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Ultrasound-guided antegrade access during laparoscopic pyeloplasty in infants less than one year of age: A point of technique.

Ganpule A, Bhattu A, Mishra S, Desai MR - J Minim Access Surg (2012)

Bottom Line: The modified technique was successfully done in five patients aged less than one year old.All patients tolerated the procedure well.Ultrasound-guided ante grade nephroureteral ureteral splint for infant laparoscopic pyeloplasty is safe.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India.

ABSTRACT

Background: Access to urethras and ureters of infants may be hazardous and injurious through an endoscopic route. Placement and removal of stents in infants requires anaesthesia and access through these small caliber urethras. We describe our technique of placing antegrade splint during a laparoscopic pyeloplasty in these infants.

Materials and methods: An ultrasound-guided percutaneous renal access is obtained. Telescopic metal two part needle is passed into the kidney over a guide wire. A second guide wire is passed through the telescopic metal two part needle. The tract is dilated with 14 Fr screw dilator. Over one guide wire, a 5 Fr ureteric catheter is passed and coiled in the renal pelvis. Over the other wire, a 14 Fr malecot catheter is placed as nephrostomy. Laparoscopic pyeloplasty is then done. During pyelotomy, the ureteric catheter is pulled and advanced through the ureter before the pyeloplasty is completed. The ureteric catheter thus acts as a splint across the anastomosis. Ureteric catheter is removed on the 3(rd) post operative day and nephrostomy is clamped. Nephrostomy is removed on 4(th) post operative day if child is asymptomatic. The modified technique was successfully done in five patients aged less than one year old. All patients tolerated the procedure well. Post operative period was uneventful in all.

Conclusion: Ultrasound-guided ante grade nephroureteral ureteral splint for infant laparoscopic pyeloplasty is safe. It avoids the need for urethral instrumentation for insertion and removal of stents in these small patients.

No MeSH data available.


Related in: MedlinePlus

(a) Line diagram showing completed anastomosis with nephrostomy and ureteric catheter (splint) in situ, (b) Laparoscopic pyeloplasty performed after the ureteric catheter and percutaneous nephrostomy is in place c) Opened up renal pelvis showing presence of both malecot catheter and ureteric catheter in pelvis (d) Ultrasound showing flower of malecot catheter opened in pelvis
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Figure 5: (a) Line diagram showing completed anastomosis with nephrostomy and ureteric catheter (splint) in situ, (b) Laparoscopic pyeloplasty performed after the ureteric catheter and percutaneous nephrostomy is in place c) Opened up renal pelvis showing presence of both malecot catheter and ureteric catheter in pelvis (d) Ultrasound showing flower of malecot catheter opened in pelvis

Mentions: An egress of clear fluid suggests entry in the pelvicalyceal system which can further be confirmed with a contrast study [Figure 3]. Next a guide wire is parked in a distant calyx and the tract dilated up to 14 Fr using a screw dilator. An Alken needle, which is a two part needle, helps in passing a second guide wire after removing the inner stylet [Figure 4]. Once both guide wires are in place, one wire is used for passing a ureteric catheter and the second one is used for placing a nephrostomy tube [Figure 5]. The ureteric catheter is coiled in the pelvis. The salient feature of our technique is that all steps of percutaneous access which include access and dilation are done solely using ultrasound guidance.


Ultrasound-guided antegrade access during laparoscopic pyeloplasty in infants less than one year of age: A point of technique.

Ganpule A, Bhattu A, Mishra S, Desai MR - J Minim Access Surg (2012)

(a) Line diagram showing completed anastomosis with nephrostomy and ureteric catheter (splint) in situ, (b) Laparoscopic pyeloplasty performed after the ureteric catheter and percutaneous nephrostomy is in place c) Opened up renal pelvis showing presence of both malecot catheter and ureteric catheter in pelvis (d) Ultrasound showing flower of malecot catheter opened in pelvis
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3401718&req=5

Figure 5: (a) Line diagram showing completed anastomosis with nephrostomy and ureteric catheter (splint) in situ, (b) Laparoscopic pyeloplasty performed after the ureteric catheter and percutaneous nephrostomy is in place c) Opened up renal pelvis showing presence of both malecot catheter and ureteric catheter in pelvis (d) Ultrasound showing flower of malecot catheter opened in pelvis
Mentions: An egress of clear fluid suggests entry in the pelvicalyceal system which can further be confirmed with a contrast study [Figure 3]. Next a guide wire is parked in a distant calyx and the tract dilated up to 14 Fr using a screw dilator. An Alken needle, which is a two part needle, helps in passing a second guide wire after removing the inner stylet [Figure 4]. Once both guide wires are in place, one wire is used for passing a ureteric catheter and the second one is used for placing a nephrostomy tube [Figure 5]. The ureteric catheter is coiled in the pelvis. The salient feature of our technique is that all steps of percutaneous access which include access and dilation are done solely using ultrasound guidance.

Bottom Line: The modified technique was successfully done in five patients aged less than one year old.All patients tolerated the procedure well.Ultrasound-guided ante grade nephroureteral ureteral splint for infant laparoscopic pyeloplasty is safe.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India.

ABSTRACT

Background: Access to urethras and ureters of infants may be hazardous and injurious through an endoscopic route. Placement and removal of stents in infants requires anaesthesia and access through these small caliber urethras. We describe our technique of placing antegrade splint during a laparoscopic pyeloplasty in these infants.

Materials and methods: An ultrasound-guided percutaneous renal access is obtained. Telescopic metal two part needle is passed into the kidney over a guide wire. A second guide wire is passed through the telescopic metal two part needle. The tract is dilated with 14 Fr screw dilator. Over one guide wire, a 5 Fr ureteric catheter is passed and coiled in the renal pelvis. Over the other wire, a 14 Fr malecot catheter is placed as nephrostomy. Laparoscopic pyeloplasty is then done. During pyelotomy, the ureteric catheter is pulled and advanced through the ureter before the pyeloplasty is completed. The ureteric catheter thus acts as a splint across the anastomosis. Ureteric catheter is removed on the 3(rd) post operative day and nephrostomy is clamped. Nephrostomy is removed on 4(th) post operative day if child is asymptomatic. The modified technique was successfully done in five patients aged less than one year old. All patients tolerated the procedure well. Post operative period was uneventful in all.

Conclusion: Ultrasound-guided ante grade nephroureteral ureteral splint for infant laparoscopic pyeloplasty is safe. It avoids the need for urethral instrumentation for insertion and removal of stents in these small patients.

No MeSH data available.


Related in: MedlinePlus