Department of Urology, University Clinic Hospital of Valencia, INCLIVA, Instituto de Investigación Sanitaria, Facultat de Medicina i Odontologia, Universitat de València, Av Blasco Ibáñez, 17, CP 46010 Valencia, Spain.
J Pediatr Urol. 2024 Aug;20(4):730.e1-730.e5. doi: 10.1016/j.jpurol.2024.05.001. Epub 2024 May 7.
Ureteral stent placement during laparoscopic pyeloplasty is a common procedure in pediatric patients. Although an apparently safe maneuver, ascending placement of the stent can lead to complex removal or repositioning reinterventions.
In this study we compare two methods for intraoperative verification of correct positioning.
Prospective observational study collecting data on laparoscopic pyeloplasties in pediatric patients in our center over three years. We carried out descriptive and univariate comparative analyses. Data were compared between ultrasound and reflux visualized by the catheter after intraoperative salineinjection into the bladder through the urethral catheter. We recorded time to catheter visualization in both ultrasonography and in reflux from the start of bladder instillation, as well as bladder volume at the time of placement verification with each method.
Data were collected from 20 patients (15 male and 5 female) with a median age of 48 months. Pyeloplasty was successful in 100% of the sample (as observed by ultrasound and MAG-3), while one patient had postoperative leak requiring nephrostomy placement. Correct distal positioning of the ureteral stent could be verified by intraoperative ultrasound and reflux in all cases. Using reflux, the bladder volume needed to verify correct positioning exceeded the age-related maximum in half the cohort, while on ultrasound, the stent was visualized in the bladder without reaching the maximum bladder capacity for age in any case (p = 0.02 comparing percentages). Likewise, mean time to verification was lower with ultrasound than with reflux (61.8 s versus 115 s), but without these differences reaching statistical significance (p = 0.14).
The present study is the first to compare two methods to verify the correct positioning of the ureteral stent in laparoscopic pyeloplasties in pediatric patients. Our results show that both intraoperative ultrasound and visualization of reflux are useful methods, although ultrasound requires a lower volume of saline instilled through the bladder catheter for verification. This work can be very useful for the daily clinical practice of urologists and pediatric surgeons.
Both intraoperative ultrasound and visualization of reflux are useful methods to verify the correct positioning of the ureteral stent in laparoscopic pyeloplasty of pediatric patients. With ultrasound, a smaller volume is required to check for reflux. Although ultrasound is faster for verification, there are no differences in procedural times.
腹腔镜肾盂成形术中留置输尿管支架是小儿患者常见的操作。虽然这是一种看似安全的操作，但支架的逆行放置可能导致复杂的取出或重新定位的介入治疗。
本研究比较两种术中验证正确位置的方法。
前瞻性观察研究，在我们中心收集了三年内小儿腹腔镜肾盂成形术的数据。我们进行了描述性和单变量比较分析。将超声检查和通过尿道导管向膀胱注入生理盐水后导管反流的结果进行比较。记录两种方法下从开始膀胱灌注到导管可视化的时间，以及用每种方法放置验证时的膀胱容量。
数据来自 20 名患者（男 15 名，女 5 名），中位年龄为 48 个月。所有患者（通过超声和 MAG-3 观察）的肾盂成形术均成功，1 例患者术后漏尿需放置肾造口管。术中超声和反流均可在所有病例中验证输尿管支架的远端正确位置。在使用反流的情况下，有一半的队列需要验证正确的定位所需的膀胱容量超过了与年龄相关的最大容量，而在超声检查中，支架在膀胱中被可视化，但在任何情况下都未达到与年龄相关的最大膀胱容量（比较百分比时 p = 0.02）。同样，与反流相比，使用超声检查验证的平均时间更短（61.8 秒与 115 秒），但这些差异没有统计学意义（p = 0.14）。
本研究首次比较了两种验证小儿腹腔镜肾盂成形术中输尿管支架正确位置的方法。我们的结果表明，术中超声和反流可视化都是有用的方法，尽管超声检查需要通过膀胱导管注入更少的生理盐水来验证。这项工作对于泌尿科医生和小儿外科医生的日常临床实践非常有用。
术中超声和反流可视化都是验证小儿腹腔镜肾盂成形术中输尿管支架正确位置的有用方法。使用超声检查时，需要检查反流的膀胱容量较小。虽然超声检查的验证速度更快，但操作时间没有差异。
