Urology and Nephrology Research Center, Urology Department, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Department of Urology and Nephrology, Urology Department, Urmia University of Medical Sciences, Urmia, Iran.
J Laparoendosc Adv Surg Tech A. 2023 Mar;33(3):303-307. doi: 10.1089/lap.2022.0287. Epub 2023 Feb 14.
To evaluate the safety of antegrade percutaneous retrieval migrated ureteral stent in very small size pediatric patients with ultramini instruments under ultrasonography guide. A total number of 10 out of 115 patients who were referred to our center with upward migrated Double-J (DJ) were candidates for antegrade approach from 2017 to 2020. The pyelocalyceal system was punctured in a prone position by using an 18-gauge disposable needle with Chiba tip and visualization of the upper tract by 3.5 MHz ultrasonic guidance. Then 0.038-inch J tipped guide wire was passed through the needle and the tract was dilated up to 6F under ultrasonographic guide. The 8F access sheath was positioned over the 6F dilator. The semirigid 6F ureteroscope was introduced through the sheath and DJ was removed with a grasper. The mean age was 11.4 ± 5.48 months. The mean time from the previous surgery to DJ removal procedure was 6.4 ± 0.84 weeks. The mean operation time was 11.7 ± 1.76 minutes. All the patients were discharged from the hospital within the 1st day. There were no serious complications (grade 3, 4, or 5) according to Clavien-Dindo classification. The antegrade retrieval of upward migrated DJ with ultramini instrument under ultrasonographic guidance in failed cases of retrograde approach is a safe and effective approach in very small size pediatric patients.
为评估在超声引导下使用超微仪器经顺行途径从极度狭小的肾盂内取回上移的双 J 支架（DJ）的安全性，我们对 2017 年至 2020 年期间因 DJ 上移而转诊至我中心的 115 例患者中的 10 例（共 10 例）采用顺行途径的患者进行了研究。患者取俯卧位，使用带有 Chiba 针尖的 18 号一次性针头穿刺肾盂系统，在 3.5MHz 超声引导下观察上尿路。然后将 0.038 英寸 J 型尖端导丝穿过针头，在超声引导下将通道扩张至 6F。将 8F 通道鞘置于 6F 扩张器上。通过鞘管插入半刚性 6F 输尿管镜，并使用抓钳取出 DJ。患者平均年龄为 11.4±5.48 个月。从上次手术到 DJ 取出手术的平均时间为 6.4±0.84 周。平均手术时间为 11.7±1.76 分钟。所有患者均在第 1 天出院。根据 Clavien-Dindo 分级，无严重并发症（3、4 或 5 级）。对于逆行途径失败的病例，在超声引导下使用超微仪器经顺行途径取回上移的 DJ 是一种安全有效的方法，适用于极度狭小的小儿肾盂。
