Vinayak G Wagaskar1, Pankaj N Maheshwari2, Gyanendra Sharma3. 1. Department of Urology, Seth G.S. Medical College and Hospital Parel, Mumbai, Maharashtra 400012, India. 2. Fortis Hospital, Mulund, Mumbai, India. 3. Department of Urology, Chitale Clinic Private Limited, Solapur, Maharashtra, India.
Sir,We read with keen interest an interesting point of technique by Ratkal and Sharma [1] about a ‘pull and push’ technique of antegrade JJ stent placement after percutaneous renal procedures. The authors need to be complimented for a very interesting technique. Based on our experience of the ‘Reverse Zebra Technique’ of stent placement [2], we have a few comments on the presented technique.In the present technique, the ureteric catheter is gradually pulled until the lower end of the ureteric catheter is seen above the pubic symphysis. Through this catheter the guidewire is coiled in the bladder and the stent placed over it in an antegrade fashion. The major problem with this technique is that the lower part of the ureteric catheter is usually in the non-sterile zone of the surgical field. Due to the prone positioning of the patient, the lower end can become unsterile. By pulling the catheter up, the unsterile end of the catheter is being brought not only in the ureter but also in the kidney and out through the Amplatz sheath. In contrast, in the reverse zebra technique, the lower end remains out of the sterile field hence maintaining asepsis better.