title: Percutaneous antegrade ureteral stent placement during pediatric robot-assisted laparoscopic pyeloplasty.
abstract: OBJECTIVE
  Robot-assisted laparoscopic pyeloplasty has become more widely used. Intraoperative placement and confirmation of ureteral stent position can be cumbersome with the robotic arms in place. We present a technique of percutaneous antegrade stent placement that is reliable with minimal morbidity.
  
  
  METHODS
  A retrospective cohort study was performed. Patient demographics, radiographic imaging, intraoperative details, and surgical outcomes were abstracted from the medical record. A 14-gauge angiocatheter was placed through the abdominal wall. A ureteral stent was guided over a wire down the dismembered ureter. Stent position was confirmed by retrograde reflux of methylene blue. A urethral catheter was left in place for 12 to 36 hours.
  
  
  RESULTS
  Twenty-nine patients (15 male, 14 female) were identified. Average age was 10 years. Average follow-up was 14 months. Fifteen left- and 14 right-sided procedures were performed. Two patients needed retrograde stent placement. Mean time to correctly position the stent was less than 5 minutes. Postoperatively, one patient had a urine leak managed by an indwelling urethral catheter and did not need percutaneous drainage. All stents were removed approximately 4 to 6 weeks postoperatively. One patient had retrograde migration of the stent managed by ureteroscopy at the time of stent retrieval.
  
  
  CONCLUSIONS
  Antegrade ureteral stent placement through a percutaneous angiocatheter, during robot-assisted laparoscopic pyeloplasty, is a rapid and effective technique. Intraoperative confirmation of stent position can be obtained, using methylene blue bladder distention, without repositioning the patient or undocking the surgical robot.
authors.affiliation: Division of Pediatric Urology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio 45229-3039, USA. paul.noh@cchmc.org
authors.forename: Paul H
authors.initials: PH
authors.lastname: Noh
authors.forename: W Robert
authors.initials: WR
authors.lastname: Defoor
authors.forename: Pramod P
authors.initials: PP
authors.lastname: Reddy
mesh_terms: D000293:Adolescent; D057785:Catheters; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007682:Kidney Pelvis / Q000601:surgery; D010535:Laparoscopy; D008297:Male; D019651:Plastic Surgery Procedures / Q000379:methods*; D012371:Robotics; D015607:Stents; D014513:Ureter / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods*