Placement of double-J ureteric stent using the pull-through technique in patients with tight ureteric stenosis

Background: To evaluate the efficacy of antegrade insertion of the ureteric stent using pull-through technique in tight ureteric stricture that a guide-wire traversed, but a 5-F catheter could not. Materials and methods: Seven patients (M:F = 2:5, mean age 56 years) who underwent antegrade ureteric stent insertion using pull-through technique due to tight ureteric stricture were retrospectively evaluated. The strictures were due to impacted ureter stone (n = 3), metastasis from rectal cancer (n = 1), and idiopathic ureter stricture (n = 3). After failing to traverse a 5-F catheter through the stricture along the guide-wire, a 7-F introducer sheath was inserted through the urethra. The distal end of the guide-wire was snared and retrieved through the urethral introducer sheath. Then using pull-through technique, antegrade ureteric stent insertion was performed. Results: Double-J ureteric stent was successfully placed in all seven patients using the pull-through technique. Complications included abdominal/flank pain (n = 7), gross hematuria (n = 5) and elevated blood pressure (n = 1). All complications were relieved within 3 days after the procedure with conservative treatment. Conclusions: Antegrade double-J ureteric stent insertion using the pull-through technique is a safe and useful method, which can be used in tight ureteric strictures, where a ureteric stent cannot follow the passed guide wire.