745 - Interventional Radiology Can Do It Too: Antegrade Ureteroscopy and Lithotripsy for Ureterolithiasis

Monday, April 13, 2026

5:15 PM - 5:21 PM ET

Abstract Presenter(s)

Rachel H. Soong (she/her/hers)

Medical Student
Kirk Kerkorian School of Medicine at UNLV, United States

Author/Co-author(s)

BA

Baylor Akhavan, BS

Medical Student
Kirk Kerkorian School of Medicine at UNLV, United States
BK

Brian Kerlin, BS

Medical Student
Kirk Kerkorian School of Medicine at UNLV, United States
AC

Albert Cook, MD

Interventional Radiologist
University Medical Center of Southern Nevada, United States
RR

Ryan Rimer, MD

Vascular and Interventional Radiologist
University Medical Center of Southern Nevada, United States
BC

Brandon Chen, MD

Physician
University Medical Center of Southern Nevada, United States

Learning Objectives:

To describe the technical approach of antegrade ureteroscopy and lithotripsy in patients with ureterolithiasis.

To review clinical cases where interventional radiology (IR) performed definitive stone treatment.

To discuss how IR can improve care delivery for patients with limited urology access.

Background: Ureterolithiasis often involves urologic intervention. However, patients with limited access to urology intervention may experience prolonged dependence on nephrostomy drainage, resulting in increased patient discomfort, risk of catheter-related complications, and delays in definitive management. This educational exhibit demonstrates that antegrade ureteroscopy with electrohydraulic lithotripsy (EHL) performed by IR can safely expedite stone clearance, reduce catheter dwell time, and improve patient quality of life.

Clinical Findings/Procedure Details: Antegrade ureteroscopy was performed using the SpyGlass Discover digital catheter (10.8 Fr diameter, 65 cm working length, 3.6 Fr accessory channel), with stones fragmented by Autolith EHL probes (1.9 Fr, 375 cm) generating shockwaves through repetitive vaporization bubble expansion and collapse. Technical considerations include maintaining the EHL probe 1-2 mm from the stone surface, leaving a safety wire alongside the access sheath, and placing a Foley catheter prior to starting the case. In most cases, a 12 Fr sheath (Cook) was used, but a larger or peel-away sheath could be considered for stone retrieval. Ureteral stents or nephroureteral catheters were placed for drainage and removed at follow-up. Case 1 involved an 11 mm distal ureteropelvic junction stone, Case 2 a 6 mm distal stone, Case 3 a 5 mm obstructing left ureteral stone, and Case 4 a 9 mm proximal ureteral stone. All four cases were treated with antegrade ureteroscopic lithotripsy, achieving fragmentation < 4 mm or clearance of the ureter.

Conclusion and/or Teaching Points: As demonstrated by these cases, interventional radiology can safely and successfully treat ureteral stones. This approach is particularly valuable in regions with urology workforce shortages or for patients with limited access to care or follow up. With the SpyGlass catheter and EHL, IR can not only place the nephrostomy tube, but also offer definitive stone therapy, allowing faster comprehensive treatment and reduced indwelling catheter time, readmission rates, and nephrostomy tube complications. Interventional radiologists have the skills and tools for an expanded role in managing ureteral stones.