Intraoperative Ultrasound: Application in Pediatric Pyeloplasty

Objectives

To describe a simple method of using a readily available portable ultrasound device to confirm distal stent placement for antegrade placed stents. Antegrade placement of internal double-J ureteral stents during open or laparoscopic pyeloplasty has become an alternative to retrograde placement but might be less reliable owing to the lack of confirmation of the distal stent position.

Methods

The SonoSite S-Nerve ultrasound system was used with a L38 × 10-5 MHz linear array transducer to evaluate the distal curl of the double-J stent within the bladder intraoperatively during da Vinci robotic-assisted pyeloplasty. The patient did not require repositioning or removal of the robotic arms.

Results

Visualization of the stent was successful in all patients with an age range of 8 months to 17 years.

Conclusions

We present the first published method of using ultrasonography to assess and confirm distal stent placement intraoperatively during antegrade stent placement. This simple method uses off-the-shelf equipment available within most operating rooms. In addition, intraoperative ultrasound confirmation of double-J stent placement allows for the ease of antegrade placement with the distal visual confirmation of the stent position without necessitating fluoroscopy or patient repositioning.