[Anterograde and retrograde ureteral stent placement using fluoroscopic guidance with a radio-opaque pusher]

The aim of our work was to show that, in addition to the standard technique, double-J ureteral stent can be positioned also through a prevalently fluoroscopic method, that uses a guide wire inside the ureter and a radiopaque pusher with a metal tip.

The access can be anterograde or retrograde. In both cases, after the guide wire is in the ureter, we remove the cystoscope or the nephrostomy tube, advance the stent over the guide wire with the metal tip pusher, which can be easily localized through the amplifier. Since 1997 we have positioned a ureteral stent with metal tip pusher in 80 cases: 10 (12.5%) by anterograde technique and 70 (87.5%) by retrograde technique.

In our total experience we had only 1 (1.2%) failure and 1.4% complications with the retrograde technique (1/70, on the first 10 patients) and 10% with the anterograde one (1/10).

According to our results, the placement of a ureteral stent by means of fluoroscopy is simple, effective and safe. This technique is very useful for the outpatient where the help from an anaesthesiologist is lacking, because it allows a higher tolerance of the patient for the use of small caliper endoscopes and for a reduced permanence time of these inside the urethra. Moreover, there are particular situations (for example urethral stenosis, ureteral stenting by anterograde technique), where this procedure helps to solve some difficulties.