Deligiannis P, Katsimperis S, Kyriazis I, Angelopoulos P, Neofytou P, Kapsalos-Dedes SG, Triantafyllou P, Arseniou P, Katelani S, Papatsoris A. Fluoroscopy-guided transurethral resection with antegrade guidewire assistance for retrieval of a buried double-J stent: A case report. World J Clin Cases 2026; 14(5): 117384 [DOI: 10.12998/wjcc.v14.i5.117384]
Corresponding Author of This Article
Stamatios Katsimperis, MD, 2nd Department of Urology, National and Kapodistrian University of Athens, Sismanogliou 1, Athens 15127, Attikí, Greece. stamk1992@gmail.com
Research Domain of This Article
Urology & Nephrology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Panagiotis Deligiannis, Stamatios Katsimperis, Ioannis Kyriazis, Panagiotis Angelopoulos, Panagiotis Neofytou, Sotirios G Kapsalos-Dedes, Panagiotis Triantafyllou, Polyvios Arseniou, Stamatia Katelani, Athanasios Papatsoris, 2nd Department of Urology, National and Kapodistrian University of Athens, Athens 15127, Attikí, Greece
Co-first authors: Panagiotis Deligiannis and Stamatios Katsimperis.
Author contributions: Deligiannis P and Katsimperis S wrote the paper; Kyriazis I designed research; Angelopoulos P and Neofytou P performed research; Kapsalos S and Triantafyllou P contributed analytic tools; Arseniou P and Katelani S contributed to patient management and data collection; Papatsoris A contributed to literature review and revision of the manuscript.
Informed consent statement: Written informed consent was obtained from the patient for publication of this case report and any accompanying images.
Conflict-of-interest statement: All authors declare that they have no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Stamatios Katsimperis, MD, 2nd Department of Urology, National and Kapodistrian University of Athens, Sismanogliou 1, Athens 15127, Attikí, Greece. stamk1992@gmail.com
Received: December 8, 2025 Revised: January 5, 2026 Accepted: February 2, 2026 Published online: February 16, 2026 Processing time: 66 Days and 16.2 Hours
Abstract
BACKGROUND
Buried or submucosally embedded double-J (DJ) stents present a rare but technically demanding challenge in endourology, particularly in patients with malignant ureteral obstruction and prior instrumentation. We describe the case of a 72-year-old woman with metastatic bladder cancer who presented with urosepsis and right hydronephrosis. During attempted bilateral stent exchange, the left ureteral orifice and distal stent curl were completely obscured by fibrotic tissue. A combined antegrade-retrograde approach was employed: A guidewire was advanced from the nephrostomy under fluoroscopy, while controlled transurethral resection of the obstructed ureteral orifice permitted exposure and retrieval of the buried stent. A new stent was subsequently placed without complications. This hybrid technique offers an effective solution in cases where traditional retrograde stent retrieval is impossible.
CASE SUMMARY
A 72-year-old woman presented to the emergency department with a 2-day history of fever, nausea, and worsening malaise. She described progressive left flank discomfort and suprapubic pressure. Her medical history included muscle-invasive bladder carcinoma with metastatic spread to the vertebral column, pelvic bones, and sacrum. She was receiving immunotherapy and had undergone multiple prior chemotherapy cycles. Bilateral ureteral DJ stents had been placed several months earlier due to malignant ureteral obstruction, and a left nephrostomy tube had subsequently been inserted following a prior obstructive episode. On examination, she was febrile and clinically unwell, with left costovertebral angle tenderness. Laboratory tests revealed elevated inflammatory markers and leukocytosis. Computed tomography (CT) imaging demonstrated right-sided hydronephrosis despite the presence of a DJ stent, with the left kidney adequately decompressed through the nephrostomy tube. Urine and blood cultures were obtained, and intravenous antibiotics and hydration were initiated. Despite 48 hours of conservative treatment, the patient showed no clinical improvement. Given the persistent hydronephrosis and the need for source control, the decision was made to perform bilateral stent exchange.
CONCLUSION
On examination, she was febrile and clinically unwell, with left costovertebral angle tenderness. Laboratory tests revealed elevated inflammatory markers and leukocytosis. CT imaging demonstrated right-sided hydronephrosis despite the presence of a DJ stent, with the left kidney adequately decompressed through the nephrostomy tube. Urine and blood cultures were obtained, and intravenous antibiotics and hydration were initiated. Despite 48 hours of conservative treatment, the patient showed no clinical improvement. Given the persistent hydronephrosis and the need for source control, the decision was made to perform bilateral stent exchange.
Core Tip: Buried ureteral stents pose a significant challenge when dense fibrosis obscures the distal end, preventing retrograde retrieval. This case presents a novel combined antegrade-retrograde technique integrating fluoroscopy-guided wire placement with transurethral resection to safely expose and remove a completely embedded double-J (DJ) ureteral stent. By using the antegrade guidewire to precisely localize the intramural ureter, this approach minimizes tissue trauma and offers an effective solution for managing complex DJ stent embedding in patients with malignancy-related fibrosis.
