title: External extension of double-J ureteral stent during pyeloplasty: inexpensive stent and non-cystoscopic removal.
abstract: OBJECTIVE
  The purpose of the study is to describe our experience with the application of externalized double-J ureteral stent (DJUS) during pyeloplasty for correction of ureteropelvic junction obstruction (UPJO) in order to avoid cystoscopy for stent removal.
  
  
  METHODS
  Pyeloplasty was performed in 523 infants with UPJO using miniature pyeloplasty technique. After removing the obstructed segment, a 3-Fr. DJUS was placed into the ureter. In order to avoid cystoscopy for the removal of the stent, a feeding tube was passed through the skin and renal pelvis via a separate stab incision, connected to the DJUS and secured to the external body surface (skin), and the pyeloplasty was completed. The feeding tube along with the stent was removed after 3-4 weeks, respectively. Postoperative follow-up visits were performed 1, 3, and 6 months after the procedure.
  
  
  RESULTS
  The mean operative time was 49 min (range 41-79). Patients were discharged after 17 ± 2 h (mean ± SD). No patient experienced bladder spasm or anticholinergic administration. Forty-four patients (8.4 %) experienced minor complications including non-febrile urinary tract infections and mild hematuria. No major complication including urinoma, leakage, and stent migration or displacement was observed during the follow-up period. Stent removal was tolerated by 99.8 % of patients in an outpatient setting with minimal discomfort without performing cystoscopy.
  
  
  CONCLUSIONS
  Using external DJUS along with a pyelocutaneous stent extension during pyeloplasty is a safe, feasible, and beneficial technique. This technique resulted in high success rate with minimal cost and no renal injury. The non-cystoscopic stent removal and elimination of urethral catheterization following pyeloplasty are the other advantages of this technique.
authors.affiliation: Pediatric Urology Research Center, Section of Tissue Engineering and Stem Cell Therapy, Department of Pediatric Urology, Children's Pediatric Center of Excellence, Children's Hospital Medical Center, Tehran University of Medical Sciences, No. 62, Dr. Gharib's Street, Keshavarz Bolvard, 1419433151, Tehran, Islamic Republic of Iran, kajbafzd@sina.tums.ac.ir.
authors.forename: Abdol-Mohammad
authors.initials: AM
authors.lastname: Kajbafzadeh
authors.forename: Atefeh
authors.initials: A
authors.lastname: Zeinoddini
authors.forename: Maryam
authors.initials: M
authors.lastname: Ebadi
authors.forename: Reza
authors.initials: R
authors.lastname: Heidari
authors.forename: Afshin
authors.initials: A
authors.lastname: Tajalli
mesh_terms: D002408:Catheters, Indwelling; D020878:Device Removal / Q000295:instrumentation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006417:Hematuria / Q000209:etiology; D006801:Humans; D007223:Infant; D007682:Kidney Pelvis / Q000601:surgery*; D008297:Male; D061646:Operative Time; D019919:Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D015607:Stents; D014513:Ureter / Q000601:surgery*; D014517:Ureteral Obstruction / Q000601:surgery*; D014552:Urinary Tract Infections / Q000209:etiology