double-J Catheter Research Articles

Vesicovaginal fistula following large‐loop excision of the transformation zone in a chronic systemic glucocorticoid user

A 42-year-old woman with a history of a large-loop excision of transformation zone for cervical intraepithelial neoplasia III four years previously visited our outpatient department for cervical intraepithelial neoplasia I that newly detected by colposcopy-directed punch biopsy. Her other medical conditions include systemic lupus erythematosus on daily prednisolone 15 mg during 19 years. After second large-loop excision of transformation zone, delayed vesicovaginal fistula was confirmed by indigo carmine leakage test, computed tomography scan, and cystoscopy. Fistula was primarily repaired with indwelling double-J catheters with anchoring omentum on suture site.

Transumbilical single-incision laparoscopic ureterolithotomy

IntroductionLaparoendoscopic single-site surgery (LESS) using transumbilical access and conventional laparoscopic instruments is a very attractive alternative to perform ureterolithotomy for ureteral stone with failed endourological management. Material and methodA 29-year-old woman presented with chronic right lumbar pain and a 1.2 cm impacted calculus localized at transition of abdominal to pelvic ureter. Semirigid ureteroscopy had failed to fragment the stone and shockwave lithotripsy was not available. Double-J ureteral catheter had been inserted preoperatively. We performed a transumbilical single-incision laparoscopic ureterolithotomy. Three conventional trocars were inserted in a single semi-circular umbilical incision. Right colon was detached and the ureter was identified. Calculus was extracted and the ureteral incision was closed with intracorporal sutures. ResultsUreterolithotomy was successfully completed, with all the operative steps performed transumbically. Operative time was 180 minutes. No single-port device or articulating and bent instruments were utilized. Estimated blood loss was less than 50 mL. No intraoperative, access-related and postoperative complications took place. The duration of hospitalization was 24 hours and scarless appearance was observed on postoperative day 15. ConclusionTransumbilical single-incision laparoscopic ureterolithotomy is feasible and safe. This approach offers an inherent cosmetic advantages and few postoperative discomfort. Additional experience and continued investigation are warranted.

Ureterolitotomía laparoscópica con incisión única transumbilical

Introduction laparoendoscopic single-site surgery (LESS) using transumbilical access and conventional laparoscopic instruments is a very attractive alternative to perform ureterolithotomy for ureteral stone with failed endourological management. Material and method a 29-year-old woman presented with chronic right lumbar pain and a 1.2 cm impacted calculus localized at transition of abdominal to pelvic ureter. Semi-rigid ureteroscopy had failed to fragment the stone and shockwave lithotripsy was not available. Double-J ureteral catheter had been inserted preoperatively. We performed a transumbilical single-incision laparoscopic ureterolithotomy. Three conventional trocars were inserted in a single semi-circular umbilical incision. Right colon was detached and the ureter was identified. Calculus was extracted and the ureteral incision was closed with intracorporal sutures. Results ureterolithotomy was successfully completed, with all the operative steps performed transumbically. Operative time was 180 minutes. No single-port device or articulating and bent instruments were utilized. Estimated blood loss was less than 50 mL. No intraoperative, access-related and postoperative complications took place. The duration of hospitalization was 24 hours and scarless appearance was observed on postoperative day 15. Conclusion transumbilical single-incision laparoscopic ureterolithotomy is feasible and safe. This approach offers an inherent cosmetic advantage and few postoperative discomfort. Additional experience and continued investigation are warranted.

Kidney Healing After Laparoscopic Partial Nephrectomy Without Collecting System Closure in Pigs

To access the kidney healing after laparoscopic partial nephrectomy without closing of the collecting system in pigs. Fourteen pigs underwent left partial laparoscopic nephrectomy, with removal of 25% of the kidney length at caudal pole (n = 7) or at cranial pole (n = 7). Briefly, the surgical technique involved a transperitoneal laparoscopic access, en bloc vascular clamping of renal vessels, tissue excision with cold scissor and monopolar energy hemostasis of only the parenchyma, leaving the collecting system opened, with no insertion of a double-J catheter. The animals were clinically evaluated during 14 days, and afterward were killed. Serum levels of urea and creatinine were assessed prior and at different moments after surgery. Macroscopic necropsy analysis, a retrograde ex vivo pyelogram and a histologic study of the operated renal poles were performed. The animals did not show any postoperative clinical alterations. Serum levels of urea and creatinine showed a slight raising at the second postoperative day with gradual decreasing to preoperative levels. At necropsy, the abdominal cavity was normal, with normal quantity and aspect of peritoneal liquid. No signs of urine leakage were found. The operated renal pole was always involved by a perirenal fibrosis with adherences to adjacent organs. The pig kidney collecting system healed well without any kind of suture or internal drainage. Therefore, we concluded that the pig kidney is not an adequate model for research on which the collecting system healing is an important aspect to be considered.

Percutaneous nephrolithotomy for complex caliceal and staghorn stones in patients with solitary kidney

Treatment of patients with solitary kidney having complex stones is one of the most challenging problem in urology. We present our experience with percutaneous nephrolithotomy (PCNL) in treating 16 patients with staghorn stones in a solitary kidney to determine long-term renal functional results. We retrospectively reviewed the records of 16 patients with complex caliceal or staghorn stones in a solitary kidney treated with PCNL. Demographic data, number and location of accesses, hemoglobin values, stone analyses, and complications were studied. Serum creatinine, glomerular filtration rate (GFR), systolic and diastolic blood pressure, new onset hypertension, and kidney morphology were determined preoperatively and postoperatively at 1month and 1year. Male to female ratio was 14:2 and mean age was 49.6years (range 31-55). Of these, 10 (62.5%) patients required a single tract, while 6 (37.5%) required multiple tracts. The calculi were extracted or fragmented successfully in 13 (81.3%) patients and complete stone clearance was achieved after the first stage. In two patients with residual calculi, a double-J catheter was inserted and extracorporeal shock wave lithotripsy (SWL) was performed. There were no significant intraoperative problems except in one patient, who had bleeding from an infundibular tear attributable to torquing. During the 1-year study period, none of the patients progressed to end-stage renal disease requiring dialysis. We demonstrated a significant improvement in creatinine and GFR levels from preoperatively to 1-year follow-up. The number of patients with hypertension before PCNL was 5 and by the end of follow-up there was no new onset hypertension. The demonstrated effectiveness, small number of complications at short-term, not any poorly effect on renal function and blood pressure at the long-term follow-up confirm that PCNL is not only effective but is also safe in the solitary kidney with staghorn calculi.

Endoscopic Stented Ureterocystostomy

Fibrotic or neoplastic obstruction of the terminal ureter and ureterovesical junction can preclude internal drainage with a Double-J catheter. Some minimally invasive alternatives are described in the literature to avoid a percutaneous nephrostomy. We present a pure endourologic technique. In six patients with an obstructed upper urinary tract, after the introduction of iodine contrast, the ureter was punctured with a needle to introduce a guidewire in the urinary tract under cystoscopic and fluoroscopic control. The alternative path between the bladder and ureter was then dilated up 10F to facilitate the Double-J catheter introduction. All six patients had their obstructed urinary tract drained with a Double-J catheter inserted above the level of obstruction. No complication was verified. Internal urinary tract drainage with a Double-J catheter was accomplished using endourologic principles in six patients, avoiding a percutaneous nephrostomy or other more invasive procedures.

Iatrogenic Rupture of the Ureter During Kidney Biopsy

Perirenal hematoma, hematuria, and abdominal pain are common complications of kidney biopsy, but ureter rupture is relatively less frequent. Here we report a patient who experienced severe abdominal pain and gross hematuria following a non-smooth procedure of ultrasound-guided kidney biopsy. Computed tomography showed rupture of the left upper third of the ureter. We implanted a curled double-J catheter between the renal pelvis and urinary bladder. Abdominal pain and gross hematuria improved. After 2 months, the double-J catheter was removed and the patient had no further clinical symptoms. The possibility of ureter rupture, although rare, should be considered in the presence of abdominal pain and gross hematuria in patients after receiving a kidney biopsy.

One day hospitalization after open, double-J stented pyeloplasty

This study was undertaken to assess the effect of antegrade placement of internal double-J catheters for patients who underwent open pyeloplasty for ureteropelvic junction (UPJ) obstruction. Medical records of unilateral dismembered pyeloplasties of 71 patients with UPJ obstruction treated between 1998 and 2008 were reviewed retrospectively. In all patients, a double-J catheter was placed in an antegrade fashion during the operation. The patients were reviewed in terms of age, sex, postoperative complications and length of hospital stay. All children but one using double-J catheter were discharged within 24 hours after the operation. Neither urinary leak nor re-obstruction occurred in the operated kidneys during a follow-up. Transanastomotic stenting with double-J catheter is recommended as the reasonable mode of drainage in open pyeloplasty in pediatric patients.

Do Patients Benefit from Miniaturized Tubeless Percutaneous Nephrolithotomy? A Comparative Prospective Study

A benefit of miniaturized percutaneous nephrolithotomy (MPCNL) compared with conventional percutaneous nephrolithotomy (PCNL) has not been demonstrated as yet. Thus, the aim of this study was to evaluate the outcome of conventional vs MPCNL and to determine if MPCNL offers an advantage for the patient. A prospective, nonrandomized series of 50 consecutive patients with solitary calculi (lower pole or the renal pelvis) were treated either by conventional PCNL (26F) or MPCNL (18F). Ultrasound or holmium laser were used for lithotripsy. Patients were treated tubeless after uncomplicated MPCNL, with thrombin-matrix tract closure and antegrade Double-J catheter placement. After PCNL, all patients received 22F nephrostomies. Demographic data, stone characteristics, perioperative course, and complication rates were assessed. Patients characteristics were comparable in both groups, except for stone size, which was 18 +/- 8 mm (MPCNL) and 23 +/- 9 (PCNL; P = 0.042). Operative time was comparable in both groups (48 +/- 17 vs 57 +/- 22 min, not significant [NS]). After MPCNL, 96% were stone free at day 1 vs 92% after PCNL (NS). Significant complications did not occur in both groups. Minor complications were: Fever, 12% (MPCNL) vs 20% (PCNL; NS); bleeding, 4% vs 8%; perforations, 0% vs 4% (all NS). Overall outcome was not influenced by body mass index. Calcium oxalate stones were predominant with 75%. Patients after tubeless MPCNL had less pain (visual analogue score, 3 +/- 3 vs 4 +/- 3; P = 0.048.) and needed slightly less additional pain medication (25 +/- 12 mg/d vs 37 +/- 10 mg/d piritramid; NS). Hospital stay was significantly shorter after MPCNL (3.8 +/- 28 vs 6.9 +/- 3.5 d; P = 0.021.). Both techniques were safe and effective for the management of renal calculi. While stone-free rates were comparable in our series, MPCNL showed advantages in terms of shorter hospital stay and postoperative pain. The lower stone burden and the tubeless fashion of MPCNL, however, might have influenced these results.

Unusual complication of percutaneous nephrostomy in a renal transplant recipient

Context:Ureteral obstruction, resulting in impaired graft function, is a well-known problem following renal transplantation. Management of ureteral complications includes percutaneous nephrostomy, which is considered to be a safe and effective measure.Case Report:Here, we demonstrate a case of a 35-year old renal allograft recipient with primary graft function but stagnating serum creatinine following extraction of the double-J catheter. Ureteral stenosis was suspected by ultrasound imaging and magnetic resonance tomography, and urinary flow was preserved with a percutaneous nephrostomy. However, early displacement of the percutaneous nephrostomy catheter resulted in distinct clinical discomfort. CT imaging suggested an intra-abdominal position of the catheter's tip, requiring immediate surgical action.Conclusion:The present case demonstrates that performing PCN following renal transplantation may have unexpected risks.

Endourologic Implants to Treat Complex Ureteral Stenosis After Kidney Transplantation

To evaluate the safety and efficacy of nitinol stents and the Detour extra-anatomical ureteral bypass graft in treatment of ureteral stenosis after kidney transplantation. Eighteen kidney transplant recipients with complex stenosis caused by failure of primary treatment or with high surgical risk or a poorly functioning graft (serum creatinine concentration >2.5 mg/dL) were treated using antegrade percutaneous implantation of nitinol stents (n = 16) or extra-anatomical ureteral bypass grafts (n = 3); 1 patient was treated with both techniques. Mean (range) follow-up of ureteral stents was 51.2 (3-118) months. Patency rate at last follow-up, resumption of dialysis therapy, or death was 75% (12 of 16 patients). In 4 patients (25%), stent occlusion developed, which was treated using a double-J catheter in 2 patients, stent removal and pyeloureterostomy using the native ureter in 1 patient, and implantation of an extra-anatomical bypass graft in 1 patient. Mean follow-up in patients with extra-anatomical ureteral bypass grafts was 32 (8-64) months. One patient developed a urinary tract infection, and another had encrustation with obstruction. Use of nitinol ureteral stents and extra-anatomical ureteral bypass grafts is a safe and effective alternative to surgery for treatment of post-kidney transplantation ureteral stenosis in patients with chronic graft dysfunction, those at high surgical risk, and those in whom previous surgical treatment has failed.

Relationship Between Urinary Tract Infection and Self-Retaining Double-J Catheter Colonization

Long-term ureteral stenting is associated with bacterial colonization of both catheter surface and urine. The aim of the study was to evaluate the correlation between the type of bacteria cultured from the Double-J catheter, removed from urinary tract, and cultured from urine. Relationship of the Double-J catheter and urine culture with the duration of Double-J stenting, gender, the presence of diabetes mellitus, as well as the reason for stenting and manner of catheter insertion was also evaluated. Sixty-five patients were enrolled in the study. Urine specimens were cultured before stent insertion and removal. The stent was sent immediately for culture. Data such as age, sex, presence of diabetes mellitus, reason for stenting, and manner of catheterization were recorded. Urine cultures were positive in 17 cases, while catheter cultures were positive in 64 cases. In 10 cases, the same bacterial species were colonized from urine and stent surface, while in one case, both cultures were negative. In seven patients, both cultures showed different bacterial species, and in 47 cases, urine cultures were negative while the catheters were colonized. The only significant correlation was noted between urine culture and stenting duration (P < 0.05). Double-J catheter retention in the urinary tract is associated with a high risk of bacterial colonization, while the risk of urine infection is about fourfold lower. There is a great discrepancy between urine and catheter cultures.

Development of a Mathematical Model to Predict Extracorporeal Shockwave Lithotripsy Outcome

To determine statistically significant parameters that influence shockwave lithotripsy (SWL) outcome and to develop a mathematical equation to predict the possibility of a successful outcome. Radiopaque ureteral and renal stones (1997) underwent SWL in a single center using the Siemens Lithostar Plus lithotripter. Investigated variables were stone size and location; presence of multiple stones; patient sex, age, body mass index (BMI), and ureteropelvic junction (UPJ) diameter; and Double-J catheter presence. The investigation included intravenous urography or ultrasonography and plain radiography of the kidneys, ureters, and bladder (KUB). Ten percent of the patients also underwent unenhanced CT to determine stone volume and density. Patients were evaluated 3 months postoperatively by plain radiography of the KUB. Student t test, chi-square test, and multiple logistic regression analysis were used to determine statistically significant variables and to create predictive mathematical equations. Kidney, ureter, total stone-free rate, and re-treatment rate were 71%, 80.9%, 74.9% and 18%, respectively. Complications included two perirenal hematomas, one significant cardiac arrhythmia, and 3.7% stein-strasse. Statistically significant variables were patient age, sex, BMI, stone size, volume, density, multiple lithiasis, and UPJ diameter. By using statistical analysis, coefficients were calculated for each significant variable. The mathematical model calculating the probability (P) of success with a mean predictive value of about 80% is: P = 1/1 + e(-z) where e is the base of the natural logarithm and z = ct + the total of products of each coefficient multiplied by each variable value. Using the described method, similar predictive equations can be created for different lithotripters and used by computer software to aid both patient counseling and doctor decision and ensure an optimal combination of maximum efficacy and safety and minimum cost.

1.04] Analysis of encrustation of double-J catheters with optical coherence tomography (OCT)

Objective Encrustation of pigtail catheters with crystalline deposit of urine components is a well-known problem and in addition to lower urinary tract infection, the most common complication of any material placed in the urinary tract. There is neither any data about the beginning of encrustation in literature, nor about location or progression. The aim of this study is to make an analysis of the level of encrustation and to document the longitudinal progression with OCT. Material and methods Fourteen double-J (DJ) catheters (Neomedical Ch 7/28 cm) with different indwelling times were compared with a new DJ catheter as a reference, after removal. The external surfaces of the catheters were examined using endoscopic surface OCT (Imalux) and the intraluminal surfaces with endoluminal-radial OCT (LightLab Imaging) with regard to possible encrustation or crystalline sedimentation. The resolution of OCT was 20 μm. The pullback mode of the endoluminal radial OCT allowed the documentation in 6 μm sequences. Results The median indwelling time was 100 days (19–27 days; n =12 female and n =2 male patients). Firstly, the external encrustation was macroscopically rated in “low”, “medium” and “high”. The macroscopic and the extraluminal OCT results were correlated. With the help of endoluminal OCT, the dimension of intraluminal encrustation could be expressed as a percentage relating to the reference catheter. The luminal reduction caused by encrustation is significant higher at the proximal end of the pigtail. An encrustation at the distal end of the pigtail was only present when there was also an encrustation at the proximal end. Only 2 stents showed an encrustation in the middle part. Conclusion OCT made it possible to detect the encrustation of DJ catheters and express the degree of encrustation quantitatively. The encrustation started at the proximal side and seemed to expand antegrade. Further studies have to be carried out in order to answer the question if an encrustation expands from intra- to extraluminal or vice versa. With the help of OCT, the effect of surface modification of the implanted material could be examined in order to reduce encrustation.

Laparoscopic Repair of a Ureter Damaged During Inguinal Herniorrhaphy

Laparotomy has been used generally to deal with ureteral injury. Recently, a few papers have reported the repair of gynecologic ureteral injuries by laparoscopy, with encouraging results; however, successful repair of a ureter damaged during an open inguinal herniorrhaphy fully performed by laparoscopy has not been reported yet. A 49-year-old obese man (body mass index=35) in the 10 years before surgery began to note a protrusion in the scrotal region. The protrusion evolved asymptomatically for 8 years, and began to cause pain in the lumbar spine to the right and paresthesia of the right leg. An open right inguinal herniorrhaphy was performed. When the exeresis of the fatty tissue around the spermatic cord was being carried out, resection of a 12-cm tubular structure, supposedly the appendix, was performed. Wall defect was closed by a polypropylene mesh. Acute abdominal pain developed immediately in the postoperative period and investigation using laparoscopy was undertaken. After confirmation of ureteral injury, laparoscopic repair was performed, and the ureter was anastomosed without tension over a double-J catheter. A suction drain was left near the anastomosis. Postoperative period was uneventful. The vesical catheter was withdrawn on the eighth postoperative day and the drain on the twelfth postoperative day. The histopathologic report confirmed that the resected structure was the ureter. The patient has remained asymptomatic for 2 years since the surgery.

Application of double-J catheter in treatment of renal tuberculosis

Application of double-J catheter in treatment of renal tuberculosis

Immediate ureterovaginal fistula secondary to oocyte retrieval—a case report

To report a case of ureterovaginal fistula secondary to transvaginal oocyte retrieval (TVOR). Case report. IVF Center IN a private hospital. A 31-year-old woman presented immediately after TVOR with right lower abdominal pain with irradiation to the suprapubic area and vaginal discharge. Vaginal examination, creatinine dosage in plasma and vaginal discharge, excretory urography. A double-J catheter was inserted under general anesthesia. Clinical follow-up. Vaginal leakage ceased a few hours after catheter insertion. Transfer of two embryos was performed 3 days after TVOR, but no pregnancy occurred. The double-J catheter was removed 21 days after its placement. Imaging studies done 6 weeks later demonstrated a normal urinary tract morphology. Given the elective nature of TVOR and IVF, patients should be informed about all potential complications, including ureterovaginal fistula.

Comparison of a New Polytetrafluoroethylene-Covered Metallic Stent to a Noncovered Stent in Canine Ureters

The aim of this study was to determine the feasibility of using a newly designed polytetrafluoroethylene (PTFE)-covered metallic stent in the ureter by comparing its effectiveness with that of the noncovered stent in a canine model. We placed 14 stents in the ureters of seven mongrel dogs that weighed 30-40 kg each. The covered and noncovered stents were deployed in the right and left ureters, respectively, of six dogs. In the seventh dog, a covered stent and a double-J catheter were inserted in the right ureter, and a covered stent only was inserted in the left ureter. The first six dogs were sacrificed at 5, 10, and 15 weeks after deployment of the stents (two for each follow-up period), and the seventh dog was sacrificed at 30 weeks. There was no migration or poor expansion of any of the stents observed on plain radiography. On intravenous pyelogram and retrograde pyelogram, all of the covered stents at each follow-up period had patent lumens at the stented segments without hydronephrosis, and the passage of contrast material through it was well preserved. The noncovered stents in the dogs sacrificed at 5 and 10 weeks and one of the two dogs sacrificed at 15 weeks showed near-complete occlusion of the stent lumen due to ingrowth of the soft tissue, and severe hydronephrosis was also noted. The noncovered stent in the other dog sacrificed at 15 weeks showed the passage of contrast material without hydronephrosis, but the lumen of the stent was still nearly occluded by the soft tissue. There was no evidence of hydronephrosis or passage disturbance of the contrast material in both ureters of the dog sacrificed at 30 weeks. We conclude that the newly designed PTFE-covered stent effectively prevented the luminal occlusion caused by urothelial hyperplasia compared to the near-total occlusion of the noncovered stents, and no migration of the covered stents was noted.

Percutaneous nephrolithotomy in patients with solitary kidney.

The aim of this study was to evaluate percutaneous nephrolithotomy (PCNL) in the patients with solitary kidneys. Between 1995 and 2005, we had 11 patients with a solitary kidney and kidney calculi who underwent PCNL at our center. Tubeless and standard PCNLs were performed in 3 and 7 patients. In 1 patient, we could not achieve access to the system due to the stricture of the infundibulum. The calculi were extracted or fragmented successfully in 10 patients. In 2 patients with residual calculi, a double-J catheter was inserted and extracorporeal shock wave lithotripsy (SWL) was performed. Retroperitoneal hematoma was detected in 3 cases by ultrasonography 1 week after the procedure, which was treated conservatively. Also, fever occurred in 3 patients after the procedure which was treated successfully. The patients were discharged on the 3rd and 4th postoperative days. Although PCNL is accompanied by the risk of complications such as severe bleeding that may result in kidney loss in patients with a solitary kidney, the rate of success and complications seem to be similar to the other patients if careful operation and correct selection of candidates are done. Therefore, we recommend cautious performance of PCNL in patients with solitary kidneys.

Pediatric Robot Assisted Retroperitoneoscopic Pyeloplasty: A 5-Year Experience

We report our 5-year experience with retroperitoneoscopic robot assisted pyeloplasty for the treatment of ureteropelvic junction obstruction in children using the da Vinci Surgical System. A total of 65 children (median age 7.9 years, range 1.7 to 17.1) underwent 67 robot assisted retroperitoneoscopic pyeloplasties with the da Vinci Surgical System between 2002 and 2006. Operative data were sampled prospectively, while outcome data were collected from chart review. Retroperitoneal access was modified from standard retroperitoneoscopic access due to the limits of the camera arm movement. Median operative time was 143 minutes (range 93 to 300). Complications occurred in 12 of the 67 procedures (17.9%), with urinary tract infection observed in 2 cases, transient hematuria in 2, displaced Double-J catheter in 3 and postoperative temporary nephrostomy in 4. One case was converted to open surgery due to lack of space and limits in the movement of the camera arm. Four patients (6%) underwent repeat surgery due to a kinking ureter (2 patients), an overlooked aberrant vessel (1) and decreasing differential function on renography necessitating balloon dilation (1). In all other cases followup was uneventful. Robot assisted retroperitoneoscopic pyeloplasty gives more direct access to the ureteropelvic junction, allowing shorter operative times with results and complication rates comparable to transperitoneal robot assisted pyeloplasty, and laparoscopic and open procedures in children.