Simple urethral sound technique eases stent placement in children’s laparoscopic reimplantation

Surgeons performing modified laparoscopic Lich-Gregoir ureteral reimplantation in children sometimes struggle with one specific step: placing a double-J stent retrograde through the ureterovesical junction. The working space during the laparoscopic procedure is narrow, and the angle between the stent and the junction is sharp, which makes the maneuver difficult particularly when the ureter needs tailoring or the anastomosis requires support. A new study describes a modified technique that uses an 8-Fr urethral sound to assist retrograde stent placement and reports its technical feasibility and early outcomes in children who required stenting.

The study, published in BMC Urology, was a retrospective review of consecutive children who underwent modified laparoscopic Lich-Gregoir ureteral reimplantation with stent placement using the modified 8-Fr urethral sound between January 2023 and June 2024. The authors reviewed the number of treated ureters, laterality, and vesicoureteral reflux grades from operative and imaging records. Because this was an initial technical feasibility series, no formal a priori power calculation was performed, and demographic data, operative details, stent-insertion time, complications, stent position, and early follow-up findings were analyzed descriptively.

Seventeen patients were included, and 17 ureters were treated. Fourteen of the patients had unilateral vesicoureteral reflux with dilated or tortuous ureters requiring tailoring; ten of these cases were left-sided and four were right-sided. Reflux was grade IV in nine patients and grade V in five. The remaining three patients had unilateral right-sided vesicoureteral junction obstruction.

The results showed that stent placement was completed in all cases. The mean stent-insertion time was 2.11 plus or minus 0.35 minutes. No urethral, bladder, or stent-placement-related intraoperative injury was recorded. Postoperative kidney-ureter-bladder radiography confirmed an acceptable stent position in all patients. These early technical outcomes form the core of the report: the technique succeeded in every attempted case in this series, with short insertion times and no recorded placement-related injuries during surgery.

Follow-up data, though limited in duration, were also reported. The mean follow-up was 10.2 plus or minus 1.9 months, with a range of six to fourteen months. At three and six months after surgery, voiding cystourethrography showed no recurrent vesicoureteral reflux, and clinical follow-up together with ultrasonography showed no evidence of obstructive deterioration during the available follow-up period. The authors are careful to frame these as early findings within the available follow-up window rather than definitive proof of long-term durability.

The technical logic behind the modification addresses the two obstacles identified in the background of the study. During laparoscopic Lich-Gregoir reimplantation, the retrograde approach to the ureterovesical junction must be carried out in a confined operative field, and the sharp angle between the stent and the junction can impede smooth advancement of the stent.

The authors conclude that, in this small single-surgeon series, modified 8-Fr urethral sound-assisted retrograde double-J stent placement was technically feasible during modified laparoscopic Lich-Gregoir ureteral reimplantation in children who required stenting. They explicitly state that these preliminary findings support the technical feasibility of the method, but that comparative studies are required to determine whether it offers advantages over conventional stent-placement techniques. That distinction between feasibility and superiority is important for readers to keep in mind.

Several limitations follow directly from the study design. The series was small, retrospective, single-surgeon, and descriptive, with no control group and no formal power calculation. The reported follow-up of roughly six to fourteen months captures early outcomes only. The findings therefore establish that the technique can be performed successfully in this selected group of children, while questions about how it compares with standard methods, and how it performs more broadly, remain open for future comparative research.

Subject of Research: A modified 8-Fr urethral sound-assisted technique for retrograde double-J stent placement during laparoscopic ureteral reimplantation in children

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

Article References: Li, X., Liu, P., Sun, N., Song, H., Han, W., & Zhang, W. (2026). A novel and simple modification for implantation of double-J stents during modified laparoscopic Lich Gregoir ureteral reimplantation. BMC Urology. https://doi.org/10.1186/s12894-026-02376-y

Image Credits: AI Generated

DOI: 10.1186/s12894-026-02376-y

Keywords: double-J stent, ureteral reimplantation, Lich-Gregoir technique, laparoscopy, vesicoureteral reflux, pediatric urology, urethral sound, surgical technique, feasibility study, retrograde stent placement, vesicoureteral junction obstruction, novel