Double J ureteral stent removal following pediatric laparoscopic pyeloplasty without cystoscopy

Journal of Pediatric Surgery Open Pub Date : 2024-10-01 DOI:10.1016/j.yjpso.2024.100178

Edit Kecskés, Levente Szabó, Gábor Varga, László Sasi Szabó

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Abstract

Background

Double J ureteral stents (DJUS) require anesthesia and cystoscopy for its removal. We analysed the effectivity of a noncystoscopy (NC) DJUS removal procedure in vivo described by Shao. The study aimed to determine whether this method can safely be applied in our practice.

Methods

We analysed the data of all pediatric patients who had noncystoscopy DJUS removal following laparoscopic pyeloplasty in our Department between January 2021- December 2023 and compared data from cystoscopic (CS) interventions in 2020. We examined the success and complication rate of the in vivo intervention and its cost-effectivity. Ex-vivo bladder models were used to study the success rates of DJUS removal under different conditions and the impact of suture positioning.

Results

After laparoscopic pyeloplasty 34 NC and 10 CS stent removals were performed. The mean age was 35.65 months (NC) vs. 67.6 months (CS). DJUS removal was successful after an average of 2.08 trials without perioperative complications. Intervention time was significantly shorter in NC (4.62 mins vs. 12.90 mins, p<0.005). Noncystoscopic removal reduces hospital material costs (NC: ∼ 8.4 EUR vs. CS: ∼ 98 EUR). In the ex-vivo bladder model, 400 attempts were made to remove the stent. The success rate was higher in the empty model (38.5% vs. full: 32%, p = 0.21). The position of the suture did not significantly affect the success rate (37% vs. 33.5%, p= 0.53).

Conclusions

This innovative technique proved to be safe and effective. NC removal significantly shortens procedural time, is less burdensome for the patient and reduces hospital material costs.

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无需膀胱镜的小儿腹腔镜肾盂成形术后双 J 输尿管支架移除术

背景双J输尿管支架（DJUS）的取出需要麻醉和膀胱镜检查。我们分析了 Shao 所描述的体内非膀胱镜（NC）DJUS 移除术的效果。方法我们分析了2021年1月至2023年12月期间在我科接受腹腔镜肾盂成形术后进行非膀胱镜DJUS移除术的所有儿科患者的数据，并与2020年的膀胱镜（CS）干预数据进行了比较。我们研究了体内干预的成功率、并发症发生率及其成本效益。我们使用体外膀胱模型来研究不同条件下 DJUS 移除的成功率以及缝合位置的影响。结果腹腔镜肾盂成形术后进行了 34 例 NC 和 10 例 CS 支架移除术。平均年龄为 35.65 个月（NC）和 67.6 个月（CS）。平均经过 2.08 次试验后，DJUS 移除成功，且无围手术期并发症。NC的干预时间明显更短（4.62 分钟 vs. 12.90 分钟，p<0.005）。非囊镜切除术降低了医院的材料成本（NC：8.4 欧元对 CS：98 欧元）。在体外膀胱模型中，共进行了 400 次支架移除尝试。空膀胱模型的成功率更高（38.5% vs. 满膀胱模型：32%，p = 0.21）。缝合位置对成功率没有明显影响（37% 对 33.5%，P= 0.53）。NC切除术大大缩短了手术时间，减轻了患者的负担，降低了医院的材料成本。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Journal of Pediatric Surgery Open

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