Search

Objective We report our initial experience, and describe our technique, in performing laparoscopic ipsilateral ureteroureterostomy (IUU) in the pediatric population. Materials and methods An IRB-approved, retrospective review of all patients undergoing laparoscopic IUU at our institution between 2006 and 2009 was performed. Demographic data, mode of presentation, underlying diagnosis, operative parameters, complications and follow-up data were analyzed. Cystoscopy, retrograde pyelograms and ureteral stent placement into the lower pole ureter were performed at the beginning of all cases. All were performed via a transperitoneal approach. An end-to-side ureteral anastamosis was carried out along the proximal lower pole ureter. No drains were left in place. Urethral catheters were left for 48 h. Results There were seven patients in the series. All were female with a mean age of 84 months (11舐190). Diagnosis was an ectopic ureter in six patients and a ureterocele in one patient. No patient required conversion to an open approach. Mean total operative time was 187 min (140舐252). Mean hospital stay was 2 days (1舐4) with a mean follow up of 8 months (1舐15). No complications occurred postoperatively. Follow-up studies demonstrate decreased or resolved hydronephrosis in all cases. Conclusions In our initial experience, laparoscopic IUU can be accomplished in a safe and effective manner with minimal complication.

A new coil-based metallic ureteral stent offers greater radial strength with longer indwelling time compared with plastic stents. This multicenter retrospective study reviews the clinical experience with this stent for malignant or benign chronic ureteral obstruction.Patients had stent placement in a retrograde fashion. We analyzed preplacement and postplacement renal imaging to determine degree of hydronephrosis. Stent encrustation was determined by either visual inspection at the time of stent change or plain abdominal radiography. Preoperative and follow-up serum creatinine values were compared for each patient.A total of 76 stents in 59 renal units (40 patients) were successfully placed. Creatinine value follow-up on 54 renal units showed 20 (37%) units to have stable, 15 (28%) improved, and 19 (35%) with worsening values. No stent showed encrustation on plain radiography despite it being seen on two during direct visualization. Three stents needed operative removal with either percutaneous nephrolithotomy or cystolitholapaxy. Fifteen of 41 (37%) metallic stents placed because of an obstructed plastic stent also became obstructed. At last follow-up, 6 of 40 patients were kept from nephrostomy tubes because of the metallic stent.Metallic stents are a viable alternative to nephrostomy tubes in patients in whom conventional stents fail because of malignant obstruction, but patients need to be followed closely. Stent encrustation that resulted in retained stents was poorly visualized on plain radiography. Patients still remain at risk for obstruction, urinary tract infections, and lower urinary tract symptoms from the metallic stent.