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Fluoroscopic Guidance of Retrograde Exchange of Ureteral Stents in Women

Ruey-Sheng Chang1, Huei-Lung Liang1,2, Jer-Shyung Huang1,2, Po-Chin Wang1, Matt Chiung-Yu Chen1, Ping-Hong Lai1,2 and Huay-Ben Pan1

1 Department of Radiology, Kaohsiung Veterans General Hospital, 386 Ta-Chung 1st Rd., Kaohsiung, Taiwan, Republic of China.
2 Department of Radiology, National Yang-Ming Medical School, Kaohsiung, Taiwan, Republic of China.


Figure 1
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  		Fig. 1A —66-year-old woman with right obstructive uropathy due to recurrent cervical carcinoma. Photograph shows triple-loop snare catheter.

 

Figure 2
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  		Fig. 1B —66-year-old woman with right obstructive uropathy due to recurrent cervical carcinoma. Fluoroscopic image shows snare catheter (arrows) curved downward to reach stent (arrowhead) abutting on mucosa.

 

Figure 3
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  		Fig. 2A —68-year-old woman with bladder end of double-J catheter in bladder diverticulum. Photograph shows foreign body retrieval forceps with opening width of 11.3 mm.

 

Figure 4
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  		Fig. 2B —68-year-old woman with bladder end of double-J catheter in bladder diverticulum. Fluoroscopic image shows bladder end of stent in bladder diverticulum (arrow), which excludes possibility of exchange with snare catheter.

 

Figure 5
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  		Fig. 2C —68-year-old woman with bladder end of double-J catheter in bladder diverticulum. Fluoroscopic image shows stent successfully grasped with forceps catheter.

 

Figure 6
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  		Fig. 3A —55-year-old woman with solid blockade of bladder end of stent. Fluoroscopic image shows sheath (arrows) does not advance into ureter.

 

Figure 7
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  		Fig. 3B —55-year-old woman with solid blockade of bladder end of stent. Fluoroscopic image shows guidewire (arrow) inserted through sheath alongside occluded stent (arrowhead) for successful cannulation of ureteral orifice.

 

Figure 8
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  		Fig. 3C —55-year-old woman with solid blockade of bladder end of stent. Fluoroscopic image shows ureteral stent successfully exchanged.

 

Figure 9
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  		Fig. 4A —79-year-old woman with bladder carcinoma after cystectomy. Fluoroscopic images show lower end of stent in ileal conduit grasped with forceps catheter.

 

Figure 10
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  		Fig. 4B —79-year-old woman with bladder carcinoma after cystectomy. Fluoroscopic images show lower end of stent in ileal conduit grasped with forceps catheter.

 

Figure 11
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  		Fig. 4C —79-year-old woman with bladder carcinoma after cystectomy. Fluoroscopic image shows that owing to occlusion of renal end of stent, 0.035-inch guidewire did not pass through; 0.018-inch (0.5 mm) guidewire was inserted through sidehole (arrow) of stent into renal pelvis (arrowhead).

 

Figure 12
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  		Fig. 4D —79-year-old woman with bladder carcinoma after cystectomy. Fluoroscopic image shows stent replaced by retrograde technique.

 

Figure 13
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  		Fig. 5A —38-year-old woman who incurred iatrogenic ureteral injuries during surgical intervention for ovarian endometriosis. Bilateral ureteral stents were placed during operation. Stents were occluded and replaced in retrograde manner twice within 6 months. Fluoroscopic image shows segmental fibrotic narrowing (arrow) in lower part of ureter.

 

Figure 14
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  		Fig. 5B —38-year-old woman who incurred iatrogenic ureteral injuries during surgical intervention for ovarian endometriosis. Bilateral ureteral stents were placed during operation. Stents were occluded and replaced in retrograde manner twice within 6 months. Fluoroscopic image shows cutting balloon (arrow) used to dilate stenotic segment. Inlay stent was inserted and remained patent for 8 months.

 

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