The Usefulness of Flexible Cystoscopy for Preventing Double-J Stent Malposition After Laparoscopic Ureterolithotomy
The Usefulness of Flexible Cystoscopy for Preventing Double-J Stent Malposition After Laparoscopic Ureterolithotomy
The aim of this study was to evaluate the role of flexible cystoscopy in preventing
 malpositioning of the ureteral stent after laparoscopic ureterolithotomy in male patients.

 From April 2009 to June 2015, 97 male patients with stones >1.8 cm in the upper ureter
 underwent intracorporeal double-J stenting of the ureter after laparoscopic ureterolithotomy
 performed by four different surgeons. In the last 50 patients who underwent laparoscopic
 ureterolithotomy flexible cystoscopy was performed through the urethral route to confirm the
 position of the double-J stent, while in the first 47 correct positioning of the stent was
 confirmed through postoperative KUB.
The treatment of large upper ureteral stones is still controversial. The American Urological
 Association (AUA) and the European Association of Urology (EAU) recommend that laparoscopic
 stone removal may be considered in rare cases in which shockwave lithotripsy (SWL),
 ureteroscopic lithotripsy (URS), and percutaneous nephrolithotomy fail or are unlikely to be
 successful. In a recent meta-analysis of treatment of large proximal ureteral stones,
 Torricelli et al. reported that the outcomes of laparoscopic ureterolithotomy (LUL) for
 larger upper ureteral stones are favorable compared with those of URS, and LUL should be
 considered as a first-line option when flexible ureteroscopy is not available. After such
 surgery, many surgeons prefer placing a double-J stent, a ureteral catheter that is passed
 through the ureter from the kidney to the bladder. Although double-J stent placement after
 LUL remains controversial, many urologists believe that it may help prevent postoperative
 urinary leakage.

 Intracorporeal double-J stenting is technically difficult, and malpositioning often occurs
 after surgery in clinical practice. However, the actual rate of malpositioning of stents has
 not been reported yet. Although clinicians use different ways to place double-J stents
 precisely, accurate stent placement before the closure of the ureteral incision might be
 difficult to confirm.

 Upward malpositioning of the stent after surgery may necessitate removal of the stent using a
 ureteroscope. It is difficult to remove stents in the outpatient setting without anesthesia
 to reduce pain and discomfort, especially in male patients.

 In this study, The investigators used flexible cystoscopy through the urethral route before
 closure of the ureteral incision to confirm that the double-J stent was placed correctly in
 the bladder of male patients. Upon identification of upward malpositioning of the ureteral
 stent, position adjustments were performed by intracorporeally manipulating the ureteral
 stent through the incision site of the ureter. The aim of this study was to determine the
 malpositioning rate and predicting factors associated with upward malpositioning of
 intracorporeal double-J stents after LUL and to evaluate the usefulness of flexible
 cystoscopy in preventing such malpositioning in male patients.
Inclusion Criteria:

 -  the patients with large stones (>1.8 cm in size) of the upper ureter

 -  male patients

 Exclusion Criteria:

 -  the patients planing to be treated with other treatment except laparoscopic
 ureterolithotomy about the upper ureter stone

 -  female patients

 -  non operable patients