Clinical Outcomes of Antegrade Double-J Stent Placement in Patients with Failed Retrograde Ureteral Stenting

Abstract

Objective: This study aimed to evaluate the technical and clinical success, complication profile, and clinical effectiveness of antegrade double-J (DJ) stent placement in patients in whom retrograde ureteral stenting had failed.Materials and Methods: This retrospective study included patients who underwent antegrade DJ stent placement between 2021 and 2025 due to unsuccessful retrograde access. All procedures were performed under ultrasonographic and fluoroscopic guidance. Patients were categorized into single-stage and 2-stage antegrade stenting groups based on their clinical condition. All interventions were performed by a single experienced interventional radiologist. Technical and clinical success rates were assessed, and procedure-related complications were classified according to the Society of Interventional Radiology (SIR) guidelines.Results: A total of 40 patients were included in the study; 45.0% were treated for benign and 55.0% for malignant ureteral obstruction. Antegrade double-J stent placement was technically successful in all patients, with a significant reduction in the degree of hydronephrosis observed after the procedure. Clinical evaluation demonstrated a statistically significant decrease in serum creatinine levels and visual analog scale (VAS) pain scores at 24 hours post-procedure (p < 0.001). No clinically significant decrease in hemoglobin levels was observed. The overall complication rate was 7.5%, and all complications were minor and resolved with conservative management.Conclusion: Antegrade DJ stenting represents a safe, effective, and minimally invasive alternative in patients with failed retrograde access. When performed within a multidisciplinary framework involving urology and interventional radiology, this approach improves patient comfort and reduces the need for long-term percutaneous nephrostomy.