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Feasibility and safety of magnetic-end double-J ureteral stent insertion and removal in children

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Abstract

Purpose

The need for surgical removal of a double-J ureteral stent (DJUS) is considered one of its disadvantages. Apart from increased cost, repeated exposure to general anesthesia is a concern in children. Alternative techniques have been described, all failing to become integrated into mainstream practice. Stents with a distal magnetic end, although introduced in the early 1980s, have only recently gained acceptance. We report the feasibility and safety of insertion and removal of a magnetic-end double-J ureteral stent (MEDJUS) in a pediatric population.

Materials and methods

We retrospectively analyzed the use of the Magnetic Black-Star Urotech® MEDJUS between 11/2016 and 12/2019 in children. Stents were removed in the outpatient clinic using a transurethral catheter with a magnetic tip.

Results

MEDJUS insertion was attempted in 100 patients (65 boys). Mean age was 7.8 years (0.5–18). The stent was placed in an antegrade procedure (n = 47), by a retrograde route (n = 10), and during open surgery (n = 43). Stent insertion was successful in 84 cases (84%). All 16 failures occurred during the antegrade approach in laparoscopic pyeloplasty, with inability to push the stent and its magnet through the ureterovesical junction in 14. Magnetic removal was attempted in 83 patients, successful in 81 (98%). There was no added morbidity with the MEDJUS.

Conclusions

The use of MEDJUS is a safe and effective strategy that obviates the need for additional general anesthesia in children. Its insertion is similar to that with regular DJUS, and its easy and less time-consuming removal benefits both the patient and the hospital and validates its clinical use.

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Availability of data and material

All data discussed in the paper can be found within the main text, figures and movie.

Abbreviations

DJUS:

Double-J ureteral stent

GA:

General anesthesia

MEDJUS:

Magnetic-end double-J ureteral stent

UVJ:

Ureterovesical junction

References

  1. Finney RP (1978) Experience with new double J ureteral catheter stent. J Urol 120(6):678–681. https://doi.org/10.1016/S0022-5347(17)57326-7

    Article  CAS  PubMed  Google Scholar 

  2. Donahue RP et al (2018) Evolution of the ureteral stent: the pivotal role of the gibbons ureteral catheter. Urology 115:3–7. https://doi.org/10.1016/j.urology.2018.02.007

    Article  PubMed  Google Scholar 

  3. Kawahara T et al (2012) Ureteral stent retrieval using the crochet hook technique in females. PLoS ONE 7(1):e29292. https://doi.org/10.1371/journal.pone.0029292

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Jones JS (2002) Shortened pull-string simplifies office-based ureteral stent removal. Urology 60(6):1095–1097. https://doi.org/10.1016/s0090-4295(02)02000-9

    Article  PubMed  Google Scholar 

  5. Rassweiler M-C, Michel M-S, Ritter M, Honeck P (2017) Magnetic ureteral stent removal without cystoscopy: a randomized controlled trial. J Endourol 31(8):762–766. https://doi.org/10.1089/end.2017.0051

    Article  PubMed  Google Scholar 

  6. Söylemez H, Sancaktutar AA, Bozkurt Y, Atar M, Penbegül N, Yildirim K (2011) A cheap minimally painful and widely usable alternative for retrieving ureteral stents. Urol Int 87(2):199–204. https://doi.org/10.1159/000327610

    Article  PubMed  Google Scholar 

  7. McCann ME, Soriano SG (2019) Does general anesthesia affect neurodevelopment in infants and children? BMJ 367:l6459. https://doi.org/10.1136/bmj.l6459

    Article  PubMed  Google Scholar 

  8. Shao H, Liu P, Zhang H, Chen C, Lin X (2018) Noncystoscopic removal of retained ureteral stents in children. Medicine (United States) 97(1):e9540. https://doi.org/10.1097/MD.0000000000009540

    Article  Google Scholar 

  9. Bockholt NA, Wild TT, Gupta A, Tracy CR (2012) Ureteric stent placement with extraction string: no strings attached? BJU Int 110(11 C):E1069–E1073. https://doi.org/10.1111/j.1464-410X.2012.11219.x

    Article  PubMed  Google Scholar 

  10. Doizi S et al (2017) First clinical evaluation of a new single-use flexible cystoscope dedicated to double-J stent removal (IsirisTM): a European prospective multicenter study. World J Urol 35(8):1269–1275. https://doi.org/10.1007/s00345-016-1986-0

    Article  PubMed  Google Scholar 

  11. Soria F et al (2018) Evaluation of a new design of Antireflux-biodegradable ureteral stent in animal model. Urology 115:59–64. https://doi.org/10.1016/j.urology.2018.02.004

    Article  PubMed  Google Scholar 

  12. Helmy T, Blanc T, Paye-Jaouen A, El-Ghoneimi A (2011) Preliminary experience with external ureteropelvic stent: alternative to double-J stent in laparoscopic pyeloplasty in children. J Urol 185(3):1065–1069. https://doi.org/10.1016/j.juro.2010.10.056

    Article  PubMed  Google Scholar 

  13. Braga LHP, Lorenzo AJ, Farhat WA, Bägli DJ, Khoury AE, Pippi Salle JL (2008) Outcome analysis and cost comparison between externalized pyeloureteral and standard stents in 470 consecutive open pyeloplasties. J Urol 180(4 Suppl.):1693–1699. https://doi.org/10.1016/j.juro.2008.05.084

    Article  PubMed  Google Scholar 

  14. Macaluso JN, Deutsch JS, Goodman JR, Appell RA, Prats LJ, Wahl P (1989) The use of the magnetip double-J ureteral stent in urological practice. J Urol 142(3):701–703. https://doi.org/10.1016/S0022-5347(17)38858-4

    Article  PubMed  Google Scholar 

  15. Taylor WN, McDougall IT (2002) Minimally invasive ureteral stent retrieval. J Urol 168(5):2020–2023. https://doi.org/10.1016/S0022-5347(05)64286-3

    Article  CAS  PubMed  Google Scholar 

  16. Mitchell A, Bolduc S, Moore K, Cook A, Fermin C, Weber B (2019) Use of a magnetic double J stent in pediatric patients: a case–control study at two Canadian pediatric centers. J Pediatr Surg. https://doi.org/10.1016/j.jpedsurg.2019.03.014

    Article  PubMed  PubMed Central  Google Scholar 

  17. Blanc T et al (2013) Retroperitoneal laparoscopic pyeloplasty in children: long-term outcome and critical analysis of 10-year experience in a teaching center. Eur Urol 63(3):565–572. https://doi.org/10.1016/j.eururo.2012.07.051

    Article  PubMed  Google Scholar 

  18. Almeras C et al (2017) Double J stent removal’s cost estimate using a re-sterilizable fibroscope in a French private structure. Prog Urol 27(16):1031–1035. https://doi.org/10.1016/j.purol.2017.07.240

    Article  CAS  PubMed  Google Scholar 

  19. Chu DI et al (2018) Outcomes of externalized pyeloureteral versus internal ureteral stent in pediatric robotic-assisted laparoscopic pyeloplasty. J Pediatr Urol 14(5):450.e1–450.e6. https://doi.org/10.1016/j.jpurol.2018.04.012

    Article  CAS  Google Scholar 

  20. Mykulak DJ, Herskowitz M, Glassberg KI (1994) Use of magnetic internal ureteral stents in pediatric urology: retrieval without routine requirement for cystoscopy and general anesthesia. J Urol 152(3):976–977. https://doi.org/10.1016/S0022-5347(17)32634-4

    Article  CAS  PubMed  Google Scholar 

  21. Rassweiler M-C, Michel M-S, Ritter M (2014) Black-Star®—magnetic DJ removal. J Urol 191(4S):e949–e950

    Google Scholar 

  22. Oonnell L, Broe MP, Rooney D, Elhag S, Cheema I, McGuire BB (2018) Magnetic stent removal in a nurse Led Clinic; a nine month experience. Iran Med J 111(2):687

    Google Scholar 

  23. Singh KM, Goel A, Shankhwar SN, Dalela D (2004) Confirmation of the correct placement of lower end of DJ stent during open surgery: point of technique. Int Urol Nephrol 36(3):335–336. https://doi.org/10.1007/s11255-004-0924-z

    Article  CAS  PubMed  Google Scholar 

  24. Kurien T, Price KR, Pearson RG, Dieppe C, Hunter JB (2016) Manipulation and reduction of paediatric fractures of the distal radius and forearm using intranasal diamorphine and 50% oxygen and nitrous oxide in the emergency department: a 2.5-year study. Bone Jt J 98-B(1):131–136. https://doi.org/10.1302/0301-620X.98B1.36118

    Article  CAS  Google Scholar 

  25. Mehrabi A et al (2019) Surgical outcomes after pediatric kidney transplantation at the University of Heidelberg. J Pediatr Urol 15(3):221.e1–221.e8. https://doi.org/10.1016/j.jpurol.2019.01.007

    Article  CAS  Google Scholar 

  26. Administration UFaD (2016) FDA Drug Safety Communication: FDA review results in new warnings about using general anesthetics and sedation drugs in young children and pregnant women. https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-fda-review-results-new-warnings-about-using-general-anesthetics-and. Accessed 3 Aug 2018

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Authors and Affiliations

  1. Service de Chirurgie Viscérale et Urologie Pédiatriques, APHP, Hôpital Necker, Paris, France

    Marc Chalhoub, Jules Kohaut, Nicolas Vinit, Nathalie Botto, Yves Aigrain, Yves Héloury, Henri Lottmann & Thomas Blanc

  2. Université de Paris, Paris, France

    Marc Chalhoub, Jules Kohaut, Nicolas Vinit, Yves Aigrain, Yves Héloury & Thomas Blanc

  3. Département Croissance et Signalisation, Hôpital Necker Enfants Malades, Institut Necker Enfants Malades, INSERM U1151-CNRS UMR 8253, Université Paris Descartes, Paris, France

    Thomas Blanc

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  1. Marc Chalhoub
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Contributions

MC: data collection or management. JK: data collection or management. NV: data collection or management. NB: data analysis. YA: data analysis; manuscript writing/editing. YH: data analysis; manuscript writing/editing. HL: protocol/project development; data analysis. TB: protocol/project development; data analysis; manuscript writing/editing.

Corresponding author

Correspondence to Thomas Blanc.

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No financial conflicts are declared.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional national research committee at Necker-Enfants malades Hospital and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Given that this was a retrospective analysis, a separate IRB approval was not required by the institutional or national standards.

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Movie 1 Antegrade MEDJUS placement failure during redo transperitoneal pyeloplasty. An open-closed DJUS was subsequently inserted (MP4 92838 kb)

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Chalhoub, M., Kohaut, J., Vinit, N. et al. Feasibility and safety of magnetic-end double-J ureteral stent insertion and removal in children. World J Urol 39, 1649–1655 (2021). https://doi.org/10.1007/s00345-020-03339-0

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  • DOI: https://doi.org/10.1007/s00345-020-03339-0

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