A novel and simple modification for implantation of double-J stents during modified laparoscopic Lich Gregoir ureteral reimplantation

Abstract Background During laparoscopic Lich-Gregoir ureteral reimplantation, retrograde double-J (DJ) stent placement may be difficult when ureteral tailoring or anastomotic support is needed, mainly because the working space is narrow and the angle between the stent and the ureterovesical junction is sharp. This study aimed to describe a modified 8-Fr urethral sound-assisted retrograde DJ-stent placement technique and to evaluate its technical feasibility and early outcomes in children undergoing modified laparoscopic Lich-Gregoir ureteral reimplantation who required stenting. Methods We retrospectively reviewed consecutive children who underwent modified laparoscopic Lich-Gregoir ureteral reimplantation with DJ-stent placement using a modified 8-Fr urethral sound between January 2023 and June 2024. The number of treated ureters, laterality, and VUR grades were reviewed from the operative and imaging records. This was an initial technical feasibility series, so no formal a priori power calculation was performed. Demographic data, operative details, stent-insertion time, complications, stent position, and early follow-up findings were analyzed descriptively. Results Seventeen patients were included, and 17 ureters were treated. Fourteen patients had unilateral vesicoureteral reflux (VUR) with dilated or tortuous ureters requiring tailoring, including 10 left-sided and 4 right-sided cases; reflux was grade IV in 9 patients and grade V in 5 patients. The remaining three patients had unilateral right-sided vesicoureteral junction obstruction (VUJO). Stent placement was completed in all cases. The mean stent-insertion time was 2.11 ± 0.35 min. No urethral, bladder, or DJ-stent placement-related intraoperative injury was recorded. Postoperative kidney-ureter-bladder radiography confirmed acceptable stent position in all patients. The mean follow-up duration was 10.2 ± 1.9 months (range, 6–14 months). At 3 and 6 months after surgery, voiding cystourethrography showed no recurrent VUR; clinical follow-up and ultrasonography showed no evidence of obstructive deterioration during the available follow-up period. Conclusion In this small single-surgeon series, modified 8-Fr urethral sound-assisted retrograde DJ-stent placement was technically feasible during modified laparoscopic Lich-Gregoir ureteral reimplantation in children who required stenting. These preliminary findings support the technical feasibility of the method, but comparative studies are required to determine whether it offers advantages over conventional stent-placement techniques.