Stone surgeries

Ureteral Stent

Cystoscopic stent placement technique (better for stent placement alone)

  1. Use single or double bridge
  2. Enter bladder with rigid cystoscope
  3. Place wire (double floppy, sensor, motion) into ureteral orifice
  4. Optional: place bumblebee catheter and obtain urine culture from collecting system
  5. Optional: place bumblebee catheter and shoot retrograde pyelogram to define collecting system
  6. Place stent over wire, back up cystoscope once thick black line visualized at ureteral orifice, and visualize pusher at bladder neck
  7. Remove wire, confirm proximal curl with fluoroscopy and distal curl with visualization
  8. Place catheter if concern for severe infection

Fluoroscopic stent technique (better at end of ureteroscopy)

  1. Place wire similar to cystoscopic technique, proceed with rest of procedure
  2. Pass stent over wire, then pass pusher behind stent - ensure visualization of radiopaque pusher mark, position at midsymphysis.
  3. Tip: maintain good back-tension and use a stiffer wire, otherwise wire can buckle in bladder (fix by slowly withdrawing wire)
  4. Remove wire to ensure proximal curl, then remove wire completely and gently push distal tip into bladder

Slick stent exchange technique

  1. Use double bridge
  2. Enter bladder with rigid cystoscope
  3. Pass bumblebee next to stent at ureteral orifice
  4. Pass wire (sensor, bentson) through bumblebee and up to kidney
  5. Remove bumblebee
  6. Insert flexible graspers through other channel and into bladder
  7. Grasp stent
  8. Push/pull with one hand on wire, and other hand simultaneously holding graspers shut and camera/scope
  9. Once stent is outside meatus, remove stent and grasper, then reinsert scope into bladder over wire
  10. Place stent using direct visualization, sitting at bladder neck and releasing once distal end is at bladder neck and pusher is visible

Resonance Stent placement

  1. Perform cystoscopy
  2. Place glide or sensor wire up to renal pelvis
  3. Place bumblebee over wire up to renal pelvis (retrograde pyelogram optional), exchange for stiffer wire
  4. Place resonance sheath over wire, shoot retrograde to define pelvic anatomy, then align mark at UPJ
  5. Insert stent into sheath, then push up to renal pelvis (watch curl under fluoroscopy)
  6. Slowly push distal end to mid-pubic symphysis, then push/pull sheath out to curl stent in bladder