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29
th
CONGRESS OF THE ESPU
T&T: Special Session "TIPS AND
TRICKS"
Moderator: Stuart O'Toole (UK)
ESPU Meeting on Friday 13, April 2018, 17:20–18:00
17:20–17:25
T&T-1 (VP)
TRICKS TO RETRIEVE A DOUBLE J STENT LOST
IN THE URETER AFTER COHEN REIMPLANTATION
IN A 2 YEARS OLD GIRL
Annabel PAYE JAOUEN
Hôpital Robert Debre, Chirurgie viscérale et urologie pédiatrique, Paris, FRANCE
PURPOSE
A 2 years old girl was operated for a left primary obstructive mega-ureter by a Cohen reimplanta-
tion. The surgeon had inserted a double J stent in the ureter 4 weeks. When the surgeon did the
endoscopy to remove the JJ stent, it was not anymore in the bladder. The child was asymptomatic.
Plain Xray showed the JJ stent with the two extremities in the ureter, the US scan showed a ureteral
dilatation but no pelvic dilatation. Interventional antegrade percutaneous treatment was not feasible.
The child was referred to our center for further management. We have decided to perform an
endoscopic treatment with a percutaneous ureteroscopy of the reimplanted ureter. The simple guide
wire insertion was impossible to introduce inside the ureter. So, we have decided to use double
endoscopic procedures. transurethral cystoscope (9.5 Fr) was used to identify the reimplanted
ureteral meatus then under cystoscopic vision, a 3-mm laparoscopic trocart was inserted percu-
taneous in the axes of the reimplanted ureter. Finally, a guide wire could be introduced through
the meatus up to the renal pelvis. We also used two video units and a X ray control. Semi rigid 6fr
ureteroscope was introduced through the 3 mm trocart and then the ureteral meatus. The retrieval
was finally achieved by a 1.5 Fr Dormia catheter through the operating channel of the ureteroscope.
The cystoscope and then the JJ stent was retrieved through the cystoscope. These maneuver was
done using two video units and C-Arm. Foley catheter was left for 12 hours. The child was painless
and discharged the next day after this procedure.
CONCLUSIONS
The association of both cystoscopy and percutaneous ureteroscope through 3 mm trocart solved
our difficulties to retrieve a lost JJ stent without dilatation of the upper tract.
A video clip shows all the details of the procedure.