Candidates:  Benign structures less than 2 cm

Procedure:

1. Cross stricture (antegrade or retrograde) and place a 10 F x 60 cm RETROGRADE nephrostomy tube.  A balloon may be used to dilate prior to retrograde PCN placement.  If UNABLE to cross, leave an 8 Fr PNC and can re-attempt once in the future.

2. Upsize RETROGRADE nephrostomy every 4-6 weeks with the goal of 16 Fr nephrostomy.

3.  After placement of 16 Fr RETROGRADE nephrostomy, leave in place for 4-8 weeks.

4. Remove 16 Fr. Catheter over the wire and advance a 3.3 Fr Mongoose or 4 Fr Kumpe into the inferior-most renal pelvis.  If the flow through the stricture is good, we can remove everything.  If the flow is questionable, perform 6 mm prolonged balloon dilatation and replace 16 Fr Skater for 8 weeks.  Can repeat if necessary versus decision on surgery or chronic Bander stent.

5. Refer back to urology after removal or failure.