Ureteral stricture following ureteroscopic stone surgery is a common clinical challenge. Repeated placement of a Double-J Stent(DJ) stent is often used as an initial management strategy. However, in some patients, the interval between stent exchanges becomes progressively shorter due to recurrent obstruction, persistent hydronephrosis, and declining quality of life.

This case presents a patient with recurrent upper ureteral stricture who experienced unsatisfactory outcomes after multiple DJ stent placements. The patient subsequently underwent ureteral balloon dilatation followed by implantation of a domestically developed Ureteral Stent System. At the 3-month follow-up, imaging demonstrated stable stent positioning, maintained ureteral patency, and significant improvement in hydronephrosis.

Case Presentation

A 47-year-old woman was admitted with a history of recurrent left flank pain accompanied by chills and fever for more than one year.

The patient had previously been diagnosed with a left upper ureteral stone associated with severe left hydronephrosis and multiple bilateral renal calculi. She underwent ureteroscopic holmium laser lithotripsy followed by percutaneous nephrolithotomy (PCNL).

Postoperatively, she developed a stricture of the left upper ureter. Despite repeated Double-J stent placements and left percutaneous nephrostomy drainage, symptom relief was only temporary. During the intervals between stent exchanges, recurrent flank pain, chills, and fever persisted.

The final diagnosis was left upper ureteral stricture.

                                                            Preoperative CT Scan

Treatment Strategy

After comprehensive evaluation, Professor Zhu Wu and his team selected the following treatment strategy:

Ureteral Balloon Dilatation + Ureteral Stent System Placement

Post-lithotripsy ureteral strictures often result in progressive narrowing of the ureteral lumen, impaired urinary drainage, and worsening hydronephrosis.

Although Double-J stents remain a widely used temporary drainage solution, they have inherent limitations in lumen diameter and indwelling duration. Long-term placement is also associated with complications such as encrustation and obstruction, frequently requiring repeated stent replacement.

In this case, a Ureteral Stent System was selected to provide a more durable endoluminal treatment option. The stent features a large drainage lumen and a full-length hydrophobic membrane designed to facilitate long-term urinary drainage.

Its self-expanding nitinol framework provides continuous radial force to maintain ureteral patency, while the hydrophobic covering helps minimize tissue ingrowth through the stent mesh, reducing the risks of restenosis, tissue hyperplasia, and stent encrustation.

Procedure

Following standard preoperative preparation, the patient was placed in the lithotomy position. Endoscopic examination confirmed the location of the stricture in the upper ureter.

                                                                        Identification of the Stricture Segment

Balloon dilatation of the stenotic segment was first performed. The Ureteral Stent System was then advanced over the guidewire to the target location.

Under fluoroscopic guidance, the proximal end of the stent was positioned to adequately bridge the proximal margin of the stricture. The delivery catheter was stabilized, and the stent was deployed gradually under continuous C-arm fluoroscopic monitoring. The positioning wire was subsequently removed, and final fluoroscopy confirmed accurate deployment without stent migration.

                                                                       Successful Ureteral Stent System Placement

Follow-Up

At the 3-month follow-up, kidney-ureter-bladder (KUB) radiography demonstrated that the Ureteral Stent System remained in the correct position with no evidence of migration.

Ultrasound examination also showed a marked reduction in left hydronephrosis compared with the preoperative findings.

         3-Month Postoperative KUB Radiograph                                                 3-Month Postoperative Ultrasound

Clinical Significance

For patients with recurrent ureteral stricture after stone surgery who require frequent Double-J stent exchanges, Ureteral Stent Systems may offer a promising long-term alternative.

By combining sustained radial support with a hydrophobic barrier designed to reduce tissue ingrowth and encrustation, Ureteral Stent Systems have the potential to maintain long-term ureteral patency, reduce repeat interventions, and improve patient quality of life.