INJECTABLE INTERNAL URETERAL STENT LEONARD J. GROSS GEORGE E. BRANNEN, M.D. From the Section of Urology and the Kidney Stone Treatment Center, The Virginia Mason Clinic, Seattle, Washington

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i:iurinary tract calculi with marginal i~ation or small size may be poorly visual~i~lain film. Consequently; contrast injec~!!thecollecting system to aid in stone loion under fluoroscopy may be required 'factory stone therapy using extracorpoihbck-wave lithotripsy (ESWL). We

describe a method by which a Double-J stent may be placed which also permits retrograde injection of contrast material during ESWL. This approach condenses the placement of a ureteral catheter for retrograde injection and placement of a postoperative ureteral stent into a one-step procedure.

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Tip of ureteral

. catheter

Detail: Ureteral catheter

J Stent

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Double J Stent Syringe

F[CUUE 1. Double-J stent advanced using infusion assembly (ureteral catheter) a~s guidewire. Pusher catheter is advanced over ureteral catheter to contact Double-J stent at its. end in bladder. Ureteral catheter is attached to syringe and extension tube for contra~st injection.

catheter

tube

Connector teral catheter as guide wire

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MARCH1990 ., VOLUMEXXXV,NUMBER3

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Material and Method The advancing tip of a 3-F ureteral catheter is trimmed back to a 2-3 mm in front of the fully a d v a n c e d stylet. A pusher c a t h e t e r trimmed to 28 em in length is advaneed over the ureteral catheter. This infusion assembly is packaged and autoelaved in preparation for sterile use. A Double-J stent (6, 7, or 8.5 F) is prepared for placement using the 3-F ureteral catheter (and stylet) as the guidewire. Using eystoscopy, the stent (and ureteral catheter) is advanced up the ureter into the renal eolleeting system. The pusher is advanced over the 3-F ureteral catheter to the point of eontaet with the bladder end of the stent. The ureteral stent eatheter is pulled baek 5 em to establish a coil in the renal pelvis (confirmed by fluoroscopy). The stylet in the 3-F ureteral catheter is withdrawn, and the eystoseope is carefully removed. The ureteral catheter is left in the lumen of the positioned Double-J stent and the

pusher is left in eontaet with the [ the stent (over the 3-F ureteral c ureteral catheter is prepared for i radiographic contrast using a syril tubing, and adapter. The injeetic secured to an indwelling Foley adhesive tape. The syringe is aeee trast injeetion any time during E~ Following ESWL the ureter~ withdrawn as the Double-J stent ! position with the pusher catheter. of the Double-J stent is eonfirm~ teral catheter and, subsequently; i withdrawn under fluoroscopie g to removing the patient from the Ureteral eatheter plaeement fi tive contrast injection and plaeerr ble-J stent for postoperative man be eondensed to a one-step proee isling inventory. Seattle, W a s h i n ~ o ~

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