Retrieval of migrated ureteral stents by coaxial cannulation with a flexible ureteroscope and paired helical basket

Purpose: Retrieval of a proximally migrated ureteral stent is a technically challenging endoscopic procedure. We describe the use of a paired wire helical stone retrieval basket through a flexible ureteroscope to remove proximally migrated ureteral stents. Materials and Methods: Five ureteral stents were lost in the proximal (1) and distal (4) ureter after lithotripsy or stent exchange. Once the location of the distal aspect of the ureteral stent was identified by either fluoroscopy or ureteroscopy, a safety guidewire was placed alongside the migrated stent. A flexible ureteroscope was brought to the distal end of the stent under direct visualization. Through the working port of the ureteroscope, the paired wire helical basket was deployed to grasp or coaxially cannulate the lumen of the migrated stent. Once inside the stent, the basket was then opened. The outward resistance of the deployed basket is sufficient to provide enough lateral force to reposition the stent into the bladder. Results: All stents were successfully retrieved without complication. No patient had visual evidence of ureteral injury, and all patients were discharged on the same day as their procedure. Conclusion: While proximal migration of a ureteral stent is usually caused by technical error, the ideal technique to reposition the stent should require the least time, trauma to the ureter, and expense to the patient. We describe a simple technique to retrieve migrated stents anywhere along the urinary tract.