3:27 PM Abstract No. 64 Radiological retrograde ureteric stent exchange: a large single-center review

Safety and efficacy of fluoroscopy-guided retrograde transurethral replacement of ureteral stents as an alternative to cystoscopy-guided exchange has been proven. We assess our practice of retrograde stent exchange using an inexpensive modified wire loop snare technique. All the patients are from our women’s hospital where there is no Urology cover. Patients were identified retrospectively from our radiological information system database. Between Jan 2012 and Dec 2016, there were 79 patients (mean age 55 years, range 32-79) of whom 14 underwent retrograde stent retrieval on the first visit and the rest underwent stent exchange. In total we retrieved 255 stents and replaced 241. The procedures were performed on an outpatient basis unless the patient was already an inpatient. Under fluoroscopic guidance, a 10F sheath was inserted into the urinary bladder through the urethra. Using a 0.018” Terumo wire loop as a modified snare, the distal end of the stent was withdrawn just outside the urethra. A 0.035” guidewire was then advanced into the renal pelvis through the stent and the old stent exchanged for a new one. Ureteroplasty was performed if there was contrast hold up. Stent exchange was successful in 237/241 (98%) of cases. Failure was due to loss of access (1 case), inability to snare stent due to distorted anatomy (2 cases) and inability to cross ureteric stricture (1 case). In 218 (90%) of cases, stent was retrieved using modified snare while in 21 (10%) of cases other snare devices were used. Most of the patients tolerated the procedure well. 43/65 (66%) patients had regular 3-4 monthly exchanges till death or study end point. 10/65 (15%) no longer required ureteral stenting as there was resolution of ureteral obstruction. 10 were lost to follow-up or care transferred back to urologists and 2 no longer wished to be on ureteral stenting. Fluoroscopy-guided retrograde ureteral stent exchange is safe, effective and quick and can be easily performed with equipment used in daily intervention practice. It may also be coupled with ureteroplasty, which may help the patient achieve eventual stent-free status.