Division of Pediatric Urology, University of Utah, Salt Lake City, Utah, USA.
J Endourol. 2009 Dec;23(12):1991-4. doi: 10.1089/end.2009.0170.
Laparoscopic pyeloplasty has become increasingly used in the pediatric population for ureteropelvic junction (UPJ) obstruction. When choosing laparoscopic pyeloplasty, it is common to leave a Double-J ureteral stent across the anastomosis. In adult practice, this stent is easily removed in the office during follow-up; however, in pediatrics, cystoscopy and stent removal necessitates a trip back to the operating room. We report a novel method for placing a Kidney Internal Splint Stent (KISS) catheter, which can then be removed in the office during follow-up.
The UPJ is dismembered, spatulated, and the new lateral edges are anastomosed as usual. With the renal pelvis still open, a STING needle is passed through the epigastric midline port. The laparoscope is used to visualize an appropriate posterior calix and direct the needle through the calix and out the back of the patient. A 7F vascular dilator is then threaded over the needle in retrograde fashion and into the collecting system. A 4F or 6F KISS catheter is then threaded through the dilator and down the ureter. The dilator is removed and the surgery is then finished according to the surgeon's preference.
We have placed this catheter in nine children without difficulties or intraoperative complications. Mean age was 8 years. All stents were otherwise removed at an average of 13 days in the office without difficulty. Three patients had problems with intermittently poor drainage necessitating flushing; in one of these patients, a recurrence of the UPJ obstruction developed.
A laparoscopic approach for KISS catheter placement is a technically feasible and advantageous technique when placing a stent for a pyeloplasty repair. This eliminates a trip back to the operating room for stent removal in the pediatric population and likely decreases bladder irritation.
腹腔镜肾盂成形术已越来越多地用于小儿肾盂输尿管连接部（UPJ）梗阻。选择腹腔镜肾盂成形术时，通常会在吻合口处留置双 J 输尿管支架。在成人实践中，这种支架在随访时可在办公室轻松取出；然而，在儿科，膀胱镜检查和支架取出需要返回手术室。我们报告了一种放置 Kidney Internal Splint Stent（KISS）导管的新方法，随后可在随访时在办公室取出。
将 UPJ 切断、斜切，然后像往常一样吻合新的侧缘。肾盂仍保持开放，通过上腹中线端口插入 STING 针。使用腹腔镜观察适当的后盏，并引导针通过盏和患者背部穿出。然后将 7F 血管扩张器沿针逆行插入收集系统。将 4F 或 6F KISS 导管穿过扩张器并向下插入输尿管。取出扩张器，然后根据外科医生的喜好完成手术。
我们在 9 名儿童中顺利放置了这种导管，没有出现术中并发症。平均年龄为 8 岁。所有支架均在平均 13 天在办公室顺利取出。3 名患者间歇性出现引流不良问题，需要冲洗；其中 1 名患者出现 UPJ 梗阻复发。
当进行肾盂成形术修复时，腹腔镜放置 KISS 导管是一种可行且有利的技术。这种方法消除了小儿患者返回手术室取出支架的需要，并可能减少膀胱刺激。
