PERCUTANEOUS INTERNAL URETERAL STENT PLACEMENT - REVIEW OF TECHNICAL ISSUES AND SOLUTIONS IN 50 CONSECUTIVE CASES

Fifty consecutive percutaneous ureteral stent placements in 40 patient s over 2 1/2 years were reviewed. Thirty-seven of 50 cases were perfor med following failed retrograde stenting. Antegrade stenting failed in 2/37 (5%) cases of malignant obstruction, and 4/13 (31%) cases of ben ign ureteral disease. Causes of failure and common technical problems included poor angulation of the percutaneous track, tortuous dilated u reters, tight obstructions, wedging of stent assembly components due t o high resistance, and difficulty in positioning of the proximal pigta il. Helpful technical modifications included mid-pole rather than lowe r pole calyceal access, urinary decompression prior to stenting, and t he routine use of a peel-away sheath (success rate 23/24 placements wi th sheath vs 21/26 without sheath). Stent patency rates were 95% at 3 months and 54% at 6 months. With attention to technique and appropriat e modifications, success rate of percutaneous stenting remained high i n this series despite the large number of cases referred after retrogr ade stenting had failed.