Antegrade ureteric stents are performed under fluoroscopic guidance, typically by an interventional radiologist or urologist. It is performed via percutaneous access from the kidney. It is usually performed using the access from a prior percutaneous nephrostomy, a so-called two-step procedure, although may be performed de novo.
The vast majority of ureteric stents placed are polyurethane in composition and require changing if left for longer than 3 months. Metallic stents, composed of coiled spirals, have been available in recent years for those with malignant ureteric obstruction. These may be left for 12 months or more since they are corrosion resistant. Metallic stents demonstrate a reduction in the rate of tumour regrowth compared with conventional stents.1
Most practitioners leave a 'covering nephrostomy' in place for 24-48 hours after stent insertion. This may be clamped to ensure good output from the stent (via the bladder), before the nephrostomy is removed and access is lost.