Original Article
Extracorporeal Ureteric Stenting for Pediatric Laparoscopic Pyeloplasty Stanislav Kocherov1
Genady Lev1
Leonid Chertin2
1 Department of Pediatric Urology, Shaare Zedek Medical Center,
Jerusalem, Israel 2 Faculty of Medicine, Bar Ilan University, Zfat, Israel
Boris Chertin1 Address for correspondence Boris Chertin, MD, Department of Pediatric Urology, Shaare Zedek Medical Center, pob3235, Jerusalem 91031, Israel (e-mail: [email protected]).
Abstract
Keywords
► extracorporeal stenting ► laparoscopic pyeloplasty ► pediatric
Introduction We aimed to evaluate a novel technique for ureteric stent insertion during dismembered pediatric laparoscopic pyeloplasty. Patients and Methods Following identification and dissection of the ureteropelvic junction (UPJ) with the proximal part of ureter, the ureter is dismembered just proximal to the UPJ at the level of the renal pelvis, allowing use of the excess pelvic tissue for further manipulation of the ureter. Then the abdomen is desufflated and the ureter delivered to the skin level. The externalized ureter is then spatulated and the stent inserted in an antegrade fashion to the bladder. The first stitch for further laparoscopic anastomosis is applied to the lower part of the spatulated ureteric end and then following insufflations the ureter is returned to the abdomen. The laparoscopic anastomosis is completed in a routine fashion. Results Over the past 4 years, we have used this technique in 26 children (17 boys and 9 girls) with median age of 4 years (range, 2–18 years). Left pyeloplasty was performed in 16 and right pyeloplasty in the remaining 10 patients. The mean (range) time of insertion was 6 minutes (range, 4–7 minutes). All stents were correctly placed. In one patient, the stent dislodged to distal part of the ureter. No other intraoperative or postoperative complications related to our technique of stent insertion were observed. Conclusion Our data show that extracorporeal antegrade ureteric stent insertion is an easy-to-learn and a safe and reliable technique for pediatric dismembered pyeloplasty. It obviates the problem of having the stent in the pelvis during dissection and the need for patient repositioning.
Introduction In recent years, many treatment modalities have been developed to manage ureteropelvic junction obstruction (UPJO), such as antegrade or retrograde endopyelotomy, the Acucise cutting balloon, and ureteral dilation. Although all of these are minimally invasive alternatives, the success rate of these procedures is low (70–80% in well-selected patients) when compared with the traditional open pyeloplasty, with success rate around 90%.1,2 In 1993, Schuessler et al performed the first
received September 24, 2014 accepted after revision December 16, 2014
laparoscopic pyeloplasty, and since then many papers have shown that this technique is a safe and effective treatment for UPJO.1–3 One of the most difficult steps in laparoscopic pyeloplasty is the ureteropelvic anastomosis when the classic dismembered technique (Anderson-Hynes) is performed. Beyond the complexity imposed by the intracorporeal suturing, the presence of a ureteral stent (previously placed by cystoscopy) in front of the anastomotic site makes the suture even more difficult and time consuming. The retrograde cystoscopic and the antegrade laparoscopic approaches are currently the two
© Georg Thieme Verlag KG Stuttgart · New York
DOI http://dx.doi.org/ 10.1055/s-0035-1546756. ISSN 0939-7248.
Downloaded by: National University of Singapore. Copyrighted material.
Eur J Pediatr Surg
Ureteric Stenting for Pediatric Laparoscopic Pyeloplasty
Kocherov et al.
Table 1 Demographic characteristics and intraoperative finding in 26 studied patients Patients characteristics
N
Total number of reported patients
26
Age (range years)
2–18
Boys
17
Girls
9
Left side
16
Right side
10
Insertion time (range, minutes)
4–7
Aberrant vessels
5
Stent dislodgment
1
Stent-related UTI
0
options for stent insertion during laparoscopic pyeloplasty.4–7 To overcome these difficulties, numerous alternative techniques for ureteric stent placement have been suggested.8–12 We aimed to evaluate a technique of extracorporeal insertion of the ureteric stent in pediatric patients who underwent dismembered laparoscopic pyeloplasty.
Patients and Methods A retrospective cohort study was performed. Patient demographics, radiographic imaging, intraoperative details, and surgical outcomes were abstracted from the medical records ►Table 1. Our follow-up and indications for surgery have been presented previously.13 All patients underwent three 5-mm-port transabdominal dismembered pyeloplasty. The patients were secured in a flank position and urinary catheter inserted. On catheter insertion, antibiotic prophylaxis was administrated. The bladder was filled with indigo carmine–stained irrigation water. Following ports insertion and abdominal insufflations, the upper ureter and the renal pelvis were identified and dissected. If an aberrant vessel is identified, it is dissected free from the UPJ/upper ureteral area. At this stage, trans-flank holding stitch through the renal pelvis is placed to facilitate pelvic dissection and to stabilize the renal pelvis during intracorporeal anastomosis (►Fig. 1). The ureter was dismembered proximal to the UPJ at the level of the renal pelvis. The excess tissue of the renal pelvis was used for grasping and manipulating the ureter. The abdomen was desufflated, the lateral port removed, and the dismembered ureteric end externalized to skin level at the port site (►Fig. 2). The externalized ureter was then spatulated. The JJ ureteral stent was inserted in an antegrade fashion over a hydrophilic guidewire. The presence of the indigo carmine–stained urine indicated the correct position of the distal part of the stent in the urinary bladder (►Fig. 3). The first stitch for future intracorporeal anastomosis was applied on the lower part of the spatulated ureter (►Fig. 4). Insufflation was resumed and the stented, spatulated ureter European Journal of Pediatric Surgery
Fig. 1 Trans-flank holding stitch through the renal pelvis.
was returned to the abdomen (►Fig. 5). The laparoscopic anastomosis was made in the usual way, using two Vicryl 4/0 or 5/0 running sutures; the excess tissue was then excised; and a stent inserted. The use of excess renal pelvic
Fig. 2 Externalized ureteral end at the skin level, at the port site.
Downloaded by: National University of Singapore. Copyrighted material.
Abbreviation: UTI, urinary tract infection.
Ureteric Stenting for Pediatric Laparoscopic Pyeloplasty
Kocherov et al.
Fig. 3 The JJ ureteral stent is inserted in an antegrade fashion.
tissue facilitates manipulation of the ureter and avoids injury to the ureteric tissue in the anastomotic area. Following anastomosis completion, the excess renal pelvic tissue was excised and the renal pelvis closed using running 4/0 Vicril suture. The 7Fr drain was left alongside the anastomosis. The stent was left in place for a period of 4 to 6 weeks and removed under general anesthesia or deep sedation at cystoscopy.
Results Over the past 4 years, we have used this technique in 26 children (17 boys and 9 girls) with median age of 4 years (range, 2–18 years). It is a general policy of our department to refer the patients for laparoscopic pyeloplasty from the age of 2 years. Left pyeloplasty was performed in 16 and right pyeloplasty in the remaining 10 patients. The mean (range) time of insertion was 6 minutes 6 (range, 4–7 minutes). All stents were correctly placed. In one patient during follow-up, the stent migrated to the distal part of the ureter. No other intraoperative or postoperative complications related to our technique of stent insertion were observed. Improvement in hydronephrosis was confirmed in all patients. Pyeloplasty led to increased relative renal function from 32.7 1.7% before surgery to 40.2 0.63% in all patients.
Discussion
Fig. 4 The first stitch for future intracorporeal anastomosis is applied on the lower part of the spatulated ureter.
While the technique of laparoscopic pyeloplasty in children is well established, the search continues for the ideal method of stenting the repair, with a multitude of techniques reported.6–10 The double J stent has been reported to be very effective in children required stenting of the new anastomosis.14,15 However, it is often difficult to pass the double J into the bladder in an intracorporeal fashion through one of the trocars.6,7 While the retrograde approach is less technically demanding, it requires cystoscopy and time for patient repositioning.6 Moreover, stenting obstructed renal pelvis upon dissection renders it European Journal of Pediatric Surgery
Downloaded by: National University of Singapore. Copyrighted material.
Fig. 5 Insufflation is resumed and the stented, spatulated ureter is returned to the abdomen.
flaccid, which can make its exposure difficult. It can also be difficult to spatulate the ureter in a young child with the stent occupying the lumen. For these reasons, others have placed the JJ stent at the end of the repair, assuming the risk of the guidewire extruding across the suture line. To overcome these limitations, some researchers have suggested the drainage of the collecting system using percutaneous approach either via renal parenchyma or via renal pelvis.9,16 Although good outcome was reported with both approaches, the risk of renal trauma and bleeding still exists. Furthermore, the possibility of urinary leakage from the puncture site in the renal pelvis cannot be brushed aside. The presented technique of antegrade percutaneous stent insertion was previously reported on 20 consecutive adult patients who underwent laparoscopic dismembered pyeloplasty.10 No stent-insertion–related complications were reported in this series. Also in our series of 26 children, this technique of stent placement proved to be both simple and effective. Precise positioning of the nonvisualized distal end of the JJ stent within the bladder is potentially problematic with the antegrade approach, since it is essentially a blind maneuver. We have overcome this potential obstacle by filling the bladder with indigo carmine–stained irrigation water on stent passing into the bladder. In one patient the stent migrated into the intramural part of the ureter and was easily removed at the time of the scheduled cystoscopy 6 weeks following pyeloplasty. We have further improved the presented method by the Nadu et al technique of ureter externalization and have also applied the first stitch utilizing for further incorporeal anastomosis while the ureter is still externalized. This allows for a first anastomosis stitch in a precise fashion without additional ureteral manipulation. In our opinion, this step further facilitates this operative technique and its simplicity makes it easy to learn. Of course, this technique is not without limitations, which should be mentioned. In the desufflated abdomen, the length of the ureter needed to externalize the ureteric end is minimal and usually no additional ureteric dissection is needed after dismembering the UPJ. However, the width of the abdominal wall can be a limiting factor and it is possible that in obese patients this maneuver might not be feasible. Our method of verification of the position of the distal end of the JJ stent inside of the bladder by appearance of the stained urine through the stent holes as an indication of proper positioning may be unreliable if concomitant vesicoureteric reflux is present. Although in all of our patients the postoperative KUB (kidney, ureter, bladder) demonstrated a correct stent positioning. Of course, the internal stents can irritate the bladder and require second anesthesia for stent removal.
Kocherov et al. for pediatric dismembered pyeloplasty. It obviates the problem of having the stent in the pelvis during dissection and the need for patient repositioning during surgery.
Conflict of Interest None.
References 1 Moon DA, El-Shazly MA, Chang CM, Gianduzzo TR, Eden CG.
2
3 4
5
6
7
8
9
10
11
12
13
14
15
Conclusion Our data show that extracorporeal antegrade ureteric stent insertion is an easy-to-learn and a safe and reliable technique
European Journal of Pediatric Surgery
16
Laparoscopic pyeloplasty: evolution of a new gold standard. Urology 2006;67(5):932–936 Schuessler WW, Grune MT, Tecuanhuey LV, Preminger GM. Laparoscopic dismembered pyeloplasty. J Urol 1993;150(6): 1795–1799 Peters CA, Schlussel RN, Retik AB. Pediatric laparoscopic dismembered pyeloplasty. J Urol 1995;153(6):1962–1965 Mandhani A, Goel S, Bhandari M. Is antegrade stenting superior to retrograde stenting in laparoscopic pyeloplasty? J Urol 2004; 171(4):1440–1442 Chandrasekharam VV. Is retrograde stenting more reliable than antegrade stenting for pyeloplasty in infants and children? Urology 2005;66(6):1301–1304, discussion 1304 Arumainayagam N, Minervini A, Davenport K, et al. Antegrade versus retrograde stenting in laparoscopic pyeloplasty. J Endourol 2008;22(4):671–674 Minervini A, Siena G, Masieri L, Lapini A, Serni S, Carini M. Antegrade stenting in laparoscopic pyeloplasty: feasibility of the technique and time required for stent insertion. Surg Endosc 2009; 23(8):1831–1834 Taveres A, Manaboriboon N, Lorenzo AJ, Farhat WA. Insertion of an internal-external nephroureteral stent during pediatric laparoscopic pyeloplasty: description of the technique. Urology 2008; 71(6):1199–1202 Hadley DA, Wicher C, Wallis MC. Retrograde percutaneous access for kidney internal splint stent catheter placement in pediatric laparoscopic pyeloplasty: avoiding stent removal in the operating room. J Endourol 2009;23(12):1991–1994 Nadu A, Mor Y, Ramon J. Direct extracorporeal ureteric stenting during laparoscopic pyeloplasty: a novel technique. BJU Int 2009; 103(6):844–847 Eassa W, Al Zahrani A, Jednak R, El-Sherbiny M, Capolicchio JP. A novel technique of stenting for laparoscopic pyeloplasty in children. J Pediatr Urol 2012;8(1):77–82 Yu J, Wu Z, Xu Y, et al. Retroperitoneal laparoscopic dismembered pyeloplasty with a novel technique of JJ stenting in children. BJU Int 2011;108(5):756–759 Chertin B, Pollack A, Koulikov D, et al. Conservative treatment of ureteropelvic junction obstruction in children with antenatal diagnosis of hydronephrosis: lessons learned after 16 years of follow-up. Eur Urol 2006;49(4):734–738 Zoeller C, Lacher M, Ure B, Petersen C, Kuebler JF. Double J or transrenal transanastomotic stent in laparoscopic pyeloplasty in infants and children: a comparative study and our technique. J Laparoendosc Adv Surg Tech A 2014;24(3):205–209 Rodriguez AR, Rich MA, Swana HS. Stentless pediatric robotic pyeloplasty. Ther Adv Urol 2012;4(2):57–60 Helmy T, Blanc T, Paye-Jaouen A, El-Ghoneimi A. Preliminary experience with external ureteropelvic stent: alternative to double-j stent in laparoscopic pyeloplasty in children. J Urol 2011; 185(3):1065–1069
Downloaded by: National University of Singapore. Copyrighted material.
Ureteric Stenting for Pediatric Laparoscopic Pyeloplasty
Extracorporeal Ureteric Stenting for Pediatric Laparoscopic Pyeloplasty Stanislav Kocherov1
Genady Lev1
Leonid Chertin2
1 Department of Pediatric Urology, Shaare Zedek Medical Center,
Jerusalem, Israel 2 Faculty of Medicine, Bar Ilan University, Zfat, Israel
Boris Chertin1 Address for correspondence Boris Chertin, MD, Department of Pediatric Urology, Shaare Zedek Medical Center, pob3235, Jerusalem 91031, Israel (e-mail: [email protected]).
Abstract
Keywords
► extracorporeal stenting ► laparoscopic pyeloplasty ► pediatric
Introduction We aimed to evaluate a novel technique for ureteric stent insertion during dismembered pediatric laparoscopic pyeloplasty. Patients and Methods Following identification and dissection of the ureteropelvic junction (UPJ) with the proximal part of ureter, the ureter is dismembered just proximal to the UPJ at the level of the renal pelvis, allowing use of the excess pelvic tissue for further manipulation of the ureter. Then the abdomen is desufflated and the ureter delivered to the skin level. The externalized ureter is then spatulated and the stent inserted in an antegrade fashion to the bladder. The first stitch for further laparoscopic anastomosis is applied to the lower part of the spatulated ureteric end and then following insufflations the ureter is returned to the abdomen. The laparoscopic anastomosis is completed in a routine fashion. Results Over the past 4 years, we have used this technique in 26 children (17 boys and 9 girls) with median age of 4 years (range, 2–18 years). Left pyeloplasty was performed in 16 and right pyeloplasty in the remaining 10 patients. The mean (range) time of insertion was 6 minutes (range, 4–7 minutes). All stents were correctly placed. In one patient, the stent dislodged to distal part of the ureter. No other intraoperative or postoperative complications related to our technique of stent insertion were observed. Conclusion Our data show that extracorporeal antegrade ureteric stent insertion is an easy-to-learn and a safe and reliable technique for pediatric dismembered pyeloplasty. It obviates the problem of having the stent in the pelvis during dissection and the need for patient repositioning.
Introduction In recent years, many treatment modalities have been developed to manage ureteropelvic junction obstruction (UPJO), such as antegrade or retrograde endopyelotomy, the Acucise cutting balloon, and ureteral dilation. Although all of these are minimally invasive alternatives, the success rate of these procedures is low (70–80% in well-selected patients) when compared with the traditional open pyeloplasty, with success rate around 90%.1,2 In 1993, Schuessler et al performed the first
received September 24, 2014 accepted after revision December 16, 2014
laparoscopic pyeloplasty, and since then many papers have shown that this technique is a safe and effective treatment for UPJO.1–3 One of the most difficult steps in laparoscopic pyeloplasty is the ureteropelvic anastomosis when the classic dismembered technique (Anderson-Hynes) is performed. Beyond the complexity imposed by the intracorporeal suturing, the presence of a ureteral stent (previously placed by cystoscopy) in front of the anastomotic site makes the suture even more difficult and time consuming. The retrograde cystoscopic and the antegrade laparoscopic approaches are currently the two
© Georg Thieme Verlag KG Stuttgart · New York
DOI http://dx.doi.org/ 10.1055/s-0035-1546756. ISSN 0939-7248.
Downloaded by: National University of Singapore. Copyrighted material.
Eur J Pediatr Surg
Ureteric Stenting for Pediatric Laparoscopic Pyeloplasty
Kocherov et al.
Table 1 Demographic characteristics and intraoperative finding in 26 studied patients Patients characteristics
N
Total number of reported patients
26
Age (range years)
2–18
Boys
17
Girls
9
Left side
16
Right side
10
Insertion time (range, minutes)
4–7
Aberrant vessels
5
Stent dislodgment
1
Stent-related UTI
0
options for stent insertion during laparoscopic pyeloplasty.4–7 To overcome these difficulties, numerous alternative techniques for ureteric stent placement have been suggested.8–12 We aimed to evaluate a technique of extracorporeal insertion of the ureteric stent in pediatric patients who underwent dismembered laparoscopic pyeloplasty.
Patients and Methods A retrospective cohort study was performed. Patient demographics, radiographic imaging, intraoperative details, and surgical outcomes were abstracted from the medical records ►Table 1. Our follow-up and indications for surgery have been presented previously.13 All patients underwent three 5-mm-port transabdominal dismembered pyeloplasty. The patients were secured in a flank position and urinary catheter inserted. On catheter insertion, antibiotic prophylaxis was administrated. The bladder was filled with indigo carmine–stained irrigation water. Following ports insertion and abdominal insufflations, the upper ureter and the renal pelvis were identified and dissected. If an aberrant vessel is identified, it is dissected free from the UPJ/upper ureteral area. At this stage, trans-flank holding stitch through the renal pelvis is placed to facilitate pelvic dissection and to stabilize the renal pelvis during intracorporeal anastomosis (►Fig. 1). The ureter was dismembered proximal to the UPJ at the level of the renal pelvis. The excess tissue of the renal pelvis was used for grasping and manipulating the ureter. The abdomen was desufflated, the lateral port removed, and the dismembered ureteric end externalized to skin level at the port site (►Fig. 2). The externalized ureter was then spatulated. The JJ ureteral stent was inserted in an antegrade fashion over a hydrophilic guidewire. The presence of the indigo carmine–stained urine indicated the correct position of the distal part of the stent in the urinary bladder (►Fig. 3). The first stitch for future intracorporeal anastomosis was applied on the lower part of the spatulated ureter (►Fig. 4). Insufflation was resumed and the stented, spatulated ureter European Journal of Pediatric Surgery
Fig. 1 Trans-flank holding stitch through the renal pelvis.
was returned to the abdomen (►Fig. 5). The laparoscopic anastomosis was made in the usual way, using two Vicryl 4/0 or 5/0 running sutures; the excess tissue was then excised; and a stent inserted. The use of excess renal pelvic
Fig. 2 Externalized ureteral end at the skin level, at the port site.
Downloaded by: National University of Singapore. Copyrighted material.
Abbreviation: UTI, urinary tract infection.
Ureteric Stenting for Pediatric Laparoscopic Pyeloplasty
Kocherov et al.
Fig. 3 The JJ ureteral stent is inserted in an antegrade fashion.
tissue facilitates manipulation of the ureter and avoids injury to the ureteric tissue in the anastomotic area. Following anastomosis completion, the excess renal pelvic tissue was excised and the renal pelvis closed using running 4/0 Vicril suture. The 7Fr drain was left alongside the anastomosis. The stent was left in place for a period of 4 to 6 weeks and removed under general anesthesia or deep sedation at cystoscopy.
Results Over the past 4 years, we have used this technique in 26 children (17 boys and 9 girls) with median age of 4 years (range, 2–18 years). It is a general policy of our department to refer the patients for laparoscopic pyeloplasty from the age of 2 years. Left pyeloplasty was performed in 16 and right pyeloplasty in the remaining 10 patients. The mean (range) time of insertion was 6 minutes 6 (range, 4–7 minutes). All stents were correctly placed. In one patient during follow-up, the stent migrated to the distal part of the ureter. No other intraoperative or postoperative complications related to our technique of stent insertion were observed. Improvement in hydronephrosis was confirmed in all patients. Pyeloplasty led to increased relative renal function from 32.7 1.7% before surgery to 40.2 0.63% in all patients.
Discussion
Fig. 4 The first stitch for future intracorporeal anastomosis is applied on the lower part of the spatulated ureter.
While the technique of laparoscopic pyeloplasty in children is well established, the search continues for the ideal method of stenting the repair, with a multitude of techniques reported.6–10 The double J stent has been reported to be very effective in children required stenting of the new anastomosis.14,15 However, it is often difficult to pass the double J into the bladder in an intracorporeal fashion through one of the trocars.6,7 While the retrograde approach is less technically demanding, it requires cystoscopy and time for patient repositioning.6 Moreover, stenting obstructed renal pelvis upon dissection renders it European Journal of Pediatric Surgery
Downloaded by: National University of Singapore. Copyrighted material.
Fig. 5 Insufflation is resumed and the stented, spatulated ureter is returned to the abdomen.
flaccid, which can make its exposure difficult. It can also be difficult to spatulate the ureter in a young child with the stent occupying the lumen. For these reasons, others have placed the JJ stent at the end of the repair, assuming the risk of the guidewire extruding across the suture line. To overcome these limitations, some researchers have suggested the drainage of the collecting system using percutaneous approach either via renal parenchyma or via renal pelvis.9,16 Although good outcome was reported with both approaches, the risk of renal trauma and bleeding still exists. Furthermore, the possibility of urinary leakage from the puncture site in the renal pelvis cannot be brushed aside. The presented technique of antegrade percutaneous stent insertion was previously reported on 20 consecutive adult patients who underwent laparoscopic dismembered pyeloplasty.10 No stent-insertion–related complications were reported in this series. Also in our series of 26 children, this technique of stent placement proved to be both simple and effective. Precise positioning of the nonvisualized distal end of the JJ stent within the bladder is potentially problematic with the antegrade approach, since it is essentially a blind maneuver. We have overcome this potential obstacle by filling the bladder with indigo carmine–stained irrigation water on stent passing into the bladder. In one patient the stent migrated into the intramural part of the ureter and was easily removed at the time of the scheduled cystoscopy 6 weeks following pyeloplasty. We have further improved the presented method by the Nadu et al technique of ureter externalization and have also applied the first stitch utilizing for further incorporeal anastomosis while the ureter is still externalized. This allows for a first anastomosis stitch in a precise fashion without additional ureteral manipulation. In our opinion, this step further facilitates this operative technique and its simplicity makes it easy to learn. Of course, this technique is not without limitations, which should be mentioned. In the desufflated abdomen, the length of the ureter needed to externalize the ureteric end is minimal and usually no additional ureteric dissection is needed after dismembering the UPJ. However, the width of the abdominal wall can be a limiting factor and it is possible that in obese patients this maneuver might not be feasible. Our method of verification of the position of the distal end of the JJ stent inside of the bladder by appearance of the stained urine through the stent holes as an indication of proper positioning may be unreliable if concomitant vesicoureteric reflux is present. Although in all of our patients the postoperative KUB (kidney, ureter, bladder) demonstrated a correct stent positioning. Of course, the internal stents can irritate the bladder and require second anesthesia for stent removal.
Kocherov et al. for pediatric dismembered pyeloplasty. It obviates the problem of having the stent in the pelvis during dissection and the need for patient repositioning during surgery.
Conflict of Interest None.
References 1 Moon DA, El-Shazly MA, Chang CM, Gianduzzo TR, Eden CG.
2
3 4
5
6
7
8
9
10
11
12
13
14
15
Conclusion Our data show that extracorporeal antegrade ureteric stent insertion is an easy-to-learn and a safe and reliable technique
European Journal of Pediatric Surgery
16
Laparoscopic pyeloplasty: evolution of a new gold standard. Urology 2006;67(5):932–936 Schuessler WW, Grune MT, Tecuanhuey LV, Preminger GM. Laparoscopic dismembered pyeloplasty. J Urol 1993;150(6): 1795–1799 Peters CA, Schlussel RN, Retik AB. Pediatric laparoscopic dismembered pyeloplasty. J Urol 1995;153(6):1962–1965 Mandhani A, Goel S, Bhandari M. Is antegrade stenting superior to retrograde stenting in laparoscopic pyeloplasty? J Urol 2004; 171(4):1440–1442 Chandrasekharam VV. Is retrograde stenting more reliable than antegrade stenting for pyeloplasty in infants and children? Urology 2005;66(6):1301–1304, discussion 1304 Arumainayagam N, Minervini A, Davenport K, et al. Antegrade versus retrograde stenting in laparoscopic pyeloplasty. J Endourol 2008;22(4):671–674 Minervini A, Siena G, Masieri L, Lapini A, Serni S, Carini M. Antegrade stenting in laparoscopic pyeloplasty: feasibility of the technique and time required for stent insertion. Surg Endosc 2009; 23(8):1831–1834 Taveres A, Manaboriboon N, Lorenzo AJ, Farhat WA. Insertion of an internal-external nephroureteral stent during pediatric laparoscopic pyeloplasty: description of the technique. Urology 2008; 71(6):1199–1202 Hadley DA, Wicher C, Wallis MC. Retrograde percutaneous access for kidney internal splint stent catheter placement in pediatric laparoscopic pyeloplasty: avoiding stent removal in the operating room. J Endourol 2009;23(12):1991–1994 Nadu A, Mor Y, Ramon J. Direct extracorporeal ureteric stenting during laparoscopic pyeloplasty: a novel technique. BJU Int 2009; 103(6):844–847 Eassa W, Al Zahrani A, Jednak R, El-Sherbiny M, Capolicchio JP. A novel technique of stenting for laparoscopic pyeloplasty in children. J Pediatr Urol 2012;8(1):77–82 Yu J, Wu Z, Xu Y, et al. Retroperitoneal laparoscopic dismembered pyeloplasty with a novel technique of JJ stenting in children. BJU Int 2011;108(5):756–759 Chertin B, Pollack A, Koulikov D, et al. Conservative treatment of ureteropelvic junction obstruction in children with antenatal diagnosis of hydronephrosis: lessons learned after 16 years of follow-up. Eur Urol 2006;49(4):734–738 Zoeller C, Lacher M, Ure B, Petersen C, Kuebler JF. Double J or transrenal transanastomotic stent in laparoscopic pyeloplasty in infants and children: a comparative study and our technique. J Laparoendosc Adv Surg Tech A 2014;24(3):205–209 Rodriguez AR, Rich MA, Swana HS. Stentless pediatric robotic pyeloplasty. Ther Adv Urol 2012;4(2):57–60 Helmy T, Blanc T, Paye-Jaouen A, El-Ghoneimi A. Preliminary experience with external ureteropelvic stent: alternative to double-j stent in laparoscopic pyeloplasty in children. J Urol 2011; 185(3):1065–1069
Downloaded by: National University of Singapore. Copyrighted material.
Ureteric Stenting for Pediatric Laparoscopic Pyeloplasty
