PURPOSE: Lower urinary tract decompression in children with congenital obstructive uropathy, including posterior urethral valves (PUV), is recommended until definitive surgical intervention.
Current options, limited to a feeding tube or Foley, pose unappreciated constraints in lumenal diameter, and are associated with important potential problems. Herein we assess the impact of lumenal diameter in the current draining options and present a novel, alternative method repurposing a widely available stent that optimizes drainage.
MATERIALS AND METHODS: A retrospective review was performed from January 2013 through December 2014 on patients with a diagnosis of PUV. A 6 Fr. × 12 cm double-J stent (Cook Urological, Spencer, Indiana, USA) was advanced over a guidewire in a retrograde fashion into the bladder in all patients. Lumenal flow and cross-sectional areas were also assessed for each of three tubes for urinary drainage (6 Fr. double-J stent, 5 Fr. feeding tube, and 6 Fr. Foley).
RESULTS: Thirty patients underwent uneventful bedside double-J stent placement. Mean age at valve ablation was 28.5 ± 16.6 days. Mean peak serum creatinine after birth was 2.23±0.97 mg/dL and 0.56±0.22 mg/dL at the time of procedure. Urine output post-stent placement was excellent in all patients. The Foley and feeding tube drained approximately 18 and 6 times more slowly, and exhibited half the calculated cross-sectional lumenal area, compared to the double-J stent.
CONCLUSIONS: Use of double-J stents in neonates with PUV is a safe and effective alternative method for lower urinary tract decompression that optimizes the flow/lumen relationship compared with conventional drainage options.
Written by:
Penna FJ, Bowlin P, Alyami F, Bägli DJ, Koyle MA, Lorenzo AJ. Are you the author?
Division of Paediatric Urology, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada.
Reference: J Urol. 2015 May 8. pii: S0022-5347(15)03910-5.
doi: 10.1016/j.juro.2015.04.102
PubMed Abstract
PMID: 25963187