Ureteral stents and retrograde studies: a primer for the gynecologist

Abstract

To review basic techniques and recent advances in endourology for the practicing gynecologist. New ureteral stent designs are available to improve comfort and reduce some of the complications of indwelling ureteral stents. A large prospective study failed to show a significant benefit of prophylactic ureteral catheterization prior to major gynecological surgery to reduce the risk of ureteral injury. There is a shift in the management of some iatrogenic ureteric injuries from surgical reimplantation to more conservative endoscopic management by interventional radiologists and urologists. The indications, techniques, and complications of advanced endourology techniques including the use of indwelling ureteral stents and retrograde pyelography are reviewed. Indwelling ureteral stents are used to establish and maintain patency of the ureters for many indications, including specific gynecological indications such as iatrogenic ureteral injury, ureteric fistula, extrinsic compression from tumor, and prophylactically to prevent ureteric injury. Retrograde pyelography is a very useful technique to image the renal collecting system with particular utility in patients with contraindications to intravenous contrast and to investigate suspected iatrogenic ureteral injuries.