Antegrade Ureteral Stenting During Laparoscopic Dismembered Pyeloplasty: Intraoperative Findings and Long-Term Outcome

Objective: The objective of this study was to compare the results of antegrade (AG) ureteral stenting with retrograde (RG) stenting during laparoscopic dismembered pyeloplasty. Materials and Methods: Between October 2003 and April 2007, a case series of 47 laparoscopic dismembered pyeloplasties were done by three surgeons of equal expertise in laparoscopic surgery, where the Double-J ureteral stent was placed by the RG method (RG stenting group) in 15 cases and by the AG method (AG stenting group) in 32 patients. Intraoperative findings and operative data were recorded. Clinical and radiological outcomes were evaluated during the follow-up visits at 3, 6, 12 months and then annually. Results: Differences in patient's age and body mass index were not statistically significant. Laparoscopic pyeloplasty was successfully completed in 45 patients, with two cases of conversion to open (one in each group). A crossing vessel was identified in 42% of RG stenting group versus 45% of AG stenting group. A state of high ureteral insertion was identified in 16% of AG stenting group, a finding that was never seen in RG stenting group. Mean operative time was 271 +/- 21 minutes for RG stenting group versus 199 +/- 34 minutes for AG stenting group, a difference that was statistically significant (p <= 0.01). Differences in estimated blood loss, hemoglobin decline, time to oral feeding, duration of urethral catheter, and length of hospital stay were not significant. Postoperative complications were seen in two patients: postoperative hematuria belonging to RG stenting group was managed endoscopically and prolonged urine leakage belonging to AG stenting group ceased spontaneously by postoperative day 8. Clinical and radiological improvement was evident in 97%, with a mean follow-up of 30 +/- 17 months. Conclusions: AG ureteral stenting is technically feasible and provides better dissection, especially in patients with high ureteral insertion and secondary ureteropelvic junction obstruction, with good long-term outcome in both groups.