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