Clinical Scorecard: Advancements in Pediatric Ureteral Stenting: A Comprehensive Review
At a Glance
Category
Detail
Condition
Pediatric ureteral obstruction and related urological conditions requiring urinary drainage
Key Mechanisms
Use of double-J (DJ) ureteral stents to provide urinary drainage, anastomotic support, and decompression in pediatric patients
Target Population
Children including infants, young children, and adolescents with ureteral obstruction, stone disease, or congenital anomalies
Care Setting
Pediatric urology surgical and endourological care settings, including reconstructive surgery and stone management
Key Highlights
DJ stents are primarily used in pediatric reconstructive surgery (pyeloplasty, ureteroneocystostomy) to maintain ureteral patency and support healing.
Stent use varies by indication, patient age, anatomy, and institutional protocols, with emerging techniques aiming to reduce anesthesia exposure.
Clinical studies emphasize tailoring stent caliber, insertion route, dwell time, and removal strategy to pediatric-specific needs and minimizing family burden.
Guideline-Based Recommendations
Diagnosis
Assess indication for stenting based on obstruction type, stone disease, or other endourological conditions.
Consider patient age and ureteral anatomy before selecting stent type and size.
Management
Use internal double-J stents preferentially in pediatric reconstructive surgeries to maintain repair patency.
Select stent caliber and length appropriate to patient size and surgical approach.
Consider novel removal techniques (e.g., magnetic-end retrieval, stent-on-string) to avoid general anesthesia when feasible.
Tailor insertion route (retrograde, antegrade, transrenal) based on clinical scenario and institutional expertise.
Monitoring & Follow-up
Monitor for stent-related complications including infection, encrustation, and symptoms.
Plan timely stent removal to minimize dwell time and anesthesia exposure.
Follow-up should consider age-specific risks and family impact.
Risks
Increased infection risk due to stent presence in pediatric patients.
Potential for stent-related symptoms and need for reintervention.
Anesthetic risks associated with stent insertion and removal procedures.
Patient & Prescribing Data
Pediatric patients undergoing ureteral stenting for reconstruction, stone disease, or other endourological indications.
Clinical evidence supports individualized stent selection and management to optimize outcomes and reduce anesthesia burden; externalized drainage devices are less favored unless directly compared.
Clinical Best Practices
Tailor stent choice and management to patient age, ureteral anatomy, and indication.
Employ minimally invasive stent removal techniques when possible to reduce anesthesia exposure.
Use multidisciplinary consensus and institutional protocols to guide timing and method of stent insertion and removal.
Carefully monitor for complications and plan follow-up accordingly.
Incorporate family burden considerations into clinical decision-making.
by Abdullah Altunhan, Selim Soyturk, Thomas R. W. Herrmann, Vineet Gauhar, Theodoros Tokas, Sajid Sultan, Anna Bujons, M. Selcuk Silay, Bhaskar Kumar Somani, Selcuk Guven
