V3-12: LAPAROSCOPIC PEDIATRIC PYELOPLASTY AND PLACEMENT OF AN EXTERNALIZED PYELO-URETERAL STENT
VideoIntroductions and Objectives
Minimally invasive methods to relieve uretero-pelvic junction obstruction (laparoscopic/robotic) have become the gold standard in older children and adults. In children, this is usually accompanied by placement of a ureteral stent that must be removed post-operatively, oftentimes necessitating a second general anesthetic. Aside from issues related to cost and use of operating room resources, recent literature suggests multiple anesthetics in children can lead to cognitive delays. As an alternative strategy, herein we present a technique to laparoscopically place an externalized pyelo-ureteral stent, which can be easily removed in the clinic without anesthesia.
After the ureter is dismembered from the renal pelvis during pyeloplasty and the anastomosis is started, the Salle Intraoperative Pyeloplasty Stent (Cook Medical, Inc.) is passed into the abdomen through a laparoscopic port. The stent is then placed into the ureter distally, having removed the distal/bladder coil. The proximal coil is placed in the renal pelvis and a previously tied suture is used to secure the stent to the renal pelvis, preventing migration. The tail is brought out of the abdomen through a large angiocatheter advanced percutaneously. The external portion is occluded with a knot and placed under sterile dressings, and the intra-operative indwelling Foley catheter is removed at the end of the procedure. The stent acts as a scaffold during healing, but can also be opened and used for drainage, should the need arise.
Nine patients underwent the aforementioned procedure at an average age of 9.9 years (range 5-17) between August 2011 and November 2012. There were no intra- or post-operative complications, and the stents were all removed by a nurse in the clinic approximately 1 week post-operatively. Hospital stay was uniformly
This technique allows for stenting the uretero-pelvic anastomosis during pyeloplasty, and removing the stent in the clinic without the need for anesthesia, or the complexities associated with cystoscopically removing a double-j stent in a child. The external portion of the stent also serves as a safeguard in the unlikely event of the need for improved upper tract drainage prior to stent removal.