Is antegrade stenting superior to retrograde stenting in laparoscopic pyeloplasty?

We describe a simple and timesaving technique of antegrade stenting. We compared it with retrograde stenting in laparoscopic pyeloplasty.

From December 2002 to August 2003, 24 patients with mean age of 24.29 years (range 5 to 57) had a Double-J (Medical Engineering Corp., New York, New York) stent placed laparoscopically after finishing the posterior suture line. The stent and ureteral catheter straightened over the guide wire were introduced through the lumen of a 5 mm hook or suction canula via a subcostal port. This technique was compared with retrograde stenting in 21 consecutive patients with mean age of 24.45 years (range 6 to 65) in terms of stenting time and failure to stent leading to conversion.

In 23 of 24 cases laparoscopic stenting could be completed in a mean time of 5.2 minutes. In case 1 the stent was lying outside the pelvis because it was placed after ureteropelvic anastomosis was completed. The stent was retrieved after placing the ports again and reinserted with retrograde technique. In subsequent cases the stent was inserted successfully after completing the posterior suture line and visualizing the ureteral lumen. Mean time of retrograde stenting was 39.35 minutes. One case was converted to open pyeloplasty after retrograde stenting failed and in another 5Fr ureteral catheter was left instead. However, this patient required percutaneous stenting on postoperative day 5. With retrograde stenting stent severance and upward migration into the ureter occurred in 1 patient each, while none of the patients with laparoscopic stenting showed such problems.

Laparoscopic stenting is a simple technique that obviates the need for an additional procedure and decreases the risk of the stent being cut or migrating upward. It also provides better anatomical delineation and dissection around the ureteropelvic junction since the pelvis remains distended. In addition, it makes suture placement and knot tying easy.