title: Revisiting the tethered ureteral stents in children: a novel modification.
abstract: OBJECTIVE
  To propose a simple noninvasive method for ureteral stent retrieval using an extraction string sutured to the skin in children.
  
  
  METHODS
  A retrospective chart review was performed to gather relevant data from December 2005 to February 2013. After the surgeries, if indicated, a tethered double-J stent was placed in the ureter. A 5-0 non-absorbable Prolene stitch was used as an extraction string passing through the urethra and was sutured to subcoronal skin in boys or inner surface of labia majora in girls. For stent removal, a small amount of 2 % lidocaine jelly was pushed into the urethra 5 min before the procedure. The string was then pulled by continuous and gentle force until the entire stent was out. The suture was then cut to release the stent. No sedation or anesthesia was needed.
  
  
  RESULTS
  A total of 378 double-J stents with extraction strings were inserted for a total of 325 patients (61.2 % male). Of the 53 patients with bilateral ureteral stents, one male patient (1.88 %) experienced early stent protrusion from urethral meatus. Two of 272 patients (0.73 %) with unilateral ureteral stent (one male and one female) encountered the same problem. All other stents were extracted successfully using the extraction string without any complications. No upward stent migration or suture site reaction was encountered.
  
  
  CONCLUSIONS
  This method is a safe, easy-to-use, feasible and noninvasive alternative for cystoscopic stent removal with high success rate and minimal complications. This can lead to considerable saving in time and costs for patients, families and healthcare system.
authors.affiliation: Pediatric Urology Research Center, Pediatrics Center of Excellence, Tehran University of Medical Sciences, No. 62, Dr. Gharib's Street, Keshavarz Boulevard, PO Box 1419733151, Tehran, Iran, kajbafzd@sina.tums.ac.ir.
authors.forename: Abdol-Mohammad
authors.initials: AM
authors.lastname: Kajbafzadeh
authors.forename: Behnam
authors.initials: B
authors.lastname: Nabavizadeh
authors.forename: Sorena
authors.initials: S
authors.lastname: Keihani
authors.forename: Seyed Hossein
authors.initials: SH
authors.lastname: Hosseini Sharifi
mesh_terms: D002675:Child, Preschool; D020878:Device Removal / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D015607:Stents; D014513:Ureter
references.citation: J Urol. 2001 Sep;166(3):890-3
references.pmid: 11490240
references.citation: J Urol. 2002 May;167(5):2198-202
references.pmid: 11956478
references.citation: Urology. 2014 Oct;84(4):960-6
references.pmid: 25151437
references.citation: J Urol. 2013 Feb;189(2):719-25
references.pmid: 22982432
references.citation: J Endourol. 2012 Apr;26(4):387-92
references.pmid: 22050507
references.citation: BJU Int. 2014 Apr;113(4):605-9
references.pmid: 24765679
references.citation: J Urol. 1994 Sep;152(3):976-7
references.pmid: 8051775
references.citation: J Urol. 1995 Jul;154(1):167-8
references.pmid: 7776416
references.citation: J Urol. 1996 Jan;155(1):58-61
references.pmid: 7490898
references.citation: Eur Urol. 2012 Jan;61(1):225-6
references.pmid: 21959013
references.citation: J Urol. 2008 Jul;180(1):295-6
references.pmid: 18499172
references.citation: Int Urol Nephrol. 2005;37(3):541-6
references.pmid: 16307339
references.citation: Int Urol Nephrol. 2014 Apr;46(4):671-6
references.pmid: 24202957
references.citation: J Urol. 2013 Mar;189(3):1054-60
references.pmid: 23022000
references.citation: Urology. 1986 Nov;28(5):429
references.pmid: 3787909
references.citation: J Urol. 2002 Nov;168(5):2020-3
references.pmid: 12394699
references.citation: PLoS One. 2012;7(1):e29292
references.pmid: 22235282
references.citation: J Urol. 1978 Dec;120(6):678-81
references.pmid: 731804
references.citation: J Urol. 2015 Jun;193(6):2011-4
references.pmid: 25541339
references.citation: World J Urol. 2000 Sep;18(4):237-42
references.pmid: 11000305
references.citation: BJU Int. 2014 Apr;113(4):517-8
references.pmid: 24629084
references.citation: Br J Urol. 1988 Nov;62(5):409-11
references.pmid: 3061554
references.citation: Ther Adv Urol. 2010 Apr;2(2):85-92
references.pmid: 21789086
references.citation: J Urol. 1989 Mar;141(3):510-2
references.pmid: 2918584
references.citation: J Urol. 1989 Sep;142(3):701-3
references.pmid: 2671410
references.citation: J Urol. 2007 Mar;177(3):1118-23; discussion 1123
references.pmid: 17296426