric stents post-laparoscopic pyeloplasty surgery for congenital ureteropelvic junction obstruction (UPJO) and hydronephrosis. Methods A total of 1349 patients with postoperative double-J stent placement at our center were included. Clinical variables for enrolled patients were collected by two independent authors. We compared clinical variables and the efficacy of stenting post-laparoscopic pyeloplasty. Results The mean age of the patients was 4.23 ± 2.39 years. A total of 58.49% of patients were diagnosed with left UPJO with hydronephrosis and 33.95% were diagnosed with right UPJO. Furthermore, 7.56% of patients had bilateral UPJO. In all cases, 96.96% of indwelling double-J stents were successfully removed 4 weeks post-surgery. A total of 3.04% of the patients still required further management, including stent migration to the renal pelvis (0.37%), stent migration to the bladder (0.30%), prolapse of the stent through the ureter (0.15%), blockage of stents (1.85%), and fouling of stents (0.37%). Conclusions Double-J ureteric stents used after laparoscopic pyeloplasty for treating UPJO in hydronephrosis for pediatric patients is a safe, feasible, and beneficial method, which can be recommended for routine procedures. However, caution should be practiced for follow-up and removal using this method.

Comparison of Drainage Methods After Pyeloplasty in Children: A 14-Year Study

“…No significant differences were observed in other types of complications such as UTI, stent displacement, and postoperative recurrence. This is consistent with other similar studies ( 15 , 16 ), so the cost of stent-less pyeloplasty is an unavoidable high incidence of urinary leakage. Unfortunately, almost all postoperative urine leakage needs to be treated by intubation; it means that reoperation is conducted within a short period of time after the first surgery, which is unacceptable for children and their parents, and it may cause doctor–patient conflict and bring great challenges to clinical work.…”

“…Combined with the above discussions, we find that stent-less pyeloplasty is the most minimally invasive, but it has a high incidence of urinary leakage. Combined with the results of the other studies (5,6,10,(15)(16)(17), we found that the advantages of the DJ stent are that it is safe, reliable, effective, and more minimally invasive, while the removal time of the PU stent is shorter, which can reduce the occurrence of catheter-related complications. And the disadvantages are obvious too, such as issues with anesthesia during DJ stent removal and the high risk of urine leakage associated with the PU stent.…”

“…Compared with other reported literature (5,8,(13)(14)(15)(16), the advantages of our study lie in the long follow-up time and importantly in the number of patients. To our knowledge, this is the first long-term follow-up of TEUS and study of the results.…”

Meta-Analysis of the Efficacy of Laparoscopic Pyeloplasty for Ureteropelvic Junction Obstruction via Retroperitoneal and Transperitoneal Approaches

“…UPJO is a common disease in pediatric urology with an incidence of about 1/2,000 in newborns, and the ratio of the men to women is 2~3:1 ( 20 ). UPJO usually reduces the free flow of urine from the renal pelvis to the ureter, causing dilation of the renal pelvis and calyces and hydronephrosis ( 21 ). Ureteropelvic junction stenosis, crossing vessel, and ureteropelvic junction valve and stone are also important causes of UPJO.…”

Double-J Stenting Versus Percutaneous Nephrostomy; Postoperative Complications in Management of Ureteral Obstruction

“…Finding of higher incidence rate of septicemia in PCN than DJS is in accordance with a previous similar work 20 indicating some loopholes in the PCN. Stent migration 21 or encrustation can be expected in DJS for ureteral obstruction but total failure of this procedure is a rare one while advanced stage of the causative agent e.g., malignancy cannot be ruled out in the context. The failure needs readdress of the issue for complete relief otherwise patient shifts to bad experience of hemodialysis 22 using various devices.…”