Outpatient ureteric procedures: a new method for retrograde ureteropyelography and ureteric stent placement

Objective To evaluate a new method for retrograde ureteropyelography and re trograde ureteric stent placement. Patients and methods Procedures were undertaken using a flexible cystoscope and digital C-arm fluoroscopy in outpatients under sedoanalgesia. The flex ible cystoscope was used to identify the ureteric orifice and a straight 0. 9 mm hydrophilic guidewire inserted and passed into the renal pelvis under fluoroscopic guidance. A 4 F general-purpose catheter was then passed over the wire and ureteropyelography performed. To place the stent the hydrophil ic guidewire was exchanged for an ultra-stiff wire, over which the stent wa s passed directly. Results Over a 47-month period, 723 procedures were carried out in 472 pati ents. The clinical indications were ureteric obstruction in 229 (32%), ston e disease in 165 (23%), unexplained hydronephrosis in 150 (21%), haematuria in 94 (13%) and others in 85 (12%). Of the 723 procedures, 643 (89%) were technically successful. Failure was most commonly caused by failure to cann ulate the ureteric orifice (51, 7%). Just over half the procedures (366, 51 %) involved stent placement or replacement. Immediate complications occurre d in 17 patients (3%). Of those who were questioned, 94% (282 of 300) repor ted the procedure to be acceptable. Conclusion Retrograde ureterography and ureteric stent placement may be sat isfactorily undertaken with the patient under sedoanalgesia on an outpatien t basis. This technique can reduce costs, hospital admissions, general anae sthetic use, demands on theatre time and complication rates.