Retrograde pyelography and ureteric stent procedures
Cystoscopic cannulation of the ureter for contrast definition, guidewire access and temporary internal drainage, including later exchange or removal.
Interactive 3D Interactive forgotten-stent model Open the 3D animation 3D Interactive retrograde and JJ stent insertion Teaching catalogue only. This coverage record is not a patient pathway or operative instruction.
Typical place in practice
Diagnosis of upper-tract anatomy, relief or prevention of ureteric obstruction, protection of a ureteric repair and facilitation of another endourological procedure.
Alternatives and neighbouring procedures
Percutaneous nephrostomy, observation, definitive treatment or externalised ureteric drainage depending on obstruction, infection and anatomy.
Same procedure family, explicit technique branches
These are variations of this canonical operation. Complication modules below identify whether they apply to all branches or only to named approaches.
Retrograde pyelogram alone
Contrast is introduced carefully to outline ureter and collecting system without leaving a device.
Primary retrograde JJ stent insertion
A wire and internal stent bridge the ureter from renal pelvis to bladder.
Ureteric stent exchange
An indwelling device is removed and replaced while upper-tract access is maintained when needed.
Ureteric stent removal
The distal coil or retrieval string is used to remove a stent once its purpose is complete.
High-level sequence
Coverage outline only; not a step-by-step technical guide.
- Confirm side, indication, infection risk and prior imaging
- Inspect bladder and identify the correct ureteric orifice
- Cannulate gently and define anatomy without excessive pressure
- Establish secure wire access and deploy the intended device
- Confirm both ends, drainage plan and a reliable removal or exchange date
Operative notes
Concise operative notes covering the key steps, landmarks and watch points, in the order you encounter them.
Ureteroscopy for ureteric stones
What it does: up the ureter with a thin rigid scope over two wires. Dust the stone.
- Cystoscopy first. See the trigone and both orifices.
- 2 wires. The first is the safety wire: up the centre, to the kidney, under screening. It stays until the end.
- Cystoscope out. Semirigid scope in with the second (working) wire through its channel. Wire 2 up the ureter through the scope. It only guides the scope.
- Hold both wires gently taut. Railroad the scope over wire 2 to the stone. Advance only under vision. See the lumen always. A semirigid scope barely bends: the ureter straightens over it. The iliac crossing is where it catches.
- Orifice too tight? Rotate the scope 180 degrees.
- Sheaths rarely help in the ureter.
- Finger on the water valve. Minimum flow. Hard flow flushes the stone back to the kidney.
- Going over the wire shields the stone.
- Stone seen: water off, pull the working wire. Keep the safety wire. Laser or pneumatic in.
- Laser tip well clear of the scope lens. Fire against the lens = cracked lens.
- Laser: dust it, do not chunk it. Paint the stone. Never leave large pieces in the ureter: they scatter and they do not pass. Dust clouds: wash out, refire.
- Let dust and fine fragments clear by gravity. A piece too big to clear: basket it, test the pull first. Resists? Release, laser it smaller. Never drag. Scope and basket come out together, fragment at the tip, wall inspected all the way down. One fragment out is not stone-free: the dust stays to pass.
- Stent after if: hole in the ureter, torn mucosa, leftover fragments, dilated stricture, 1 kidney, both sides done, or case over ~45 min.
- Simple low stone? No routine stent. (CROES data.)
- 2026 update: No change. This is still current practice.
- Watch: Scope sizes: tip 6 to 8 Fr, shaft 7.5 to 10 Fr, channel 3.6 Fr (or 2.4 and 3.4 Fr), wires 0.035 or 0.038 inch, fibre 200 to 365 micron. Owner-confirmed typical sizes.
- Wire will not pass a stone: Catheter up to just below the stone: its support often lets the sensor wire through. No? A little contrast: is the stone blocking? None passes? Terumo hydrophilic wire. Terumo up: follow with the catheter, exchange to a sensor wire. Stenting over a Terumo is hard. Still stuck: call the consultant. Semirigid scope fragments the stone so the wire passes.
- JJ over the wire: Four thin black dashes, then the thick band. Band going into the orifice: scope back to the bladder neck. Push till the golden pusher tip shows. Stop. Wire out completely. Curl in the kidney on the screen. In the bladder the stent's own end drops and curls on the base: one open coil in line with the shaft, not a separate loop out of the orifice. Lateral orifice: right side arrow to 3 o'clock, wire angles to 9; left side arrow to 9, wire to 3.
- Catheter will not go up the orifice: Guidewire through the ureteric catheter, soft tip just beyond the end. Lead the tip into the orifice. The catheter follows over it. Contrast on the screen only: it is not seen through the scope.
From the UroRef Operative Quick Guide. Open the note page →
Every failure mode is its own module.
Timing and variation coverage are recorded for each module.
Ureteric perforation or false passage
A wire, catheter or pressurised injection can leave the ureteric lumen, particularly at an impacted obstruction.
Applies to: Retrograde pyelogram alone · Primary retrograde JJ stent insertion · Ureteric stent exchangeUrinary infection or sepsis
Instrumentation of an infected or obstructed system can precipitate systemic infection; a blocked stent may fail to drain.
Applies to: Retrograde pyelogram alone · Primary retrograde JJ stent insertion · Ureteric stent exchange · Ureteric stent removalFailure to obtain retrograde access
A tight obstruction, distorted orifice or loss of access may prevent safe passage and require an alternative drainage route.
Applies to: Retrograde pyelogram alone · Primary retrograde JJ stent insertion · Ureteric stent exchangeStent malposition or migration
Incorrect length, incomplete coil formation or later movement can impair drainage and injure the tract.
Applies to: Primary retrograde JJ stent insertion · Ureteric stent exchangeStent symptoms, haematuria or reflux pain
An internal stent may cause frequency, urgency, flank discomfort and visible bleeding despite adequate position.
Applies to: Primary retrograde JJ stent insertion · Ureteric stent exchangeEncrustation, blockage or forgotten stent
Delayed removal increases mineral deposition, infection, obstruction and the complexity of eventual retrieval.
Applies to: Primary retrograde JJ stent insertion · Ureteric stent exchangeUreteric avulsion during removal
Forceful extraction of an encrusted, knotted or trapped stent can cause major ureteric injury.
Applies to: Ureteric stent removalSources for this module
SWL, ureteroscopy, RIRS, PCNL, bladder stones and decompression options.
Accessed 2026-08-03 · opens source European Association of Urology EAU Guidelines on Urological InfectionsInfection prevention, recognition and procedure-associated infection context.
Accessed 2026-08-03 · opens source British Association of Urological Surgeons Patient information leaflets by procedureUK patient-facing procedure, alternatives, recovery and complication framing.
Accessed 2026-08-03 · opens source