How I do it: Modified retrograde placement of an externalized pyeloplasty catheter during pediatric laparoscopic pyeloplasty.

Externalized drainage after pediatric laparoscopic pyeloplasty avoids repeat general anesthesia for catheter removal, but the standard straight trans-trocar Kirschner-wire technique may be limited in older or larger children. We describe a modified retrograde technique using a dedicated curved Kirschner wire with a proximal loop handle and gently rounded terminal tip. The wire is introduced through a separate skin puncture, advanced under laparoscopic vision from the collecting system outwards through a selected calyx and renal parenchyma, coupled externally to the catheter, and withdrawn to pull it retrogradely into position. The technique is demonstrated in the supplementary video.