An effective and novel technique for antegrade ureteral stent placement: The “hydroguiding” method

Purpose: Ureteral obstructions are clinically significant conditions that may develop due to benign or malignant causes and threaten renal function. Although the retrograde stenting method is generally preferred as the first-line approach, its success rate markedly decreases in cases with malignant or severe strictures. While antegrade stenting offers an alternative in such cases, it may fail when the guidewire cannot cross the stenosis. Case Presentation: 67 y/o male patient with left ureteral obstruction secondary to bladder cancer, both retrograde and conventional antegrade stenting attempts had failed. Subsequently, we applied a novel technique developed by our team and previously undescribed in the literature, termed the “Hydroguiding” technique. In this approach, a Y-hemostasis valve was connected to the tip of the guiding catheter, allowing simultaneous contrast injection and guidewire manipulation. Under fluoroscopic guidance, the hydrostatic pressure generated by the contrast injection enabled the guidewire to traverse the stenotic segment with minimal trauma and reach the bladder. Conclusion: The Hydroguiding technique may represent a feasible and promising adjunct to facilitate antegrade ureteral stent placement in selected cases with severe ureteral strictures where conventional methods fail. Further clinical studies are required to establish its safety, reproducibility, and long-term clinical effectiveness.