Percutaneous insertion of double-J ureteral stent in children with ureteral obstruction: Our experiences

https://doi.org/10.1016/j.jpurol.2012.01.017Get rights and content

Abstract

Objective

Ureteral obstruction (UO) is usually treated by surgical or endoscopic approaches. We investigated whether percutaneous anterograde treatment with insertion of double-J ureteral stent (DJ) is a feasible alternative technique for the management of UO in selected cases, where traditional approaches are not possible or too risky.

Patients and methods

The DJ was percutaneously inserted into 10 children (mean age 9 years) who suffered from UO. Three children had already been treated surgically for complex urotract congenital anomalies; six children had restenosis/reocclusion or stenosis of ureteropelvic junction; and one girl suffered migration of an intraoperatively placed DJ with stenosis of the distal ureter.

Results

Percutaneous insertion of the DJ was successful on the first attempt in 8 and on the second in 2 children. Adverse events after the procedure, all successfully treated, included one pyelonephritis and one migration of DJ, and 3 children had bacteriuria and 3 hematuria. Mean duration of insertion of the DJ was 6.4 months. After removal of the DJ, 7 children did not need any further interventions, but 2 children needed surgical correction and 1 reinsertion of the DJ.

Conclusion

In selected cases, percutanous insertion of a DJ should be considered as an alternative to surgery or endoscopic treatment in the management of children with UO.

Introduction

The double-J ureteral stent (DJ) provides internal urinary drainage from the renal pelvis to the bladder. The most common indications for the DJ are ureteral obstruction (UO) of different causes, upper urinary tract surgery, as a part of endourologic treatment, and as preparation for extracorporeal lithotripsy [1], [2]. It can be inserted intraoperatively, endoscopically or percutaneously. Intraoperative insertion of DJ is a well-known and established procedure in adults and also in children, and is often used during different surgical procedures of the urinary tract to allow better postoperative drainage of urine [3], [4]. Endoscopic retrograde insertion of DJ is also a well-known prophylactic procedure in maintaining ureteral patency after endourological surgery, before extracorporeal shock wave lithotripsy in patients with staghorn calculi [5], and as an initial approach in children with severe primary non-refluxing megaureter [6]. Percutaneous anterograde insertion of a DJ may provide a useful alternative in establishing continuity between the renal pelvis and the bladder in children when the endoscopic retrograde approach or operative treatment is not possible or too risky [7], [8]. The small number of complications observed during interventional uroradiology proves percutaneous manipulation to be a safe medical procedure in adults and also in children [9].

We describe our experience of using percutaneous anterograde DJ stenting as an alternative to surgical or endoscopic treatment in a group of children with UO. The decision to perform the procedure was made in consensus with a urologist, nephrologist and radiologist on an individual case-by-case basis.

Section snippets

Patients and methods

The DJ was percutaneously inserted into 10 children aged from 1 to 17 years (mean 9 years), nine boys and one girl, who suffered from postoperative stenosis or occlusion of a different part of the ureter, from the ureteropelvic junction (UPJ) to ureterovesical junction (UVJ).

Children were classified into two groups according to the predominant site of UO (Table 1). Four children (Cases 1–4) were included in the group with predominant distal UO. Three of them were treated because of complex

Results

Percutaneous insertion of the DJ was successful on the first attempt in 8 children; therefore the primary technical success rate was 80%. Two attempts were needed in 2 children: in a boy with bladder exstrophy and occlusion of UVJ after ureterocystoneostomy (Fig.1), and in a boy with severe fibrotic reocclusion of UPJ and with additional stenosis of the UVJ (Fig. 2).

After DJ insertion, improvement in urine drainage was seen on ultrasound (US) as a decrease in hydronephrosis and an improvement

Discussion

Ureteral obstruction (UO) is defined as impaired ureteral drainage, and it may range from severe, threatening renal function, to minor, without any clinical consequences [7]. Congenital malformations associated with the obstruction, particularly at the level of the UPJ and UVJ, are more frequent, while acquired ureteral stenoses are less common. Acquired UO can be iatrogenic, as a consequence of a local surgical or endoscopic procedure, or it can be a consequence of ureter wall inflammation,

Conclusions

In conclusion, percutaneous insertion of a DJ should be considered the method of choice when surgical and endoscopic approaches to the management of children with UO are not possible or too risky. The decision is made on an individual, case-by-case basis. With future development, the DJ ureteral stents could be used more routinely also in children. Good cooperation between urologist and interventional radiologist is mandatory.

Conflict of interest/funding

None declared.

References (14)

There are more references available in the full text version of this article.

Cited by (4)

  • Investigation of radiopacity and antibacterial properties of ethylene vinyl acetate hollow fiber utilizable in ureteral J-shaped stents

    2023, Materials Today Communications
    Citation Excerpt :

    The loss of modulus by adding SN is beneficial for intended usage as ureteral stents as the flexibility of the fiber increases during implementing and operating it. More flexibility of the material can reduce the risk of injury during placement or removal of ureteral stent in the body. [27] Since the stent in the ureter can lead to bacterial growth and infection of the digestive system, in order to measure the growth of bacteria in the urine and ureteral stent, antibacterial properties of the stent is investigated using the growth of the E. Coli bacteria on the stent. [28,29]

  • Image-guided pediatric ureteric stent insertions: An 11-year experience

    2014, Journal of Vascular and Interventional Radiology
    Citation Excerpt :

    The issue of forgotten stents has been discussed in the literature (16–19). The recommended dwell times vary widely in the literature from exchanges at 6 weeks to 6 months, although double J stents can be left in place for 12 months without any issues (6,9,17). It is necessary to have a system in place (as arranged by a urologist or interventional radiologist) to ensure the timely exchange of a patient’s double J stent is not overlooked.

View full text