Abstract
Objective: Double-J tube placement is an important procedure during upper urinary tract surgery. A primary drawback is the requirement of a second double-J tube removal under a cystoscope. Therefore, a simple and feasible alternative is required to remove the double-J tube without cystoscopy. The present study reported the feasibility and safety of a simple non-cystoscopic double-J tube removal technique.Method: We retrospectively analysed children who underwent pyeloplasty and ureterovesical reimplantation between June 2015 and August 2021. A simple device (a catheter with a suture) was used to pull out the double-J tube. Patient characteristics, detailed surgical procedures, success and complication rates and reasons for failure were evaluated.Result: A total of 613 children were included. The mean age of patients was 6.2 months (3 months−14 years). Non-endoscopic methods were used to remove the double-J tube in all except 6 patients (0.9%). Of the 6 patients who required ureteroscopy or cystoscopy, 4 had retraction of the double-J tube into the ureter, and 2 (0.6%) had bladder stones. Of the 613 patients, 479 (76.0%) required one attempt, 127 (20.1%) required two attempts and 19 (3.0%) required several attempts. No serious postoperative complications occurred in all patients. The most common complications were gross haematuria (22.5%), pain urinating (17.9%), difficulty in urinating (3.6%), foreskin injury (1.7%), and penile oedema (1.3%). No urethral strictures developed during the follow-up period.Conclusion: The study results demonstrated that the modified and simple non-cystoscopic double-J tube removal technique is a safe and an effective alternative to cystoscopy in clinical practise.
Highlights
Double-J tube removal is mostly performed under direct cystoscopic visualisation in the departments of urology and paediatric surgery
A total of 631 paediatric patients who presented with hydronephrosis and a history of pyeloplasty between June 2015 and August 2021 were admitted to our hospital
All the children or their parents who agreed to undergo our modified double-J tube extraction without a cystoscope were included in our study
Summary
Double-J tube removal is mostly performed under direct cystoscopic visualisation in the departments of urology and paediatric surgery. Some examples are as follows: the application of double-J tube with magnetic ends [1,2,3,4], surgical techniques for external placement of the double-J tube [5], and the percutaneous antegrade removal technique [6] These methods have certain limitations, such as the high cost of materials, requirement of technical expertise and additional surgical interventions, which increase the risk of complications. Our method has been reported in previous literature, such as the Vellore Catheter Snare technique [7] along with two similar techniques reported by Lin et al [8] and Shao et al [9] These studies have revealed that non-cystoscopic doubleJ tube removal had a shorter operation time and lower cost compared to that of a cystoscopic approach [7,8,9]. Our study involved large sample size to assess the feasibility and safety of the non-cystoscopic double-J tube removal technique in children
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