Flexible pneumocystoscopy for double J stenting during laparoscopic and robot assisted pyeloplasty: our experience

We present our results in terms of feasibility, safety and efficacy of flexible pneumocystoscopy during double J stenting in patients undergoing laparoscopic pyeloplasty (LP). The patient is placed on the flank at a 45 degrees angle. Laparoscopic pyeloplasty according to the Anderson-Hynes technique is carried out by transperitoneal access. After completing the running suture of the posterior wall of the uretero-pyelic anastomosis, the double J stent is placed in a retrograde manner with a pneumocystoscopy using flexible cystoscope. Thirty-six patients were prospectively evaluated; 28 of these were treated with standard LP and 8 with robot-assisted LP. Mean operative time was 124 min, whereas double J stenting time was 4.2 min (2-6). We observed one case of cranial migration of the stent, forcing us to repeat the procedure, which was completed without complications. No ancillary procedures or X-ray control were necessary. Retrograde double J stenting using flexible pneumocystoscopy during laparoscopic and robot assisted pyeloplasty is feasible, easy, safe and effective. The procedure can be completed without changing the patient's position and without the use of X-ray.