Laparoscopic pyeloplasty with antegrade ureteral stenting

Results of laparoscopic pyeloplasty (LP) with different the methods of the upper urinary tract (UUT) stenting were compared. A total of 76 patients with hydronephrosis were enrolled in the study. Antegrade and retrograde ureteral stenting was used in 42 (55.2%) and 34 (44.8%) patients, respectively. In the first group after resection of the narrowed pyeloureteral segment (PUS) and formation of posterior wall of pyeloureteral anastomosis, antegrade stent was placed into the bladder, which followed by suturing of anterior wall of pyeloureteral anastomosis. While performing transurethral ureteral stenting, cystoscopy with retrograde ureteropyelography was carried out in lithotomy position, and the stent was put into the renal pelvis. Next, the patient was put into the lateral position, and LP was performed by transperitoneal access. There were no cases of conversion. The duration of the LP with antegrade stenting was significantly shorter than LP with retrograde stenting - 135 versus 170 minutes (p <0.05). Differences in the blood loss (55 ± 20 and 60 ± 15 ml) and the length of hospital stay (5 ± 2 and 6 ± 1 day) were not statistically significant. In the group of retrograde stenting there were two cases of stent migration, which required repositioning of the stents. In one patient with antegrade stent placement, the distal end of the stent curled in ureterovesical junction. The stent position was corrected during the ureteroscopy. There was one case of antegrade stenting failure requiring ureteroscopy with retrograde ureteral stenting. Laparoscopic pyeloplasty is an efficient method of surgical management of patients with PUS narrowing. The duration of antegrade stenting was significantly shorter than retrograde stenting. LP with antegrade ureteral stenting as compared to LP with retrograde stenting enables significantly reduced surgery duration.

pyeloureteral segment, stricture, plasty, laparoscopy, stenting