Application of an external drainage tube in pneumovesicoscopic ureteral reimplantation using the Politano–Leadbetter technique in children

Application of an external drainage tube in pneumovesicoscopic ureteral reimplantation using the Politano–Leadbetter technique in children | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Application of an external drainage tube in pneumovesicoscopic ureteral reimplantation using the Politano–Leadbetter technique in children Qingya Meng, Haihua Xu, Bowen Shi, Guodong Xu, Wei Gao This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8444207/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 9 You are reading this latest preprint version Abstract Purpose The aim of this study was to investigate the feasibility and advantages of utilizing an external drainage tube in pneumovesicoscopic ureteral reimplantation using the Politano–Leadbetter technique (PVUR-PL) in children. Methods A retrospective analysis of the clinical data of 90 pediatric patients who underwent PVUR-PL at our institution from March 2024 to September 2025 was conducted. Based on the method of stent placement, the patients were randomly divided into Group A (external drainage) or Group B (internal drainage). The two groups were compared regarding postoperative parameters, including incidence of leukocyturia, hematuria, febrile urinary tract infection (fUTI), and positive urine culture; hospitalization costs; stent indwelling duration; and length of hospital stay. Results Statistically significant differences ( p < 0.05) were observed between Groups A and B regarding the incidence of postoperative leukocyturia, fUTI, and positive urine culture; hospitalization costs; stent indwelling duration; and length of hospital stay. Conclusion The application of external stent drainage in PVUR-PL is reliable and effective. Compared with internal drainage, it can reduce the postoperative incidence of urinary tract infections, shorten the length of hospital stay, decrease hospitalization costs, and alleviate patient discomfort. This approach demonstrates significant advantages and is suitable for clinical application. pneumovesicoscopic Ureteral reimplantation External drainage Internal drainage Figures Figure 1 Introduction Pediatric lower ureteral pathologies, including primary vesicoureteral reflux (VUR) and primary obstructed megaureter, are relatively common diseases in the pediatric urinary system. Various surgical approaches are used to treat these conditions. In recent years, pneumovesicoscopic ureteral reimplantation using the Politano–Leadbetter technique (PVUR-PL) procedure has been widely used in clinical practice due to its minimal invasiveness and compliance with physiological anatomy. However, complications can occur during the stent indwelling period. Furthermore, children are often unable to cooperate with stent removal under local anesthesia, and the traction suture of a double-J stent cannot be retained for an extended duration. Consequently, stent removal frequently requires re-hospitalization and general anesthesia, causing significant distress and inconvenience for both parents and children. To address this challenge, we modified the method of stent placement by replacing the internal drainage tube with an external drainage tube, achieving satisfactory results. We report our procedure and outcomes in the following report. Materials and Methods Patient demographic and clinical data A retrospective analysis of the clinical data of 90 patients who underwent PVUR-PL at our hospital from March 2024 to September 2025 was conducted. According to the stent placement method, they were randomly divided into two groups: Group A received external drainage (a silicone drainage tube), and Group B received internal drainage (a double-J stent). Group A comprised 29 males and 15 females of a median age of 54 months (interquartile range [IQR]: 11–93 months; range: 6–180 months). Eighteen were left-sided, 12 were right-sided, and 14 were bilateral. A total of 58 abnormal ureters were involved, 3 with low-grade reflux (Grade I or II), 43 with high-grade reflux (Grade III, IV, or V), and 12 with obstruction. Group B comprised 23 males and 23 females of a median age of 36 months (IQR: 10–60 months; range: 6–120 months). Seventeen were left-sided, 5 were right-sided, and 24 were bilateral. A total of 70 abnormal ureters were involved, 9 with low-grade reflux (Grade I or II), 55 with high-grade reflux (Grade III, IV, or V), and 6 with obstruction. All patients presented preoperatively with recurrent urinary tract infections and/or progressive hydronephrosis. The diagnosis and grading of vesicoureteral reflux, as well as the diagnosis of distal ureteral obstruction, were confirmed in all cases through examinations, including urinary tract B-ultrasound, computed tomography urography (CTU), and voiding cystourethrography (VCUG) (Table 1 ). Table 1 Basic characteristics of the patients Parameter Total Cases (n) Group A (%) Group B (%) χ² Value p Value Age (months) ≤ 12 39 16(41.03) 23(58.97) 3.74 0.154 13–24 9 3(33.33) 6(66.67) >24 42 25(59.52) 17(40.48) Gender Male 52 29(55.77) 23(44.23) 1.727 0.189 Female 38 15(39.47) 23(60.53) Operative Side Left 35 18(51.43) 17(48.57) 0.064 Right 17 12(70.59) 5(29.41) 5.501 Bilateral 38 14(36.84) 24(63.16) Type of lesion (Number of ureters) Low-grade VUR (Grade I–II) 12 3(25.00) 9(75.00) 0.072 High-grade VUR (Grade III–V) 98 43(43.90) 55(56.10) 5.39 Obstruction 18 12(66.67) 6(33.33) This study was approved by the Hospital Ethics Committee (approval No. L2023-011), and the requirement for informed consent was waived due to its retrospective nature. Inclusion and exclusion criteria The inclusion criteria for this study were as follows: (1) diagnosis of vesicoureteral reflux or distal ureteral obstruction confirmed by B-ultrasound, CTU, and VCUG; and (2) PVUR-PL. The exclusion criteria were as follows: (1) B-ultrasound, CTU, or VCUG findings indicating duplex kidney associated with vesicoureteral reflux or distal ureteral obstruction; and (2) surgical procedures other than PVUR-PL. Surgical and stenting techniques All pediatric patients underwent PVUR-PL under general anesthesia. The detailed surgical procedure has been extensively documented in numerous sources and will not be reiterated here. A silicone catheter of an appropriate size, selected based on the ureteral diameter, was used as the drainage tube. After the drainage tube was introduced into the bladder through a trocar port, it was retrograde placed into the ureter via the new ureteral orifice. The insertion depth was adjusted according to the patient's age and ureteral length, generally reaching the mid-upper portion of the ureter. The distal end of the tube was exteriorized through the trocar port. After trocar removal, the tube was secured to the sutures of the abdominal wall incision and connected to an external drainage bag (Fig. 1 ). Observation indicators Groups A and B were compared regarding age, gender, affected side, type of lesion (low-grade VUR, high-grade VUR, or obstruction), incidence of leukocyturia (defined as positive with urine white blood cell count ≥ 5/high power field [HPF]) during the stenting period, incidence of hematuria (defined as positive with red blood cell count ≥ 3/HPF) during the stenting period, incidence of febrile urinary tract infection (fUTI) during the stenting period, positive urine culture before stent removal, hospitalization costs, duration of stenting, operative and postoperative hospitalization days related to the disease, and anteroposterior diameter of the renal pelvis and ureteral diameter at 3 months postoperatively. Additionally, within both Groups A and B, the three-month postoperative anteroposterior diameter of the renal pelvis and ureteral diameter were compared to their respective preoperative values. Statistical methods Statistical analysis was performed using IBM SPSS, version 26.0 (IBM SPSS Statistics for MAC, USA). Measurement data are presented as the mean ± standard deviation (x̄ ± s), and intergroup comparisons were conducted using the independent samples t-test. Categorical data are expressed as numbers (percentages), and intergroup comparisons were analyzed using the chi-square test. A p-value < 0.05 was considered statistically significant. In the comparison of the three-month postoperative anteroposterior diameter of the renal pelvis and ureteral diameter with preoperative values, the differences in the observation indicators did not conform to a normal distribution. To obtain more robust statistical conclusions, the Wilcoxon signed-rank test, the corresponding non-parametric test, was employed. All statistical analyses were performed using SPSS version 26.0 at a statistical significance level of p < 0.05. Results All procedures, including surgery and ureteral stenting, were successfully performed without complications such as hypercapnia, abdominal organ injury, intestinal adhesion, or intestinal obstruction. In Group A (44 patients with 58 ureteral units), appropriately sized silicone catheters were placed as external ureteral stents on the affected side(s) and removed 10–14 days postoperatively. In Group B (46 patients with 70 ureteral units), double-J stents were placed and subsequently removed 2 months postoperatively during a scheduled return hospital visit. Patients were followed-up with for 3–21 months. Postoperative urinary tract infections were completely controlled in all cases. Follow-up VCUG performed 6–12 months postoperatively showed either complete resolution or significant downgrading of vesicoureteral reflux. Previously dilated renal pelvises and ureters showed gradual improvement, and their diameters returned to normal ranges. Comparison of baseline dat a No statistically significant differences were observed between Groups A and B regarding age, gender, affected side, or type of lesion (low-grade reflux, high-grade reflux, or obstruction) ( p > 0.05), as shown in Table 1 . Likewise, no statistically significant differences were found between the two groups regarding any of the observation indicators ( p > 0.05). Comparison of categorical data Leukocyturia before stent removal was present in 22 cases (50%) in Group A and in 35 cases (76.09%) in Group B, a statistically significant difference (p 0.05). Positive urine culture during the stenting period occurred in 3 cases (6.82%) in Group A and in 13 cases (28.26%) in Group B, a statistically significant difference (p < 0.05). fUTI during the stenting period was reported in one case (2%) in Group A and in eight cases (17%) in Group B, a statistically significant difference (p < 0.05). The costs of hospitalization were significantly lower for Group A than for Group B (p < 0.05): Group A had 14 cases in the range of 20,000–30,000, accounting for 31.81% of them, while Group B had 1 case, accounting for only 2.17%. Moreover, Group A had 21 cases in the range of 30,000.01–40,000, accounting for 47.73%, while Group B had 3 cases, accounting for 6.52%, and in the range of 40,000.01–50,000, Group A had 7 cases, accounting for 15.91%, while Group B had 27 cases, accounting for 58.70%. For values greater than 50,000, Group A had 2 cases, accounting for 4.55%, while Group B had 15 cases, accounting for 32.61%. These results indicate that the external stent group (Group A) had a significantly lower incidence of leukocyturia, positive urine culture, and fUTI during the stenting period, as well as lower hospitalization costs, compared with the internal stent group (Group B). No significant difference was observed in the incidence of hematuria between the two groups (Table 2 ). Measurement data The mean stenting duration was 13.23 ± 1.612 days in Group A and 60.07 ± 8.995 days in Group B, a statistically significant difference ( p < 0.05). The mean number of disease-related operative and postoperative hospitalization days was 20.86 ± 4.654 in Group A and 24.91 ± 8.350 in Group B, a statistically significant difference ( p 0.05). The mean ureteral diameter at 3 months postoperatively was 4.95 ± 4.12 mm in Group A and 4.95 ± 4.12 mm in Group B, a difference that was not statistically significant ( p > 0.05). These results suggest that the external stent group (Group A) had a significantly shorter stenting duration and a shorter disease-related hospitalization compared with the internal stent group (Group B). However, there was no significant difference between the two groups in the recovery of the anteroposterior pelvic diameter or the ureteral diameter at 3 months postoperatively (Table 3 ). Intra-group comparison In both Group A (external stent drainage) and Group B (internal double-J stent drainage), the anteroposterior diameter of the renal pelvis and the ureteral diameter at 3 months postoperatively showed a statistically significant reduction compared with their preoperative values ( p < 0.05). Although VCUG results provide a more direct assessment of prognosis in patients with vesicoureteral reflux, the observed postoperative changes in the anteroposterior diameter of the renal pelvis and the ureteral diameter can serve as indirect indicators of treatment efficacy. The results presented in Table 4 show that compared with their preoperative baselines, both groups experienced significant reductions in both the anteroposterior diameter of the renal pelvis and the ureteral diameter at 3 months postoperatively, suggesting that both drainage methods are effective. Table 2 Comparison of categorical data Indicator Group A (%) Group B (%) χ² Value P Value Hematuria before removal (RBC ≥ 3/HPF) 30(68.18) 27(58.70) 0.511 0.475 Leukocyturia before removal (WBC ≥ 5/HPF) 22(50.00) 35(76.09) 5.515 0.019 Positive urine culture during stenting 3(6.82) 13(28.26) 7.074 0.008 fUTI during stenting 1(2.27) 7(15.22) 4.653 0.031 Hospitalization costs (RMB) 20000–30000 14(31.81) 1(2.17) 30000.01–40000 21(47.73) 3(6.52) 46.45 50000 2(4.55) 15(32.61) Table 3 Measurement data Indicator GroupA (x̄ ± s) GroupB (x̄ ± s) T Value P Value Stenting duration (days) 13.23 ± 1.612 60.07 ± 8.995 −10.02 <0.0001 Operative and postoperative hospitalization days (days) ∗ 20.86 ± 4.654 24.91 ± 8.350 −18.61 0.001 Anteroposterior pelvic diameter at 3 months postoperatively (mm) \(\:\text{8.28±6.21}\) \(\:\text{7.27±4.85}\) 1.027 0.306 Ureteral diameter at 3 months postoperatively (mm) \(\:\text{4.95±4.12}\) \(\:\text{4.5±2.48}\) 0.759 0.449 ∗Includes hospitalization for surgery, postoperative fUTI, and readmission for stent removal Table 4 Intra-group comparison Group Paired Samples Negative Ranks (n) Positive Ranks (n) Ties (n) Z Value P Value A Ureteral Diameter (3-month postop vs. Preop) 38 6 14 -5.323 < .001 Renal Pelvic AP Diameter (3-month postop vs. Preop) 35 11 12 -4.413 3-month postoperative value; Positive Ranks: Preoperative value < 3-month postoperative value; Ties: Preoperative value = 3-month postoperative value Discussion Distal ureteral pathologies, including primary vesicoureteral reflux and primary obstructive megaureter, present with symptoms such as hydronephrosis, tortuous and dilated ureters, and/or recurrent urinary tract infections. These conditions can lead to varying degrees of functional impairment in the affected kidney. Specific techniques for performing ureteral reimplantation, the preferred surgical treatment for treating terminal ureteral diseases, include the Cohen, Politano-Leadbetter, Glenn-Anderson, and Lich-Gregoir procedures. In all reported clinical surgeries for these conditions, the placement of an internal double-J stent has been the standard for urinary drainage, regardless of the surgical technique employed. The practice of placing a double-J stent as a ureteral stent in pediatric ureteral reimplantation surgery was adopted from adult methodologies. However, significant differences exist between children and adults. Adults can undergo stent removal under local anesthesia in an outpatient setting, which is often not feasible for children. Furthermore, as a result of their poorer tolerance, children have a higher risk of indwelling stent-related complications than adults. In clinical practice, children with indwelling double-J stents frequently experience complications, most commonly urinary tract infections and stone formation [ 1 ]. In an effort to reduce these complications, we modified the drainage method by replacing the internal stent with an external stent drainage system, with favorable outcomes. Despite rapid advancements in surgical techniques, controversy persists regarding the necessity of stent placement for drainage in pyeloureteral obstruction surgery, as well as which type of stent is superior [ 2 ]. Many studies indicate that external stent drainage allows for direct observation of the repair outcome in pyeloplasty and facilitates easy stent removal without the need for sedation. However, this approach carries potential risks, including an increased risk of renal parenchymal injury, bleeding, flank pain, urinary tract infection, and a decline in the quality of life [ 3 ]. Internal double-J stents are associated with complications such as infection, stone formation, flank pain, bladder irritation symptoms, and stent migration or dislodgement. In contrast, a no-stent approach is associated with a higher incidence of urinary leakage [ 4 – 6 ]. Despite these reports, for patients undergoing ureteral reimplantation, there remains a lack of reported comparisons between these two stent drainage methods, and reports on a "tubeless" approach are scarce. This study focused specifically on patients who underwent PVUR-PL, comparing our modified external stent drainage approach with the conventional internal double-J stent drainage approach. This modification is grounded in both a theoretical and anatomical rationale. Theoretically, traditional open ureteral reimplantation surgeries have historically employed external stent drainage with consistently favorable outcomes. Anatomically, as the pneumovesicoscopic approach is performed intravesically, trocar ports are created in the bladder wall, and utilizing one of these existing ports for external tube placement does not inflict additional trauma on the child. In extravesical surgical approaches, where no such bladder ports exist, creating an additional breach solely for drainage inflicts unnecessary additional injury. Therefore, such procedures fall outside the scope of the current study. The results of this study demonstrated that compared with internal stent drainage, external stent drainage was associated with a significantly lower incidence of leukocyturia, a lower rate of positive urine cultures, and a reduced occurrence of fUTI during the stenting period. This observed difference may be partially attributable to the varying duration of stenting between the two groups. Regarding hospitalization, because external stent drainage eliminated the need for readmission for stent removal and reduced the need for readmission for fUTI therapy during the stenting period, it significantly decreased the number of hospitalizations, the total length of hospital stay, and, consequently, the overall hospitalization costs associated with treating pediatric lower ureteral pathologies. As demonstrated in this study, the removal of an internal double-J stent in young children, who often cannot cooperate, necessitates readmission and a second episode of general anesthesia. Although modern anesthesia is considered safe, it introduces an additional degree of uncertainty regarding anesthetic risks. Furthermore, the removal technique itself, whether via cystoscopy or the "fishing" technique, is invasive and can cause urethral trauma. The postoperative placement of a urinary catheter, often required after such removal, can also lead to significant discomfort for the child, including dysuria and hematuria, and an increased risk of urinary tract infection. In contrast, the external drainage tube can be removed painlessly during routine bedside dressing changes, requiring no anesthesia and causing no distress to the child. Regarding the use of internal stents for drainage, the earliest report dates back to 1967, when Zimskind et al. first described using a fenestrated silicone tube as an indwelling stent to bypass ureteral obstructions, with indwelling times ranging from 6 weeks to 19 months [ 7 ]. The double-J stent was first reported in 1978 by urologists from the University of South Florida Medical Center and the Veterans Administration Hospital in Tampa, Florida. In these reports, the stent retention time was documented as 3–6 weeks [ 8 ]. However, the reasons for requiring such a prolonged retention period for the double-J stent were not explained. The literature on the use of external drainage tubes in ureteral reimplantation surgery primarily describes its application in traditional open procedures. The timing for stent removal is generally 8–10 days postoperatively, based on the healing process of the ureterovesical anastomosis—the initial 14 days involve fibrous scar formation, transitioning to muscular connection around day 30—and considerations regarding urinary tract infection risk [ 9 ]. Due to the absence of a standardized reference for stent removal, in our pneumovesicoscopic approach, we adapted the removal timeline from that used in open surgery with external drainage, with slight modifications. Depending on the ureteral diameter, we typically remove the external stent 10–14 days after surgery. In pyeloplasty for hydronephrosis, the placement of an external stent necessitates nephrostomy, which is a more traumatic procedure compared with internal stenting. However, in ureteral reimplantation, the external drainage tube merely traverses the ureterovesical anastomotic site, causing minimal interference with the kidney. Conversely, in internal stenting, the internal double-J stent must be advanced into the renal pelvis, which inflicts additional trauma to the upper urinary tract. In 1960, Hodson proposed the theory that VUR could lead to renal scar formation, suggesting that high-grade VUR could directly cause renal scarring, while low-grade VUR required the presence of a urinary tract infection to trigger scar formation [ 10 ]. Research by Smellie et al. indicated that renal scarring is primarily associated with severe ureteral reflux and is often already present at initial diagnosis. They classified renal scarring into four grades, with the highest grade, i.e., grade IV, representing renal atrophy [ 11 ]. Higher grades of VUR are associated with a greater prevalence of scarring, and numerous studies have confirmed that the incidence of renal scarring increases with the severity of reflux [ 12 , 13 ]. The placement of a double-J stent eliminates the physiological pressure gradient between the bladder, ureter, and renal pelvis, compromising the antireflux mechanism at the ureterovesical junction. During voiding, increased bladder pressure can lead to urine refluxing along the stent into the renal pelvis, thereby increasing the risk of upper urinary tract infections [ 14 ]. The double-J stent inserted during surgery traverses from the bladder into the renal pelvis, creating iatrogenic vesicoureteral reflux in the child. Because this reflux can directly reach the renal pelvis, it constitutes at least Grade II reflux. If the patient has high-grade reflux preoperatively, this iatrogenic reflux will correspondingly be high-grade as well, thereby increasing the probability of renal scar formation and further impacting renal function. Therefore, minimizing the occurrence of iatrogenic reflux or shortening its duration should be a key objective. If the indwelling duration of the double-J stent is shortened, it might reduce postoperative complications. However, earlier removal implies a shorter interval between two episodes of general anesthesia, which is a significant concern for many parents. With our modified external drainage method, both the stent and the urinary catheter are kept in place. The stent directly drains urine from the affected side to the outside of the body. Because the bladder remains in a state of continuous drainage, urine cannot reflux upward through the potential space between the stent and the ureteral wall. During removal, the stent is extracted first, followed by the urinary catheter, thereby minimizing the possibility of iatrogenic reflux and consequently reducing the occurrence of renal scarring and injury. Based on our findings, external stent drainage provides seven advantages over internal stent drainage. First, the external drainage tube only traverses the ureterovesical anastomotic site, minimizing interference with the upper urinary tract and confining potential impact to the immediate surgical area around the distal ureter. Second, by eliminating the opportunity for iatrogenic reflux to the kidneys, it significantly reduces the incidence of urinary tract infections, including fUTI, leukocyturia, and positive urine cultures, thereby also lowering the potential for renal scar formation. Third, it reduces the number of hospitalizations by avoiding the need for readmissions for stent removal and managing postoperative fUTI, which consequently shortens the overall treatment-related hospital stay and significantly lowers costs. Fourth, bedside stent removal avoids the need for a second episode of general anesthesia for internal stent extraction, thus reducing the cumulative anesthetic risk associated with treatment. Fifth, by avoiding the need for cystoscopy, bedside removal minimizes urethral trauma and irritation, reducing discomfort for both the child and the family. Sixth, the significantly shorter stenting duration markedly decreases the incidence and duration of complications associated with double-J stents, which include bladder irritation symptoms, flank pain, stent encrustation, stent migration, stent dislodgement, hematuria, and urinary tract infections [ 15 ]. Finally, in pneumovesicoscopy, the pre-existing trocar port serves as the conduit for externalizing the drainage tube, adding no extra trauma to the bladder. In the advancement of technology, minimizing surgical trauma and facilitating faster recovery for pediatric patients have always been our primary goals. The continuous development and refinement of minimally invasive techniques have led to progressively smaller surgical insults. Building upon this foundation, we are committed to reducing patient suffering and surgical complications. By employing external stent drainage in PVUR-PL, we can decrease the length of hospital stay and associated costs for treating pediatric lower ureteral pathologies. This approach reduces the risks of complications inherent to internal stents, such as urinary tract infections, stone formation, flank pain, bladder irritation symptoms, and stent migration and/or dislodgement. Moreover, it decreases the risk of renal scar formation and avoids the necessity of a second episode of general anesthesia for removal of an internal stent. This method is safe, effective, and worthy of clinical adoption. Declarations Author Contribution Contributions:A: Qingya Meng;B:Haihua Xu;C:Bowen Shi;D:Guodong Xu;E:Wei Gao(I) Conception and design: A and B; (II) Administrative support: D andE; (III) Provision of study materials or patients: A and D; (IV) Collection and assembly of data: C; (V) Data analysis and interpretation: A and B; (VI) Manuscript writing: All authors;(VII) Final approval of manuscript: All authors. Acknowledgement We thank LetPub (www.letpub.com.cn) for its linguistic assistance during the preparation of this manuscript. References Cai PY, Lee RS (2023) Ureteropelvic Junction Obstruction/Hydronephrosis. 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BMC Urol 23:181. https://doi.org/10.1186/s12894-023-01351-1 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 20 Feb, 2026 Reviews received at journal 19 Feb, 2026 Reviews received at journal 01 Feb, 2026 Reviewers agreed at journal 31 Jan, 2026 Reviewers agreed at journal 30 Jan, 2026 Reviewers invited by journal 29 Jan, 2026 Editor assigned by journal 28 Dec, 2025 Submission checks completed at journal 26 Dec, 2025 First submitted to journal 24 Dec, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8444207","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":583540818,"identity":"1b2230b2-80c3-4623-a5e4-614d5620072e","order_by":0,"name":"Qingya Meng","email":"","orcid":"","institution":"The First Central Hospital of Tianjin Medical University","correspondingAuthor":false,"prefix":"","firstName":"Qingya","middleName":"","lastName":"Meng","suffix":""},{"id":583540819,"identity":"fe888763-0764-4447-90e4-4013be1c7e12","order_by":1,"name":"Haihua Xu","email":"","orcid":"","institution":"Tianjin Children's Hospital","correspondingAuthor":false,"prefix":"","firstName":"Haihua","middleName":"","lastName":"Xu","suffix":""},{"id":583540820,"identity":"e8a06356-daa8-4356-a575-2c8bd89567a3","order_by":2,"name":"Bowen Shi","email":"","orcid":"","institution":"Tianjin Children's Hospital","correspondingAuthor":false,"prefix":"","firstName":"Bowen","middleName":"","lastName":"Shi","suffix":""},{"id":583540821,"identity":"c797fec8-0a62-431d-9a39-f4012488d16e","order_by":3,"name":"Guodong Xu","email":"","orcid":"","institution":"Tianjin Children's Hospital","correspondingAuthor":false,"prefix":"","firstName":"Guodong","middleName":"","lastName":"Xu","suffix":""},{"id":583540822,"identity":"28e6d35b-9aa1-48c7-a459-8268a293d201","order_by":4,"name":"Wei Gao","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA5UlEQVRIiWNgGAWjYNACAwYGxuYDbAwfDGzsiNYiwdiWwMY4oyAtmWh7JBjYEtiYeT4cYmwgpFTe/fAxiQ8FDHXMbczPHtsYHGBmYD98dAM+LYZn0tIkZ4AdxmZunGNwh4+BJy3tBl4tDTlmt3lAWub3sEnnGDxjZpDgMcOvpf+N2e0/YFt42KQtDA4zNhDSIi8BtIUBpoWBGC0GEs/Sf/YYMEg2trGZSfYYpCWzEfKLfH/yYYMffxj4DYEhJvHjj40dP/vhY/htOQCm/gPDASrChk852BaYSnlCKkfBKBgFo2DkAgA8ykLqvy16FQAAAABJRU5ErkJggg==","orcid":"","institution":"The First Central Hospital of Tianjin Medical University","correspondingAuthor":true,"prefix":"","firstName":"Wei","middleName":"","lastName":"Gao","suffix":""}],"badges":[],"createdAt":"2025-12-24 16:23:17","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8444207/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8444207/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":101786904,"identity":"069192a5-dd83-4164-890d-6835f3bd770c","added_by":"auto","created_at":"2026-02-03 15:44:23","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":343508,"visible":true,"origin":"","legend":"\u003cp\u003e(a) Intravesical view showing the stent inserted retrogradely into the ureter via the new ureteral orifice. The green arrow indicates the neo-orifice. (b) The ureteral stent is exteriorized through the trocar site and secured to the abdominal wall via suture fixation of the wound. The blue arrow indicates the external portion of the ureteral stent. (c) Postoperative wound healing. The stent exit site shows no excess scar tissue\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-8444207/v1/455ae5436cd5acf3e0374370.png"},{"id":102397145,"identity":"128f63c1-2736-4895-80d0-5a34477908fb","added_by":"auto","created_at":"2026-02-11 10:03:58","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1032456,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8444207/v1/dbcd4c10-c043-4d86-b88e-c4b8ebfb7260.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Application of an external drainage tube in pneumovesicoscopic ureteral reimplantation using the Politano–Leadbetter technique in children","fulltext":[{"header":"Introduction","content":"\u003cp\u003ePediatric lower ureteral pathologies, including primary vesicoureteral reflux (VUR) and primary obstructed megaureter, are relatively common diseases in the pediatric urinary system. Various surgical approaches are used to treat these conditions. In recent years, pneumovesicoscopic ureteral reimplantation using the Politano\u0026ndash;Leadbetter technique (PVUR-PL) procedure has been widely used in clinical practice due to its minimal invasiveness and compliance with physiological anatomy. However, complications can occur during the stent indwelling period. Furthermore, children are often unable to cooperate with stent removal under local anesthesia, and the traction suture of a double-J stent cannot be retained for an extended duration. Consequently, stent removal frequently requires re-hospitalization and general anesthesia, causing significant distress and inconvenience for both parents and children. To address this challenge, we modified the method of stent placement by replacing the internal drainage tube with an external drainage tube, achieving satisfactory results. We report our procedure and outcomes in the following report.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003ePatient demographic and clinical data\u003c/h2\u003e \u003cp\u003eA retrospective analysis of the clinical data of 90 patients who underwent PVUR-PL at our hospital from March 2024 to September 2025 was conducted. According to the stent placement method, they were randomly divided into two groups: Group A received external drainage (a silicone drainage tube), and Group B received internal drainage (a double-J stent). Group A comprised 29 males and 15 females of a median age of 54 months (interquartile range [IQR]: 11\u0026ndash;93 months; range: 6\u0026ndash;180 months). Eighteen were left-sided, 12 were right-sided, and 14 were bilateral. A total of 58 abnormal ureters were involved, 3 with low-grade reflux (Grade I or II), 43 with high-grade reflux (Grade III, IV, or V), and 12 with obstruction. Group B comprised 23 males and 23 females of a median age of 36 months (IQR: 10\u0026ndash;60 months; range: 6\u0026ndash;120 months). Seventeen were left-sided, 5 were right-sided, and 24 were bilateral. A total of 70 abnormal ureters were involved, 9 with low-grade reflux (Grade I or II), 55 with high-grade reflux (Grade III, IV, or V), and 6 with obstruction. All patients presented preoperatively with recurrent urinary tract infections and/or progressive hydronephrosis. The diagnosis and grading of vesicoureteral reflux, as well as the diagnosis of distal ureteral obstruction, were confirmed in all cases through examinations, including urinary tract B-ultrasound, computed tomography urography (CTU), and voiding cystourethrography (VCUG) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBasic characteristics of the patients\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParameter\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal Cases (n)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGroup A (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eGroup B (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eχ\u0026sup2; Value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep Value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (months)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16(41.03)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e23(58.97)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e3.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e0.154\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e13\u0026ndash;24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3(33.33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6(66.67)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e25(59.52)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e17(40.48)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e29(55.77)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e23(44.23)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e1.727\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.189\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15(39.47)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e23(60.53)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOperative Side\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLeft\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18(51.43)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e17(48.57)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.064\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12(70.59)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5(29.41)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e5.501\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBilateral\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14(36.84)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e24(63.16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eType of lesion (Number of ureters)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLow-grade VUR (Grade I\u0026ndash;II)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3(25.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e9(75.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.072\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh-grade VUR (Grade III\u0026ndash;V)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e43(43.90)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e55(56.10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e5.39\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eObstruction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12(66.67)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6(33.33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThis study was approved by the Hospital Ethics Committee (approval No. L2023-011), and the requirement for informed consent was waived due to its retrospective nature.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eInclusion and exclusion criteria\u003c/h3\u003e\n\u003cp\u003eThe inclusion criteria for this study were as follows: (1) diagnosis of vesicoureteral reflux or distal ureteral obstruction confirmed by B-ultrasound, CTU, and VCUG; and (2) PVUR-PL. The exclusion criteria were as follows: (1) B-ultrasound, CTU, or VCUG findings indicating duplex kidney associated with vesicoureteral reflux or distal ureteral obstruction; and (2) surgical procedures other than PVUR-PL.\u003c/p\u003e\n\u003ch3\u003eSurgical and stenting techniques\u003c/h3\u003e\n\u003cp\u003eAll pediatric patients underwent PVUR-PL under general anesthesia. The detailed surgical procedure has been extensively documented in numerous sources and will not be reiterated here. A silicone catheter of an appropriate size, selected based on the ureteral diameter, was used as the drainage tube. After the drainage tube was introduced into the bladder through a trocar port, it was retrograde placed into the ureter via the new ureteral orifice. The insertion depth was adjusted according to the patient's age and ureteral length, generally reaching the mid-upper portion of the ureter. The distal end of the tube was exteriorized through the trocar port. After trocar removal, the tube was secured to the sutures of the abdominal wall incision and connected to an external drainage bag (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e\n\u003ch3\u003eObservation indicators\u003c/h3\u003e\n\u003cp\u003eGroups A and B were compared regarding age, gender, affected side, type of lesion (low-grade VUR, high-grade VUR, or obstruction), incidence of leukocyturia (defined as positive with urine white blood cell count\u0026thinsp;\u0026ge;\u0026thinsp;5/high power field [HPF]) during the stenting period, incidence of hematuria (defined as positive with red blood cell count\u0026thinsp;\u0026ge;\u0026thinsp;3/HPF) during the stenting period, incidence of febrile urinary tract infection (fUTI) during the stenting period, positive urine culture before stent removal, hospitalization costs, duration of stenting, operative and postoperative hospitalization days related to the disease, and anteroposterior diameter of the renal pelvis and ureteral diameter at 3 months postoperatively. Additionally, within both Groups A and B, the three-month postoperative anteroposterior diameter of the renal pelvis and ureteral diameter were compared to their respective preoperative values.\u003c/p\u003e\n\u003ch3\u003eStatistical methods\u003c/h3\u003e\n\u003cp\u003eStatistical analysis was performed using IBM SPSS, version 26.0 (IBM SPSS Statistics for MAC, USA). Measurement data are presented as the mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (x̄ \u0026plusmn; s), and intergroup comparisons were conducted using the independent samples t-test. Categorical data are expressed as numbers (percentages), and intergroup comparisons were analyzed using the chi-square test. A p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant. In the comparison of the three-month postoperative anteroposterior diameter of the renal pelvis and ureteral diameter with preoperative values, the differences in the observation indicators did not conform to a normal distribution. To obtain more robust statistical conclusions, the Wilcoxon signed-rank test, the corresponding non-parametric test, was employed. All statistical analyses were performed using SPSS version 26.0 at a statistical significance level of \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eAll procedures, including surgery and ureteral stenting, were successfully performed without complications such as hypercapnia, abdominal organ injury, intestinal adhesion, or intestinal obstruction. In Group A (44 patients with 58 ureteral units), appropriately sized silicone catheters were placed as external ureteral stents on the affected side(s) and removed 10\u0026ndash;14 days postoperatively. In Group B (46 patients with 70 ureteral units), double-J stents were placed and subsequently removed 2 months postoperatively during a scheduled return hospital visit. Patients were followed-up with for 3\u0026ndash;21 months. Postoperative urinary tract infections were completely controlled in all cases. Follow-up VCUG performed 6\u0026ndash;12 months postoperatively showed either complete resolution or significant downgrading of vesicoureteral reflux. Previously dilated renal pelvises and ureters showed gradual improvement, and their diameters returned to normal ranges.\u003c/p\u003e \u003cp\u003e \u003cb\u003eComparison of baseline dat\u003c/b\u003ea\u003c/p\u003e \u003cp\u003eNo statistically significant differences were observed between Groups A and B regarding age, gender, affected side, or type of lesion (low-grade reflux, high-grade reflux, or obstruction) (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05), as shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. Likewise, no statistically significant differences were found between the two groups regarding any of the observation indicators (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e\n\u003ch3\u003eComparison of categorical data\u003c/h3\u003e\n\u003cp\u003eLeukocyturia before stent removal was present in 22 cases (50%) in Group A and in 35 cases (76.09%) in Group B, a statistically significant difference (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Hematuria before stent removal was observed in 30 cases (68.18%) in Group A and in 27 cases (58.70%) in Group B, a difference that was not statistically significant (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Positive urine culture during the stenting period occurred in 3 cases (6.82%) in Group A and in 13 cases (28.26%) in Group B, a statistically significant difference (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). fUTI during the stenting period was reported in one case (2%) in Group A and in eight cases (17%) in Group B, a statistically significant difference (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The costs of hospitalization were significantly lower for Group A than for Group B (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05): Group A had 14 cases in the range of 20,000\u0026ndash;30,000, accounting for 31.81% of them, while Group B had 1 case, accounting for only 2.17%. Moreover, Group A had 21 cases in the range of 30,000.01\u0026ndash;40,000, accounting for 47.73%, while Group B had 3 cases, accounting for 6.52%, and in the range of 40,000.01\u0026ndash;50,000, Group A had 7 cases, accounting for 15.91%, while Group B had 27 cases, accounting for 58.70%. For values greater than 50,000, Group A had 2 cases, accounting for 4.55%, while Group B had 15 cases, accounting for 32.61%. These results indicate that the external stent group (Group A) had a significantly lower incidence of leukocyturia, positive urine culture, and fUTI during the stenting period, as well as lower hospitalization costs, compared with the internal stent group (Group B). No significant difference was observed in the incidence of hematuria between the two groups (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\n\u003ch3\u003eMeasurement data\u003c/h3\u003e\n\u003cp\u003eThe mean stenting duration was 13.23\u0026thinsp;\u0026plusmn;\u0026thinsp;1.612 days in Group A and 60.07\u0026thinsp;\u0026plusmn;\u0026thinsp;8.995 days in Group B, a statistically significant difference (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The mean number of disease-related operative and postoperative hospitalization days was 20.86\u0026thinsp;\u0026plusmn;\u0026thinsp;4.654 in Group A and 24.91\u0026thinsp;\u0026plusmn;\u0026thinsp;8.350 in Group B, a statistically significant difference (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The mean anteroposterior pelvic diameter at 3 months postoperatively was 8.28\u0026thinsp;\u0026plusmn;\u0026thinsp;6.21 mm in Group A and 7.27\u0026thinsp;\u0026plusmn;\u0026thinsp;4.85 mm in Group B, a difference that was not statistically significant (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05). The mean ureteral diameter at 3 months postoperatively was 4.95\u0026thinsp;\u0026plusmn;\u0026thinsp;4.12 mm in Group A and 4.95\u0026thinsp;\u0026plusmn;\u0026thinsp;4.12 mm in Group B, a difference that was not statistically significant (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05). These results suggest that the external stent group (Group A) had a significantly shorter stenting duration and a shorter disease-related hospitalization compared with the internal stent group (Group B). However, there was no significant difference between the two groups in the recovery of the anteroposterior pelvic diameter or the ureteral diameter at 3 months postoperatively (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eIntra-group comparison\u003c/h2\u003e \u003cp\u003eIn both Group A (external stent drainage) and Group B (internal double-J stent drainage), the anteroposterior diameter of the renal pelvis and the ureteral diameter at 3 months postoperatively showed a statistically significant reduction compared with their preoperative values (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Although VCUG results provide a more direct assessment of prognosis in patients with vesicoureteral reflux, the observed postoperative changes in the anteroposterior diameter of the renal pelvis and the ureteral diameter can serve as indirect indicators of treatment efficacy. The results presented in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e show that compared with their preoperative baselines, both groups experienced significant reductions in both the anteroposterior diameter of the renal pelvis and the ureteral diameter at 3 months postoperatively, suggesting that both drainage methods are effective.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of categorical data\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e \u003ccolgroup cols=\"1\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIndicator\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGroup A (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGroup B (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eχ\u0026sup2; Value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP\u003c/p\u003e \u003cp\u003eValue\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHematuria before removal (RBC\u0026thinsp;\u0026ge;\u0026thinsp;3/HPF)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e30(68.18)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e27(58.70)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.511\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.475\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLeukocyturia before removal (WBC\u0026thinsp;\u0026ge;\u0026thinsp;5/HPF)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e22(50.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e35(76.09)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5.515\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.019\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePositive urine culture during stenting\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3(6.82)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13(28.26)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7.074\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.008\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003efUTI during stenting\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1(2.27)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7(15.22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.653\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.031\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHospitalization costs (RMB)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e20000\u0026ndash;30000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e14(31.81)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1(2.17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e30000.01\u0026ndash;40000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e21(47.73)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3(6.52)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e46.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e40000.01\u0026ndash;50000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7(15.91)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e27(58.70)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;50000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2(4.55)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15(32.61)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMeasurement data\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eIndicator\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGroupA\u003c/p\u003e \u003cp\u003e(x̄ \u0026plusmn; s)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eGroupB\u003c/p\u003e \u003cp\u003e(x̄ \u0026plusmn; s)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eT Value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eP\u003c/p\u003e \u003cp\u003eValue\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStenting duration (days)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13.23\u0026thinsp;\u0026plusmn;\u0026thinsp;1.612\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e60.07\u0026thinsp;\u0026plusmn;\u0026thinsp;8.995\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e\u0026minus;10.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOperative and postoperative hospitalization days (days)\u0026nbsp;\u0026lowast;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20.86\u0026thinsp;\u0026plusmn;\u0026thinsp;4.654\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24.91\u0026thinsp;\u0026plusmn;\u0026thinsp;8.350\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e\u0026minus;18.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnteroposterior pelvic diameter at 3 months postoperatively (mm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\text{8.28\u0026plusmn;6.21}\\)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\text{7.27\u0026plusmn;4.85}\\)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e1.027\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.306\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUreteral diameter at 3 months postoperatively (mm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\text{4.95\u0026plusmn;4.12}\\)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\text{4.5\u0026plusmn;2.48}\\)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.759\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.449\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e\u0026lowast;Includes hospitalization for surgery, postoperative fUTI, and readmission for stent removal\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eIntra-group comparison\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGroup\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePaired Samples\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNegative Ranks\u003c/p\u003e \u003cp\u003e(n)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePositive Ranks\u003c/p\u003e \u003cp\u003e(n)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eTies\u003c/p\u003e \u003cp\u003e(n)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eZ Value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eP Value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUreteral Diameter (3-month postop vs. Preop)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-5.323\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRenal Pelvic AP Diameter (3-month postop vs. Preop)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-4.413\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eB\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUreteral Diameter (3-month postop vs. Preop)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-2.888\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRenal Pelvic AP Diameter (3-month postop vs. Preop)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-2.010\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.044\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003eNegative Ranks: Preoperative value\u0026thinsp;\u0026gt;\u0026thinsp;3-month postoperative value; Positive Ranks: Preoperative value\u0026thinsp;\u0026lt;\u0026thinsp;3-month postoperative value; Ties: Preoperative value\u0026thinsp;=\u0026thinsp;3-month postoperative value\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eDistal ureteral pathologies, including primary vesicoureteral reflux and primary obstructive megaureter, present with symptoms such as hydronephrosis, tortuous and dilated ureters, and/or recurrent urinary tract infections. These conditions can lead to varying degrees of functional impairment in the affected kidney. Specific techniques for performing ureteral reimplantation, the preferred surgical treatment for treating terminal ureteral diseases, include the Cohen, Politano-Leadbetter, Glenn-Anderson, and Lich-Gregoir procedures. In all reported clinical surgeries for these conditions, the placement of an internal double-J stent has been the standard for urinary drainage, regardless of the surgical technique employed. The practice of placing a double-J stent as a ureteral stent in pediatric ureteral reimplantation surgery was adopted from adult methodologies. However, significant differences exist between children and adults. Adults can undergo stent removal under local anesthesia in an outpatient setting, which is often not feasible for children. Furthermore, as a result of their poorer tolerance, children have a higher risk of indwelling stent-related complications than adults. In clinical practice, children with indwelling double-J stents frequently experience complications, most commonly urinary tract infections and stone formation [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. In an effort to reduce these complications, we modified the drainage method by replacing the internal stent with an external stent drainage system, with favorable outcomes.\u003c/p\u003e \u003cp\u003eDespite rapid advancements in surgical techniques, controversy persists regarding the necessity of stent placement for drainage in pyeloureteral obstruction surgery, as well as which type of stent is superior [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Many studies indicate that external stent drainage allows for direct observation of the repair outcome in pyeloplasty and facilitates easy stent removal without the need for sedation. However, this approach carries potential risks, including an increased risk of renal parenchymal injury, bleeding, flank pain, urinary tract infection, and a decline in the quality of life [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Internal double-J stents are associated with complications such as infection, stone formation, flank pain, bladder irritation symptoms, and stent migration or dislodgement. In contrast, a no-stent approach is associated with a higher incidence of urinary leakage [\u003cspan additionalcitationids=\"CR5\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDespite these reports, for patients undergoing ureteral reimplantation, there remains a lack of reported comparisons between these two stent drainage methods, and reports on a \"tubeless\" approach are scarce. This study focused specifically on patients who underwent PVUR-PL, comparing our modified external stent drainage approach with the conventional internal double-J stent drainage approach. This modification is grounded in both a theoretical and anatomical rationale. Theoretically, traditional open ureteral reimplantation surgeries have historically employed external stent drainage with consistently favorable outcomes. Anatomically, as the pneumovesicoscopic approach is performed intravesically, trocar ports are created in the bladder wall, and utilizing one of these existing ports for external tube placement does not inflict additional trauma on the child. In extravesical surgical approaches, where no such bladder ports exist, creating an additional breach solely for drainage inflicts unnecessary additional injury. Therefore, such procedures fall outside the scope of the current study.\u003c/p\u003e \u003cp\u003eThe results of this study demonstrated that compared with internal stent drainage, external stent drainage was associated with a significantly lower incidence of leukocyturia, a lower rate of positive urine cultures, and a reduced occurrence of fUTI during the stenting period. This observed difference may be partially attributable to the varying duration of stenting between the two groups. Regarding hospitalization, because external stent drainage eliminated the need for readmission for stent removal and reduced the need for readmission for fUTI therapy during the stenting period, it significantly decreased the number of hospitalizations, the total length of hospital stay, and, consequently, the overall hospitalization costs associated with treating pediatric lower ureteral pathologies.\u003c/p\u003e \u003cp\u003eAs demonstrated in this study, the removal of an internal double-J stent in young children, who often cannot cooperate, necessitates readmission and a second episode of general anesthesia. Although modern anesthesia is considered safe, it introduces an additional degree of uncertainty regarding anesthetic risks. Furthermore, the removal technique itself, whether via cystoscopy or the \"fishing\" technique, is invasive and can cause urethral trauma. The postoperative placement of a urinary catheter, often required after such removal, can also lead to significant discomfort for the child, including dysuria and hematuria, and an increased risk of urinary tract infection. In contrast, the external drainage tube can be removed painlessly during routine bedside dressing changes, requiring no anesthesia and causing no distress to the child.\u003c/p\u003e \u003cp\u003eRegarding the use of internal stents for drainage, the earliest report dates back to 1967, when Zimskind et al. first described using a fenestrated silicone tube as an indwelling stent to bypass ureteral obstructions, with indwelling times ranging from 6 weeks to 19 months [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. The double-J stent was first reported in 1978 by urologists from the University of South Florida Medical Center and the Veterans Administration Hospital in Tampa, Florida. In these reports, the stent retention time was documented as 3\u0026ndash;6 weeks [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. However, the reasons for requiring such a prolonged retention period for the double-J stent were not explained.\u003c/p\u003e \u003cp\u003eThe literature on the use of external drainage tubes in ureteral reimplantation surgery primarily describes its application in traditional open procedures. The timing for stent removal is generally 8\u0026ndash;10 days postoperatively, based on the healing process of the ureterovesical anastomosis\u0026mdash;the initial 14 days involve fibrous scar formation, transitioning to muscular connection around day 30\u0026mdash;and considerations regarding urinary tract infection risk [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Due to the absence of a standardized reference for stent removal, in our pneumovesicoscopic approach, we adapted the removal timeline from that used in open surgery with external drainage, with slight modifications. Depending on the ureteral diameter, we typically remove the external stent 10\u0026ndash;14 days after surgery.\u003c/p\u003e \u003cp\u003eIn pyeloplasty for hydronephrosis, the placement of an external stent necessitates nephrostomy, which is a more traumatic procedure compared with internal stenting. However, in ureteral reimplantation, the external drainage tube merely traverses the ureterovesical anastomotic site, causing minimal interference with the kidney. Conversely, in internal stenting, the internal double-J stent must be advanced into the renal pelvis, which inflicts additional trauma to the upper urinary tract.\u003c/p\u003e \u003cp\u003eIn 1960, Hodson proposed the theory that VUR could lead to renal scar formation, suggesting that high-grade VUR could directly cause renal scarring, while low-grade VUR required the presence of a urinary tract infection to trigger scar formation [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Research by Smellie et al. indicated that renal scarring is primarily associated with severe ureteral reflux and is often already present at initial diagnosis. They classified renal scarring into four grades, with the highest grade, i.e., grade IV, representing renal atrophy [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Higher grades of VUR are associated with a greater prevalence of scarring, and numerous studies have confirmed that the incidence of renal scarring increases with the severity of reflux [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. The placement of a double-J stent eliminates the physiological pressure gradient between the bladder, ureter, and renal pelvis, compromising the antireflux mechanism at the ureterovesical junction.\u003c/p\u003e \u003cp\u003eDuring voiding, increased bladder pressure can lead to urine refluxing along the stent into the renal pelvis, thereby increasing the risk of upper urinary tract infections [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. The double-J stent inserted during surgery traverses from the bladder into the renal pelvis, creating iatrogenic vesicoureteral reflux in the child. Because this reflux can directly reach the renal pelvis, it constitutes at least Grade II reflux. If the patient has high-grade reflux preoperatively, this iatrogenic reflux will correspondingly be high-grade as well, thereby increasing the probability of renal scar formation and further impacting renal function. Therefore, minimizing the occurrence of iatrogenic reflux or shortening its duration should be a key objective. If the indwelling duration of the double-J stent is shortened, it might reduce postoperative complications. However, earlier removal implies a shorter interval between two episodes of general anesthesia, which is a significant concern for many parents. With our modified external drainage method, both the stent and the urinary catheter are kept in place. The stent directly drains urine from the affected side to the outside of the body. Because the bladder remains in a state of continuous drainage, urine cannot reflux upward through the potential space between the stent and the ureteral wall. During removal, the stent is extracted first, followed by the urinary catheter, thereby minimizing the possibility of iatrogenic reflux and consequently reducing the occurrence of renal scarring and injury.\u003c/p\u003e \u003cp\u003eBased on our findings, external stent drainage provides seven advantages over internal stent drainage. First, the external drainage tube only traverses the ureterovesical anastomotic site, minimizing interference with the upper urinary tract and confining potential impact to the immediate surgical area around the distal ureter. Second, by eliminating the opportunity for iatrogenic reflux to the kidneys, it significantly reduces the incidence of urinary tract infections, including fUTI, leukocyturia, and positive urine cultures, thereby also lowering the potential for renal scar formation. Third, it reduces the number of hospitalizations by avoiding the need for readmissions for stent removal and managing postoperative fUTI, which consequently shortens the overall treatment-related hospital stay and significantly lowers costs. Fourth, bedside stent removal avoids the need for a second episode of general anesthesia for internal stent extraction, thus reducing the cumulative anesthetic risk associated with treatment. Fifth, by avoiding the need for cystoscopy, bedside removal minimizes urethral trauma and irritation, reducing discomfort for both the child and the family. Sixth, the significantly shorter stenting duration markedly decreases the incidence and duration of complications associated with double-J stents, which include bladder irritation symptoms, flank pain, stent encrustation, stent migration, stent dislodgement, hematuria, and urinary tract infections [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Finally, in pneumovesicoscopy, the pre-existing trocar port serves as the conduit for externalizing the drainage tube, adding no extra trauma to the bladder.\u003c/p\u003e \u003cp\u003eIn the advancement of technology, minimizing surgical trauma and facilitating faster recovery for pediatric patients have always been our primary goals. The continuous development and refinement of minimally invasive techniques have led to progressively smaller surgical insults. Building upon this foundation, we are committed to reducing patient suffering and surgical complications. By employing external stent drainage in PVUR-PL, we can decrease the length of hospital stay and associated costs for treating pediatric lower ureteral pathologies. This approach reduces the risks of complications inherent to internal stents, such as urinary tract infections, stone formation, flank pain, bladder irritation symptoms, and stent migration and/or dislodgement. Moreover, it decreases the risk of renal scar formation and avoids the necessity of a second episode of general anesthesia for removal of an internal stent. This method is safe, effective, and worthy of clinical adoption.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eContributions:A: Qingya Meng;B:Haihua Xu;C:Bowen Shi;D:Guodong Xu;E:Wei Gao(I) Conception and design: A and B; (II) Administrative support: D andE; (III) Provision of study materials or patients: A and D; (IV) Collection and assembly of data: C; (V) Data analysis and interpretation: A and B; (VI) Manuscript writing: All authors;(VII) Final approval of manuscript: All authors.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eWe thank LetPub (www.letpub.com.cn) for its linguistic assistance during the preparation of this manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eCai PY, Lee RS (2023) Ureteropelvic Junction Obstruction/Hydronephrosis. Urol Clin North Am 50:361\u0026ndash;369. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.ucl.2023.04.001\u003c/span\u003e\u003cspan address=\"10.1016/j.ucl.2023.04.001\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMorizawa Y, Aoki K, Fukui S et al (2024) Long-term follow-up of congenital hydronephrosis in a single-center study. Int J Urol 31:507\u0026ndash;511. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/iju.15391\u003c/span\u003e\u003cspan address=\"10.1111/iju.15391\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLiu X, Huang C, Guo Y et al (2019) Comparison of DJ stented, external stented and stent-less procedures for pediatric pyeloplasty: A network meta-analysis. Int J Surg 68:126\u0026ndash;133. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.ijsu.2019.07.001\u003c/span\u003e\u003cspan address=\"10.1016/j.ijsu.2019.07.001\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBayne AP, Lee KA, Nelson ED et al (2011) The impact of surgical approach and urinary diversion on patient outcomes in pediatric pyeloplasty. 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J Urol 168:1127\u0026ndash;1130. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/S0022-5347(05)64607-1\u003c/span\u003e\u003cspan address=\"10.1016/S0022-5347(05)64607-1\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZimskind PD, Fetter TR, Wilkerson JL (1967) Clinical use of long-term indwelling silicone rubber ureteral splints inserted cystoscopically. J Urol 97:840\u0026ndash;844. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/S0022-5347(17)63130-6\u003c/span\u003e\u003cspan address=\"10.1016/S0022-5347(17)63130-6\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFinney RP (1978) Experience with new double J ureteral catheter stent. J Urol 120:678\u0026ndash;681. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/s0022-5347(17)57326-7\u003c/span\u003e\u003cspan address=\"10.1016/s0022-5347(17)57326-7\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMealeer IM, Kaplan GW (1999) Renal function before and after pyeloplasty: does it improve? J Urol 162(3 Pt 2):1041\u0026ndash;1044. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/S0022-5347(01)68059-5\u003c/span\u003e\u003cspan address=\"10.1016/S0022-5347(01)68059-5\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHodson CJ, Edwards D (1960) Chronic pyelonephritis and vesico-ureteric reflex. 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Eur Urol 81:155\u0026ndash;156. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.eururo.2021.09.023\u003c/span\u003e\u003cspan address=\"10.1016/j.eururo.2021.09.023\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMattoo TK, Mohammad D (2022) Primary Vesicoureteral Reflux and Renal Scarring. Pediatr Clin North Am 69:1115\u0026ndash;1129. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.pcl.2022.07.007\u003c/span\u003e\u003cspan address=\"10.1016/j.pcl.2022.07.007\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ede la Cruz JE, Fern\u0026aacute;ndez I et al (2021) Assessment of the Grades of Vesicoureteral Reflux in Stented Ureters: An Experimental Study. Urol Int 105:554\u0026ndash;559. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1159/000515613\u003c/span\u003e\u003cspan address=\"10.1159/000515613\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChen Z, Wang Y, Wu C et al (2023) Double J stent combined with pyelostomy tube in pediatric laparoscopic pyeloplasty: a 5-year clinical experience in a single center. BMC Urol 23:181. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s12894-023-01351-1\u003c/span\u003e\u003cspan address=\"10.1186/s12894-023-01351-1\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"pediatric-surgery-international","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pesi","sideBox":"Learn more about [Pediatric Surgery International](http://link.springer.com/journal/383)","snPcode":"383","submissionUrl":"https://submission.nature.com/new-submission/383/3","title":"Pediatric Surgery International","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"pneumovesicoscopic, Ureteral reimplantation, External drainage, Internal drainage","lastPublishedDoi":"10.21203/rs.3.rs-8444207/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8444207/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003ePurpose\u003c/h2\u003e \u003cp\u003eThe aim of this study was to investigate the feasibility and advantages of utilizing an external drainage tube in pneumovesicoscopic ureteral reimplantation using the Politano\u0026ndash;Leadbetter technique (PVUR-PL) in children.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA retrospective analysis of the clinical data of 90 pediatric patients who underwent PVUR-PL at our institution from March 2024 to September 2025 was conducted. Based on the method of stent placement, the patients were randomly divided into Group A (external drainage) or Group B (internal drainage). The two groups were compared regarding postoperative parameters, including incidence of leukocyturia, hematuria, febrile urinary tract infection (fUTI), and positive urine culture; hospitalization costs; stent indwelling duration; and length of hospital stay.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eStatistically significant differences (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05) were observed between Groups A and B regarding the incidence of postoperative leukocyturia, fUTI, and positive urine culture; hospitalization costs; stent indwelling duration; and length of hospital stay.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe application of external stent drainage in PVUR-PL is reliable and effective. Compared with internal drainage, it can reduce the postoperative incidence of urinary tract infections, shorten the length of hospital stay, decrease hospitalization costs, and alleviate patient discomfort. This approach demonstrates significant advantages and is suitable for clinical application.\u003c/p\u003e","manuscriptTitle":"Application of an external drainage tube in pneumovesicoscopic ureteral reimplantation using the Politano–Leadbetter technique in children","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-03 15:44:18","doi":"10.21203/rs.3.rs-8444207/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-02-20T06:01:49+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-19T15:21:36+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-02T03:01:18+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"230922976778801863647139582547253131966","date":"2026-01-31T14:14:39+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"317377377849845197459313803967090255754","date":"2026-01-30T18:21:58+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-01-29T10:07:36+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-12-28T15:36:17+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-12-26T14:08:14+00:00","index":"","fulltext":""},{"type":"submitted","content":"Pediatric Surgery International","date":"2025-12-24T16:13:21+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"pediatric-surgery-international","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pesi","sideBox":"Learn more about [Pediatric Surgery International](http://link.springer.com/journal/383)","snPcode":"383","submissionUrl":"https://submission.nature.com/new-submission/383/3","title":"Pediatric Surgery International","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"bdc82db9-9138-435f-ac0e-80bb54e8a58b","owner":[],"postedDate":"February 3rd, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-25T14:38:47+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-03 15:44:18","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8444207","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8444207","identity":"rs-8444207","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}