Fluoroscopic guidance of retrograde exchange of ureteral stents in women.
OBJECTIVE
The purpose of this study was to review our experience with fluoroscopically guided retrograde exchange of ureteral stents in women.


METHODS
During a 48-month period, 28 women (age range, 38-76 years) were referred to our department for retrograde exchange of a ureteral stent. The causes of urinary obstruction were tumor compression in 26 patients and benign fibrotic stricture in two patients. A large-diameter snare catheter (25-mm single loop or 18- to 35-mm triple loop) or a foreign body retrieval forceps (opening width, 11.3 mm) was used to grasp the bladder end of the stent under fluoroscopic guidance. The technique entailed replacement of a patent or occluded ureteral stent with a 0.035- or 0.018-inch guidewire with or without the aid of advancement of an angiographic sheath.


RESULTS
A total of 54 ureteral stents were exchanged with a snare catheter in 42 cases or a forceps in 12 cases. One stent misplaced too far up the ureter was replaced successfully through antegrade percutaneous nephrostomy. Ten occluded stents, including one single-J stent, were managed with a 0.018-inch guidewire in three cases, advancement of an angiographic sheath over the occluded stent into the ureter in five cases, and recannulation of the ureteral orifice with a guidewire in two cases. No complications of massive hemorrhage, ureter perforation, or infection were encountered.


CONCLUSIONS
With proper selection of a snare or forceps catheter, retrograde exchange of ureteral stents in women can be easily performed under fluoroscopic guidance with high technical success and a low complication rate.
Chang
Ruey-Sheng
RS
Department of Radiology, Kaohsiung Veterans General Hospital, 386 Ta-Chung 1st Rd., Kaohsiung, Taiwan, Republic of China.
Liang
Huei-Lung
HL
Huang
Jer-Shyung
JS
Wang
Po-Chin
PC
Chen
Matt Chiung-Yu
MC
Lai
Ping-Hong
PH
Pan
Huay-Ben
HB
D000328:Adult; D000368:Aged; D020878:Device Removal / Q000379:methods*; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D008875:Middle Aged; D019919:Prosthesis Implantation / Q000379:methods*; D015607:Stents; D025321:Surgery, Computer-Assisted / Q000379:methods*; D016896:Treatment Outcome; D014513:Ureter / Q000000981:diagnostic imaging* / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods*