Clinical study
Percutaneous Antegrade Removal of Double J Ureteral Stents via a 9-F Nephrostomy Route

https://doi.org/10.1016/j.jvir.2007.06.016Get rights and content

Purpose

To evaluate the safety and clinical efficacy of an antegrade approach in the removal of double J ureteral stents via preexisting nondilated nephrostomy routes under fluoroscopic guidance.

Materials and Methods

Under fluoroscopic guidance and local anesthesia, antegrade removal of 39 ureteral stents in 27 patients was attempted by using a snare or basket. Indications for percutaneous stent removal included the presence of a preexisting nephrostomy route (n = 8), a surgical history resulting in an inaccessible retrograde route (n = 8), urethral stricture (n = 5), upward stent migration (n = 2), inability to obtain a lithotomy position (n = 1), fragmentation of the proximal stent (n = 1), and inability to find the ureteral orifice with a cystoscope (n = 2).

Results

Thirty-seven of the 39 stents (95%) were successfully removed by using a snare or basket. Two stents (5.1%) could not be removed with a snare or basket because they were embedded against the renal calyx or pelvis. There were no major complications. Blood clot formation or laceration or tract leakage of the pelvicalyceal system occurred in six and two patients, respectively, all of which resolved spontaneously.

Conclusions

Percutaneous antegrade removal of double J ureteral stents with a snare or basket via a nondilated nephrostomy route is effective without major complications in patients with an available nephrostomy route or an inaccessible retrograde option.

Section snippets

Patients

Between August 1997 and February 2007, 393 6- or 8-F double J stents (Boston Scientific/Microvasive, Boston, Mass; C.R. Bard, Covington, Ga) were placed in an antegrade manner through a nephrostomy tract under fluoroscopic guidance, and 7,860 were placed in a retrograde manner by urologists. All stents were made of polyurethane and had a double pigtail configuration at either end to prevent stent migration. Percutaneous fluoroscopically guided antegrade stent removal of 39 stents in 27 patients

Patients and Access Methods

The causes of ureteral strictures are summarized in Table 1. Ureteral strictures were located in the right ureter in 20 patients, in the left ureter in 18 patients, and in a transplanted ureter in one patient. At stent removal, 25 patients had an 8.5-F nephrostomy tube, and the mean interval between nephrostomy access and stent removal was 48.18 days (range, 2–195 days). Two patients underwent nephrostomy and stent removal during the same session.

Indications for Stent Removal

Double J stents were removed due to stent

Discussion

The retrievability of ureteral stents is very important for their removal in cases of stent blockage or migration (1, 2, 6, 7, 8). Antegrade ureteral stent placement is preferred as the primary route in cases with substantial involvement of the ureteric orifice by the tumor or a tight stricture very close to the ureterovesical junction (4). In this study, we confirmed that percutaneous removal of double J ureteral stents via preexisting nondilated nephrostomy routes was feasible and effective.

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  • Clinical Utility of the Modified Snare Technique for Percutaneous Antegrade Removal of Double J Ureteral Stents

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None of the other authors have identified a conflict of interest.

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