Percutaneous internal ureteral stent placement: review of technical issues and solutions in 50 consecutive cases

Fifty consecutive percutaneous ureteral stent placements in 40 patients over 2 1/2 years were reviewed. Thirty-seven of 50 cases were performed following failed retrograde stenting. Antegrade stenting failed in 2/37 (5%) cases of malignant obstruction, and 4/13 (31%) cases of benign ureteral disease. Causes of failure and common technical problems included poor angulation of the percutaneous track, tortuous dilated ureters, tight obstructions, wedging of stent assembly components due to high resistance, and difficulty in positioning of the proximal pigtail. Helpful technical modifications included mid-pole rather than lower pole calyceal access, urinary decompression prior to stenting, and the routine use of a peel-away sheath (success rate 23/24 placements with sheath vs 21/26 without sheath). Stent patency rates were 95% at 3 months and 54% at 6 months. With attention to technique and appropriate modifications, success rate of percutaneous stenting remained high in this series despite the large number of cases referred after retrograde stenting had failed.