Novel Method for Double-J Stenting in Retroperitoneal Laparoscopic Dismembered Pyeloplasty

Abstract

To describe a novel technique of double-J stenting in laparoscopic pyeloplasty. Between January 2008 and July 2009, 22 patients with ureteropelvic junction obstruction underwent retroperitoneal laparoscopic dismembered pyeloplasty. A ureteral catheter was inserted into the midureter cystoscopically. During pyeloplasty, the ureteral catheter was pushed up and grasped outside the body through the laparoscopic port. Its proximal end was extracorporeally sutured to the distal end of the double-J stent with a silk. The length of the silk was about that of the urethra. The ureteral catheter was then pulled down until its proximal end exited the external orifice of the urethra, while the stent was pulled smoothly and antegrade into the ureter and bladder. After the proximal end of the stent was positioned in the renal pelvis, the silk was cut and the ureteral catheter was removed. The stent was correctly placed in all these patients without any stent-related complications. The mean time for cystoscopy to place the ureteral catheter was 5 minutes, 10 seconds, and the mean time for the stent placement was 2 minutes, 45 seconds. The mean time for a total of 2 parts was 9 minutes, 15 seconds. Our new method of laparoscopic double-J stenting is reliable and easily reproducible with the combined advantages of the antegrade and retrograde approaches to eliminate the risk of the stenting failure.