Open Access

PEDIATRIC UROLOGY

Endoscopic placement of double-J ureteric stents in children as a treatment for primary hydronephrosis

Zenon Pogorelić^1,2, Tomislava Brković², Dražen Budimir¹, Jakov Todorić¹, Đurđica Košuljandić³, Ana Jerončić⁴, Mihovil Biočić¹, Marijan Saraga^2,3

1 Department of Pediatric Surgery, Split University Hospital, Split, Croatia
2 University of Split School of Medicine, Split, Croatia
3 Department of Pediatrics, Split University Hospital, Split, Croatia
4 Department of Research in Biomedicine and Health, University of Split School of Medicine, Split, Croatia
Address correspondence to Dr. Zenon Pogorelić, Department of Pediatric Surgery, Split University Hospital Centre, Spinčićeva 1, 21 000 Split, Croatia

Canadian Journal of Urology 2017, 24(3), 8853-8858.

Abstract

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, rightsided 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 timeconsuming to definitive surgery.

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