Antegrade Irrigation via a Percutaneous Nephrostomy Tube During Rigid Ureteroscopic Laser Lithotripsy for Distal Ureteral Stones: A Case Report.

Stone retropulsion during ureteroscopy (URS) remains a significant challenge that can prolong operative time and may require additional procedures. Antegrade irrigation through a percutaneous nephrostomy (PCN) tube has been described primarily for proximal ureteral stones. We report the successful application of this technique in a patient with bilateral distal ureteral stones using pre-existing bilateral PCN tubes during rigid ureteroscopic laser lithotripsy. A 50-year-old woman presented with bilateral flank pain, dysuria, hematuria, and fever. Laboratory findings showed elevated creatinine levels and leukocytosis. Non-contrast CT revealed multiple bilateral distal ureteral stones, the largest measuring 12.4 mm, with moderate-to-severe hydroureteronephrosis and left lower calyceal stones. Bilateral PCN tubes were inserted, resulting in clinical and biochemical improvement. Two weeks later, elective bilateral rigid URS with laser lithotripsy was performed under continuous gravity-assisted antegrade saline irrigation through the PCN tubes. The antegrade flow promoted the distal migration of stone fragments, minimized proximal retropulsion, and maintained a clear visual field. All fragments were successfully retrieved using a Dormia basket, and bilateral double-J stents were placed. At four weeks, a postoperative kidney-ureter-bladder (KUB) radiograph showed no visible residual radiopaque stones. No irrigation-related complications were observed. In conclusion, antegrade irrigation through PCN tubes may be a practical, low-cost adjunct that facilitates fragment management and may improve stone-free outcomes, even for distal ureteral stones, particularly in patients requiring initial urinary diversion. This technique warrants further evaluation in larger studies.