Antegrade stent placement in laparoscopic upper urinary tract surgery. Is there an easy way?

Abstract

Introduction: Antegrade placement of double J stents in laparoscopy is considered a challenging and time-consuming process due to limitations regarding stent flexibility. Aim: To describe the method we used to facilitate the antegrade placement of intracorporeal stents in laparoscopic upper urinary tract (LUUT) surgery and report its results. Material and methods: Data obtained from 42 consecutive patients who had stents placed antegradely in laparoscopic pyeloplasty or in laparoscopic ureterolithotomy for middle-upper ureteral stones were retrospectively evaluated. The mean age of the patients was 30.1 +/- 18.6 (10 months-68 years) and 13 patients were in the paediatric age group. All patients in the paediatric age group underwent laparoscopic pyeloplasty. Results: The mean operative time for the 42 total cases, of which 32 underwent laparoscopic dismembered pyeloplasty and 10 laparoscopic ureterolithotomy, was 126.9 +/- 33.5 (70-200) min and the intraoperative stent placement time was calculated as 2.61 +/- 0.8 (1.5-5) min. The patients, who had a mean hospitalization time of 2.8 +/- 0.9 (2-5) months, required no additional interventions and no complications were encountered intraoperatively. In the patient series that had a mean follow-up time of 17.4 +/- 11.3 (1-35), it was determined only in 1 patient that the distal tip of the stent had not been in the bladder. Conclusions: The described modified antegrade stent placement technique is a practical method that is safe for all LUUT cases in both paediatric and adult age groups and it has been shown to produce successful outcomes and to be time-saving.