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Endoscopic placement of double-J ureteric stents in children as a treatment for primary hydronephrosis
Zenon Pogorelić1, Tomislava Brković, Dražen Budimir
1Department of Pediatric Surgery, Split University Hospital, Split, Croatia.
Insights
Double-J ureteric stents are effective for treating primary hydronephrosis in children, with an 83.5% success rate in those under 4 years old. This minimally invasive approach offers an alternative to open surgery for pediatric hydronephrosis management.
Area of Science:
- Pediatric Surgery
- Urology
Background:
- Primary hydronephrosis is a common condition in pediatric patients.
- Treatment options for pediatric hydronephrosis include open surgery and minimally invasive procedures.
Purpose of the Study:
- To evaluate the efficacy and complications of double-J ureteric stents in treating primary hydronephrosis in pediatric patients.
- To determine the optimal age group for this intervention.
Main Methods:
- A retrospective review of 133 pediatric patients treated with double-J ureteric stents for primary hydronephrosis between 1997 and 2014.
- Patients were followed clinically and radiologically for at least 2 years post-stent insertion.
Main Results:
- Double-J ureteric stenting achieved a 73% overall success rate in resolving hydronephrosis.
- Success rates were highest in younger children, with 83.5% in the 0-4 year age group, decreasing significantly with age.
- Complications included symptomatic infections, stent migration, and progression of hydronephrosis.
Conclusions:
- Endoscopic double-J ureteric stenting is a minimally invasive and effective first-line treatment for primary hydronephrosis in children, particularly those under 4 years.
- It provides a viable alternative to open surgery, with a high success rate and manageable complications.
- Definitive surgery may be required in cases of treatment failure.
Introduction:
The aim of this study was to determine the efficacy and potential complications of double-J ureteric stents in the treatment of primary hydronephrosis in pediatric patients.
Materials And Methods:
A retrospective case-records review of 133 patients (45 girls and 88 boys) treated because of primary hydronephrosis with double-J ureteric stents, in Department of Pediatric Surgery, Split University Hospital, between December 1997 and December 2014, was performed. Success of treatment, results of follow up investigations and complications were recorded. Patients were followed up clinically and radiologically for a minimum of 2 years following stent insertion.
Results:
In all, 133 endoscopic double-J ureteric stents insertions were performed. Of the total number of patients, left-sided hydronephrosis was found in 82 patients, right-sided in 38, and bilateral in 13 patients. The median age of children was 2 years (range 0-17 years). Mean hospital stay was 2 days (range 1-10 days). In primary hydronephrosis, double-J ureteric stenting alone was effective with resolution of hydronephrosis in 73% of cases (97/133 insertions). Regarding the age of the patients the highest success of 83.5% was achieved in age group 0-4 years. Success in groups 5-9 years; 10-14 years and 15-17 years were 47%; 33.5% and 0%, respectively. Several complications have been recorded: symptomatic infections, migration in the renal pelvis and bladder, progression of hydronephrosis, spontaneously prolapse of prosthesis, bleeding and perforation of the renal pelvis. A significant, decreasing trend in success rates by age of participants was observed (p < 0.001).
Conclusions:
Ureteric stenting is minimally invasive procedure that provides an alternative to open surgery in patients with primary hydronephrosis. Endoscopic placement of ureteric double-J stents should be considered as a first-line treatment in the management of primary hydronephrosis especially in children till 4 years of age, with success rate of 83.5% and without the need for conventional surgery. In a case of failure we are time-consuming to definitive surgery.
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