The use of stenting after Percutaneous nephrolithotomy (PCNL) is not uncommon, especially in complex cases and their removal requires an additional procedure. Dangler's stent came with a promise of avoiding this additional procedure for stent removal but was complicated by limited availability, possible infections, and premature pulling out of the stent. This novel technique of antegrade stent removal with strings hanging out from the patient's loin. The objective of this study is to describe this novel technique and estimate its outcomes.

A prospective descriptive observational case-series including consenting patients requiring stenting after PCNL during 18 months. We excluded patients requiring stenting for prolonged periods >2 weeks. A total of 39 patients met the criteria, underwent this novel technique which involves tying prolene suture to the renal end of the stent and then inserting the stent in antegrade fashion, later stent removal was done by pulling the strings from the loin in outpatient room. We followed subjects for 3 months and recorded outcomes in terms of successful stent removal, urinary tract infections, accidental pulling out or migration of stent and sinus formation.

The subjects including 24 men (61.5%) and 15 women (38.5%) with mean BMI of 22.7(17.5-26.2). All 39 patients underwent safe stent removal without any retained stent or stent fragments. The timing of the stent removal ranged from the 7th-14th postoperative day. 7 out of 39 patients had urinary tract infections which were uncomplicated and treated conservatively. None of the patients had stent migration or accidental stent removal. 19 patients experienced mild stent-related symptoms like frequency.

This antegrade stenting and stent removal technique with the help of strings can save the patient from additional procedure, reduces the cost of the treatment as well as save valuable healthcare resources. It is a safe and effective technique in PCNL procedures requiring stenting.