Live Renal Ultrasonography Facilitates Double-J Ureteral Stent Insertion at the Bedside: A Pilot Study for the COVID-19 Era

Abstract

Objectives: To investigate the feasibility and efficacy of live renal ultrasonography to guide Double-J ureteral stent placement at the bedside. Patients and Methods: Between April 12 and June 5, 2020, patients presenting with acute ureteral obstruction requiring decompression were prospectively selected for ultrasound-guided bedside ureteral stent placement. During stent placement, upper tract access confirmed using ultrasound with or without retrograde injection of ultrasound contrast before Double-J stent insertion. A postprocedural abdominal X-ray was obtained for stent position confirmation. Results: Eight patients (four men and four women) were offered bedside ultrasound-guided ureteral stent placement, and all eight consented to proceed. Stents were placed in seven of eight patients. One patient had an impacted ureterovesical junction stone and stricture requiring ureteroscopy and laser lithotripsy in the operating room. All patients tolerated procedures without immediate complications. Conclusion: Live renal ultrasonography can facilitate a high success rate for bedside ureteral stent placement outside the operating room. This approach is an attractive alternative to fluoroscopy-guided stent placement in the operating room and is of particular value in the COVID-19 era when judicious use of these resources is salient.

Keywords: bedside procedure; hydronephrosis; nephrolithiasis; ultrasound; ureteral stent.

FIG. 1.

Ultrasound imaging of wire insertion and ultrasound contrast injection in collecting system. (A) Kidney with dilated collecting system before (left) and after (right) insertion of wire (white arrow). Schematic shown hereunder with cortex outlined with thin solid black line, collecting system outlined with dashed gray line, and wire within the collecting system represented by thick solid black line. (B) Injection of ultrasound contrast in three frames. Schematic shown hereunder, with ultrasound contrast represented by gray cloud within collecting system. Recorded video is available in supplementary material.

FIG. 2.

Postprocedural abdominal X-ray to confirm stent placement. Patient 3 is not shown because procedure was aborted. Follow-up scout film of CT scan for patient 5 is shown in panel 5a.