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Is confirmation of ureteric stent placement in laparoscopic pyeloplasty necessary?

  • Urology - Original Paper
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Abstract

Purpose

Placement of an antegrade double-J (JJ) ureteric stent is an important component of pyeloplasty. Correct siting of distal end of the stent in the bladder is essential for ease of removal. To date, no studies have compared methods for confirming stent position. This study aims to address that void in the literature.

Methods

Eligible patients underwent laparoscopic pyeloplasty with antegrade stent placement at our institution from 2007 to 2015 inclusive. Methods to verify distal stent position of rigid cystoscopy, artificial bladder filling or no confirmation were compared. Effectiveness was determined by the proportion of malpositioned stents detected intra-operatively compared to the total found malpositioned, both intra-operatively and during follow-up.

Results

A total of 75 patients underwent laparoscopic pyeloplasty. Forty-six (61.3%) patients had distal stent position assessed intra-operatively, comprising 27 by cystoscopy and 19 by artificial bladder filling, while for 29 (38.7%) patients no verification method was used. Cystoscopy, artificial bladder filling and no confirmation detected intra-operatively 2, 1 and 0 malpositioned stents, from malpositioned stent totals of 2, 2 and 1, respectively.

Conclusion

Malposition of JJ ureteric stent is uncommon, and omitting intra-operative position verification appears reasonable in select cases. Artificial bladder filling can help detect malpositioned JJ stents without repositioning the patient for cystoscopy. However, our results suggest both may be unreliable. If stent malposition is suspected, certainty is desired or extended operative duration is less critical, then the surgeon should proceed with cystoscopy.

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Guarantor

D. Hennessey.

Authors’ contribution

AT conceived the study. CH was involved in protocol development. DH wrote the first draft of the manuscript. ME and NK reviewed and edited the manuscript.

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Authors and Affiliations

  1. Department of Urology, Belfast City Hospital, Lisburn Road, Belfast, UK

    D. B. Hennessey, R. M. Evans, C. Hagan & A. Thwaini

  2. Department of Urology, Austin Hospital, 145 Studley Road, Heidelberg, VIC, 3084, Australia

    D. B. Hennessey & N. J. Kinnear

Authors
  1. D. B. Hennessey
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  2. N. J. Kinnear
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  3. R. M. Evans
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  4. C. Hagan
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  5. A. Thwaini
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Corresponding author

Correspondence to N. J. Kinnear.

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Conflict of interest

None.

Informed consent

Written informed consent was obtained from the patients included in the study for their anonymised information to be published in this article.

Ethical approval

Ethics approval for this study was granted by the Austin Health Human Research Ethics Committee, reference LNR/16/Austin/470.

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Hennessey, D.B., Kinnear, N.J., Evans, R.M. et al. Is confirmation of ureteric stent placement in laparoscopic pyeloplasty necessary?. Int Urol Nephrol 49, 931–936 (2017). https://doi.org/10.1007/s11255-017-1560-8

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  • DOI: https://doi.org/10.1007/s11255-017-1560-8

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