title: Is confirmation of ureteric stent placement in laparoscopic pyeloplasty necessary?
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Urology, Belfast City Hospital, Lisburn Road, Belfast, UK.|Department of Urology, Austin Hospital, 145 Studley Road, Heidelberg, VIC, 3084, Australia.
authors.forename: D B
authors.initials: DB
authors.lastname: Hennessey
authors.affiliation: Department of Urology, Austin Hospital, 145 Studley Road, Heidelberg, VIC, 3084, Australia. ned.kinnear@gmail.com.
authors.forename: N J
authors.identifier: http://orcid.org/0000-0002-7833-2537
authors.initials: NJ
authors.lastname: Kinnear
authors.affiliation: Department of Urology, Belfast City Hospital, Lisburn Road, Belfast, UK.
authors.forename: R M
authors.initials: RM
authors.lastname: Evans
authors.affiliation: Department of Urology, Belfast City Hospital, Lisburn Road, Belfast, UK.
authors.forename: C
authors.initials: C
authors.lastname: Hagan
authors.affiliation: Department of Urology, Belfast City Hospital, Lisburn Road, Belfast, UK.
authors.forename: A
authors.initials: A
authors.lastname: Thwaini
mesh_terms: D000328:Adult; D003558:Cystoscopy; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000175:diagnosis* / Q000209:etiology*; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D011475:Prosthesis Failure / Q000209:etiology*; D019919:Prosthesis Implantation / Q000009:adverse effects*; D012189:Retrospective Studies; D015607:Stents / Q000009:adverse effects*; D014513:Ureter; D055815:Young Adult
keywords: Antegrade JJ stent; Artificial bladder filling; Laparoscopic pyeloplasty; PUJ obstruction