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Endoscopic placement of double-J ureteric stents in children as a treatment for primary obstructive megaureter
Daniel Carroll1, Harish Chandran, Ashwini Joshi
1Department of Paediatric Urology, Birmingham Children's Hospital NHS Trust, Steelhouse Lane, Birmingham, UK.
Insights
Double-J ureteric stenting is effective for pediatric primary non-refluxing megaureter, offering an alternative to surgery. Complications are uncommon, with 66% of cases showing resolution after stent placement.
Area of Science:
- Pediatric Urology
- Nephrology
- Surgical Innovation
Background:
- Primary obstructive megaureter is a condition requiring effective management in pediatric patients.
- Persistent or progressive cases can lead to significant renal compromise.
- Early surgical intervention carries potential risks and complications.
Purpose of the Study:
- To evaluate the efficacy of double-J ureteric stents in treating pediatric primary obstructive megaureter.
- To assess the complication rate associated with double-J ureteric stent placement.
- To determine if stenting is a viable alternative to early surgery.
Main Methods:
- Retrospective review of 31 pediatric patients (2 months to 15 years) who received 38 double-J ureteric stents between 1997 and 2004.
- Data collected included stent insertion details, complications, and follow-up results.
- Minimum 2-year clinical and radiological follow-up post-stent insertion.
Main Results:
- Endoscopic double-J ureteric stent placement in children is technically straightforward with a low complication rate (8/38 insertions).
- Double-J ureteric stenting alone achieved resolution in 66% (25/38) of cases with non-resolving or progressive primary non-refluxing megaureter.
- Successful stenting was observed even in very young patients (as young as 2 months).
Conclusions:
- Ureteric stenting is an effective alternative to early surgery for primary non-refluxing megaureter in pediatric patients.
- Endoscopic double-J ureteric stent insertion should be considered a first-line treatment option.
- This approach is suitable for managing persistent or progressive megaureter causing hydronephrosis or pyonephrosis.
Aim:
To determine the efficacy and potential complications of double-J ureteric stents in the treatment of persistent or progressive primary obstructive megaureter in pediatric patients within our institution.
Materials And Methods:
A retrospective case-note review of all patients with double-J ureteric stents, between 1997 and 2004, was performed. In all, 38 stents were inserted in 31 patients aged between 2 months and 15 years of age. Complications and results of follow-up investigations and the need for follow-up investigations were recorded. Patients were followed up clinically and radiologically for a minimum of 2 years following stent insertion.
Results:
Endoscopic placement of double-J ureteric stents in childhood is straightforward and complications are uncommon (8/38 insertions). In non-resolving or progressive primary non-refluxing megaureter, double-J ureteric stenting alone is effective with resolution of primary non-refluxing megaureter in 66% of cases (25/38 insertions).
Conclusions:
Ureteric stenting provides an alternative to early surgery in patients with primary non-refluxing megaureter. The youngest patient in our series was 2 months old at the time of endoscopic ureteric double-J stent insertion. Endoscopic placement of ureteric double-J stents should be considered as a first-line treatment in the management of persistent or progressive non-refluxing megaureter leading to progressive hydronephrosis or pyonephrosis.
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