Ketsuwan Chinnakhet, Phengsalae Yada, Viseshsindh Wit, Ratanapornsompong Wattanachai, Kiatprungvech Nattaradee, Kongchareonsombat Wisoot
Division of Urology, Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand.
Res Rep Urol. 2021 May 5;13:215-219. doi: 10.2147/RRU.S309894. eCollection 2021.
Double-J stents are favorably utilized after pyeloplasty. In rare situations, the stent may migrate upward. Here, we demonstrate the implementation and result of a supine percutaneous nephroscopic surgery (PNS) to retrieve a proximately migrated ureteral catheter in a pediatric patient.
A 1-year-old boy was suffering from an upward migration of a ureteric catheter into the right ureter after an open Anderson-Hynes pyeloplasty. The child was placed in the Galdakao-modified supine Valdivia (GMSV) position and a PNS procedure was performed. The calyceal access was carefully punctured by ultrasonographic guidance. The nephrostomy tract was dilated with a metal dilator using a one-step technique. An exploratory nephroscopy of the renal pelvis was conducted with a 12Fr miniature nephroscope and the migrated ureteral catheter was removed. A hybrid guidewire was retrogradely inserted into the ureteric orifice using a rigid ureteroscope. An antegrade double J stent was inserted in the proper position and a percutaneous nephrostomy was performed.
This is the first report of a successfully removed upwardly migrated ureteral catheter with concurrent insertion of an antegrade double J stent by supine PNS in the GMSV position in an infant. The patient recovered well after surgery with no adverse event, demonstrating that this operation can be carried out safely on pediatric patients.
肾盂成形术后常使用双J支架。在极少数情况下，支架可能向上迁移。在此，我们展示了在一名儿科患者中采用仰卧位经皮肾镜手术（PNS）取出近端迁移的输尿管导管的实施过程及结果。
一名1岁男孩在开放性安德森 - 海因斯肾盂成形术后，输尿管导管向上迁移至右侧输尿管。患儿置于加尔达考改良仰卧瓦尔迪维亚（GMSV）体位，实施PNS手术。在超声引导下仔细穿刺肾盏入路。采用一步技术用金属扩张器扩张肾造瘘通道。用12Fr微型肾镜对肾盂进行探查性肾镜检查并取出迁移的输尿管导管。使用硬性输尿管镜将混合导丝逆行插入输尿管口。在适当位置顺行插入双J支架并进行经皮肾造瘘。
这是首例关于在婴儿中采用仰卧位PNS在GMSV体位成功取出向上迁移的输尿管导管并同时顺行插入双J支架的报告。患者术后恢复良好，无不良事件发生，表明该手术可在儿科患者中安全进行。
