Facilitation of difficult percutaneous ureteral stent insertion

Area of Science:

• Urology
• Interventional Radiology

Background:

• Retrograde ureteral stent placement is often unsuccessful in cases of complete ureteral obstruction or complex strictures.
• Percutaneous nephrostomy is typically used for drainage but can be adapted for stent insertion.

Purpose of the Study:

• To evaluate the efficacy and challenges of antegrade ureteral stent placement in patients with previously unsuccessful retrograde attempts.
• To demonstrate that complete ureteral obstruction does not necessarily preclude stent insertion via an antegrade approach.

Main Methods:

• Antegrade ureteral stent placement was performed in 26 patients with failed retrograde attempts.
• Techniques included navigating complete obstructions, dilating strictures, and managing ureteral tortuosity and kinking.
• Fluoroscopy, pigtail catheters, and specialized guide wires were utilized.

Main Results:

• Successful ureteral stent insertion was achieved in patients with apparent complete obstruction.
• Fifteen patients with malignant or benign ureteral strictures underwent successful dilation and stenting.
• Ureteral tortuosity was managed with pigtail catheters; kinking in the renal pelvis was resolved with transparenchymal approaches and specialized catheters.

Conclusions:

• The antegrade approach is a valuable alternative for ureteral stent placement when retrograde techniques fail.
• Complete ureteral obstruction is not an absolute contraindication for ureteral stenting using an antegrade method.
• Specific technical challenges can be overcome with appropriate tools and manipulation under fluoroscopy.