Retrograde percutaneous access for kidney internal splint stent catheter placement in pediatric laparoscopic pyeloplasty: avoiding stent removal in the operating room.

摘要

BACKGROUND AND PURPOSE: Laparoscopic pyeloplasty has become increasingly used in the pediatric population for ureteropelvic junction (UPJ) obstruction. When choosing laparoscopic pyeloplasty, it is common to leave a Double-J ureteral stent across the anastomosis. In adult practice, this stent is easily removed in the office during follow-up; however, in pediatrics, cystoscopy and stent removal necessitates a trip back to the operating room. We report a novel method for placing a Kidney Internal Splint Stent (KISS) catheter, which can then be removed in the office during follow-up. METHODS: The UPJ is dismembered, spatulated, and the new lateral edges are anastomosed as usual. With the renal pelvis still open, a STING needle is passed through the epigastric midline port. The laparoscope is used to visualize an appropriate posterior calix and direct the needle through the calix and out the back of the patient. A 7F vascular dilator is then threaded over the needle in retrograde fashion and into the collecting system. A 4F or 6F KISS catheter is then threaded through the dilator and down the ureter. The dilator is removed and the surgery is then finished according to the surgeon's preference. RESULTS: We have placed this catheter in nine children without difficulties or intraoperative complications. Mean age was 8 years. All stents were otherwise removed at an average of 13 days in the office without difficulty. Three patients had problems with intermittently poor drainage necessitating flushing; in one of these patients, a recurrence of the UPJ obstruction developed. CONCLUSION: 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.