Percutaneous antegrade ureteral stent placement during pediatric robot-assisted laparoscopic pyeloplasty
Noh, P.H.; Defoor, W.R.; Reddy, P.P.
Journal of Endourology 25(12): 1847-1851
2011
ISSN/ISBN: 1557-900X PMID: 21967318 DOI: 10.1089/end.2011.0168
Accession: 054920190
Robot-assisted laparoscopic pyeloplasty has become more widely used. Intraoperative placement and confirmation of ureteral stent position can be cumbersome with the robotic arms in place. We present a technique of percutaneous antegrade stent placement that is reliable with minimal morbidity. A retrospective cohort study was performed. Patient demographics, radiographic imaging, intraoperative details, and surgical outcomes were abstracted from the medical record. A 14-gauge angiocatheter was placed through the abdominal wall. A ureteral stent was guided over a wire down the dismembered ureter. Stent position was confirmed by retrograde reflux of methylene blue. A urethral catheter was left in place for 12 to 36 hours. Twenty-nine patients (15 male, 14 female) were identified. Average age was 10 years. Average follow-up was 14 months. Fifteen left- and 14 right-sided procedures were performed. Two patients needed retrograde stent placement. Mean time to correctly position the stent was less than 5 minutes. Postoperatively, one patient had a urine leak managed by an indwelling urethral catheter and did not need percutaneous drainage. All stents were removed approximately 4 to 6 weeks postoperatively. One patient had retrograde migration of the stent managed by ureteroscopy at the time of stent retrieval. Antegrade ureteral stent placement through a percutaneous angiocatheter, during robot-assisted laparoscopic pyeloplasty, is a rapid and effective technique. Intraoperative confirmation of stent position can be obtained, using methylene blue bladder distention, without repositioning the patient or undocking the surgical robot.