Antegrade stenting in laparoscopic pyeloplasty: feasibility of the technique and time required for stent insertion.

Abstract BACKGROUND: This study aimed to evaluate the authors' initial experience with antegrade stenting. It focused on the success rate, time required for stent insertion, possible complications, and relative solutions in the first 44 procedures. METHODS: Between March 2005 and April 2008, 44 patients (21 women and 23 men) with a mean age of 33 years (range, 17-59 years) underwent transperitoneal laparoscopic Anderson-Hynes pyeloplasty in the authors' department. Antegrade stenting was attempted for all the patients. The time required for stent insertion was recorded as the time from cannula insertion to the correct positioning of the stent in the pelvis. A 4.8-Fr, 26-cm stent was the stent of choice for the first four cases. Then the 6-Fr, 26-cm stent was adopted for all the remaining patients except for one, for whom a 6-Fr, 28-cm stent was adopted. RESULTS: The mean operative time was 197 min (median, 180 min; range, 150-390 min). No conversions to open surgery were required. The stent was positioned correctly in the bladder at the end of the antegrade procedure in 97.7% of the patients without the need for a postoperative X-ray in 95% of the cases. The mean time required for antegrade insertion of the stent was 7 min 30 s (median, 6 min 13 s; range, 3 min 40 s to 22 min 30 s). In the final 12 procedures, the time for stent insertion was constantly reduced to a mean of 4 min 10 s (median, 4 min; range, 3 min 40 s to 7 min). Neither intraoperative nor postoperative complications related to antegrade stent positioning were observed. CONCLUSION: Our data confirm the antegrade procedure to be an easy-to-learn, safe, and reliable stenting technique, with an overall mean time of 7 min 30 s required for insertion, and with a mean time of 4 min 10 s required for insertion in the final 12 procedures. It obviates the problem of having the stent in the renal pelvis during dissection and suturing and of repositioning the patient onto the flank for the laparoscopic procedure.