Novel technique of retrograde ureteral stenting during laparoscopic pyeloplasty

We describe a novel technique of ureteral Double-J stent placement during laparoscopic pyeloplasty.

A ureteropelvic junction (UPJ) occlusion balloon catheter is inserted retrograde into the ureter cystoscopically, under fluoroscopic guidance. Before insertion, a Foley catheter is calibrated and marked to indicate the point on its external surface to which the distal end of the Double-J ureteral stent pusher must reach to position the proximal end of the pusher at the midportion of the Foley catheter balloon (inside the bladder). The Foley and occlusion catheters (OC) are prepped into the operative field. The renal pelvis is distended by injecting saline through the OC to aid with dissection of the UPJ. After pyelotomy, the balloon is deflated, and the OC is withdrawn into the proximal ureter. After completion of the posterior suture line of the dismembered pyeloplasty, a guidewire is inserted through the OC and grasped within the renal pelvis. The OC is removed and the ureteral stent advanced until it is positioned in the renal pelvis and the distal end of the pusher has reached the calibrated mark on the Foley catheter. On removal of the guidewire, the lower end of the stent accurately lies in the bladder. The anastomosis is then completed.

Ten patients who underwent robot-assisted laparoscopic pyeloplasty between January 2005 and July 2006 at our institution had ureteral stenting using this technique. The stent was positioned accurately in all 10 patients without any stent-related complications. All patients had resolution of their UPJ obstruction on follow-up imaging.

Our technique of ureteral stent placement facilitates identification of the distended renal pelvis, ensures an unencumbered operative field with less chance of stent damage/migration during laparoscopic pyeloplasty, and permits accurate positioning of the ureteral stent.