Innovative Technique for Ureteral Stenting during Retroperitoneal Laparoscopic Ureterolithotomy

Abstract

Large calculi in the upper and mid ureter are best managed by laparoscopic ureterolithotomy. Stenting after laparoscopic ureterolithotomy is difficult because of the curls and pliability of the double-J stent. To make the procedure easy, we have devised a double-J stent, closed at both ends, that is threaded on a guidewire, the length of which is 1 cm greater than the stent. The guidewire is passed from the sideholes in the stent, leaving 1 or 2 cm of the guidewire outside. This guidewire makes the stent taut so that it is easily negotiated up and down the ureter. After the stone has been extracted by incising the ureter, the straightened stent on the guidewire is passed in the retroperitoneal space through a 5-mm port. The stent is passed down the ureter into the bladder first and then up the ureter to the renal pelvis. The portion of the guidewire lying outside the stent is positioned at the site of ureterolithotomy. The guidewire is pulled out with a grasper after insertion of stent, and the two ends of the stent coil up in the bladder and the kidney. This innovative technique with the modified stent and guidewire has made stenting during laparoscopic ureterolithotomy easy and saves precious time.