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Open-Ended Ureteral Catheters

Simple, straight, non-self-retaining ureteral catheters — typically 5 Fr — with an open distal end-hole, used primarily for temporary diagnostic and intraoperative indications: retrograde pyelography, upper-tract urine collection, intraoperative ureteral identification during pelvic surgery, opacification and access during percutaneous nephrolithotomy (PCNL), and as the initial over-the-wire catheter during placement of a definitive double-J stent. Distinct from the double-J stent — which is indwelling and self-retaining — and from externalized ureteral catheters, which leave the catheter in place for postoperative drainage but exit through the urethra rather than through skin.[1][2]

Design and Tip Configurations​

Tip typeDescriptionKey feature
End-hole (standard)Single distal openingSimplest design; end-hole prone to occlusion by urothelium / debris on aspiration
End-hole + sideholeAdds a lateral sidehole near the tipAspirates significantly more fluid (5.1 vs 2.6 mL initial in Pace 2003 single-blind RCT) — preferred for upper-tract urine collection[1]
Flexi-tipSoft tapered flexible distal portionNavigates tortuous / obstructed ureters with reduced perforation risk; rare complication: tip separation within the collecting system (Bundrick 1991) requiring endoscopic retrieval[4][5]
Whistle-tipAngled beveled distal cutClassic atraumatic-passage design
Cone-tip (bulb-tip)Slightly tapered / rounded endAtraumatic seating at the ureteral orifice for occlusion / pyelography

Typical caliber 4–7 Fr, with 5 Fr the workhorse size; length 60–70 cm; usually radiopaque polyurethane or PVC.

Reconstructive-Urology and Urogyn Uses​

Retrograde pyelography (RUG of the upper tract)​

  • Inserted cystoscopically into the ureteral orifice and advanced under fluoroscopic guidance; water-soluble contrast injected retrograde to opacify the ureter and collecting system.[6][7]
  • Defines obstruction, stones, tumor, iatrogenic ureteral injury after pelvic / urogyn surgery, and stricture location / length — the canonical preoperative workup for ureteral reimplant or Boari-flap planning.

Intraoperative ureteral identification during urogyn / pelvic-floor surgery​

  • Pre-procedure cystoscopic placement of an open-ended catheter (sometimes a lighted ureteral catheter) into each ureter facilitates palpation and visual identification of the ureter during sacrocolpopexy, uterosacral suspension, deep endometriosis dissection, fistula repair, and oncologic pelvic resections — adjunctive to standard intraoperative cystoscopy.

Upper-tract urine collection for culture / cytology​

  • Advance to the renal pelvis and aspirate urine directly, bypassing bladder contamination. End-hole + sidehole design preferred for aspiration performance.[1]

Initial over-the-wire catheter during double-J stent placement​

  • After guidewire passage into the renal pelvis, the open-ended catheter is the standard first catheter advanced to position the wire, perform retrograde pyelography, then exchange for the double-J stent.[11][12]

PCNL access​

  • Routine first step of PCNL: open-ended catheter placed in the renal pelvis to opacify the collecting system with contrast for percutaneous puncture guidance, distend with saline, and provide drainage. In mini-PCNL, an open-ended catheter, occlusion balloon, or Accordian device is used pre-puncture.[2][3][8]

Externalized ureteral catheter after PCNL (tubeless)​

  • Gönen 2019 RCT — overnight 6 Fr open-ended ureteral catheter (removed at 12 h postop) vs 14 Fr nephrostomy tube (removed at 48 h) after PCNL: significantly lower VAS pain (3.37 vs 6.17, p < 0.001).[9]
  • Zhou 2017 RCT — externalized ureteral catheter (EUC) vs double-J stent in tubeless minimally invasive PCNL: fewer stent-related symptoms and less severe vesicoureteral reflux with EUC.[10]

Placement Technique​

  1. Cystoscopy (rigid or flexible) to identify the ureteral orifice.
  2. 0.035-inch guidewire passed through the orifice into the renal pelvis under fluoroscopy.
  3. Open-ended catheter advanced over the wire to the desired position (UPJ, renal pelvis, or below the obstruction).
  4. Fluoroscopic confirmation of position.
  5. Contrast injection for retrograde pyelography, or urine aspiration for culture / cytology, or wire exchange for the definitive stent.
  6. In straightforward cases, the catheter can be passed without a guidewire — though guidewire-assisted placement is standard in endourology.[2][11][12]

Open-Ended vs Other Ureteral Catheters / Stents​

FeatureOpen-ended catheterDouble-J stentExternalized ureteral catheter (EUC)
Self-retainingNoYes (pigtail curls)No (externalized via urethra)
Dwell timeMinutes – hours (intraoperative)Days – monthsHours – days
Primary useRUG, urine collection, PCNL access, intraoperative IDIndwelling drainage, post-URS, post-anastomosisShort-term post-PCNL drainage
RemovalSimple withdrawalCystoscopy requiredBedside withdrawal
Stent-related symptomsMinimal (short dwell)Significant (pain, frequency, urgency)Fewer than DJ (Zhou 2017)
Typical size4–7 Fr (5 Fr standard)4.7–8 Fr5–6 Fr

Safety Profile​

  • Tip separation of flexi-tip catheters within the collecting system — rare but reported; requires endoscopic retrieval.[5]
  • Caudal catheter migration into the bladder during fluoroscopically guided procedures — ~ 5% of perurethral transvesical interventions.[13]
  • Ureteral perforation — uncommon; risk increased with forceful advance through stricture or obstruction.[13]
  • Urosepsis — ~ 1% of retrograde procedures, particularly when infected urine is disturbed.[13]
  • Mucosal trauma — end-hole catheters can suction urothelium during aspiration; mitigated by the sidehole-added design.[1]
  • Bladder discomfort — minimal because of short dwell.

Limitations​

  • Not for indwelling drainage — no self-retaining feature; cannot replace a double-J for medium- or long-term drainage.[14]
  • End-hole occlusion during aspiration unless sidehole-added.[1]
  • Smaller caliber than the largest double-J or nephroureteral options — caliber-dependent drainage.

References​

1. Pace KT, Dyer S, Harju M, Honey RJ. "Randomized, single-blind comparison of sidehole and end-hole v end-hole ureteral catheters." J Endourol. 2003;17(9):763–5. doi:10.1089/089277903770802335

2. Zhu W, Liu S, Cao J, et al. "Tip bendable suction ureteral access sheath versus traditional sheath in retrograde intrarenal stone surgery: an international multicentre, randomized, parallel group, superiority study." EClinicalMedicine. 2024;74:102724. doi:10.1016/j.eclinm.2024.102724

3. Soderberg L, Ergun O, Ding M, et al. "Percutaneous nephrolithotomy versus retrograde intrarenal surgery for treatment of renal stones in adults." Cochrane Database Syst Rev. 2023;11:CD013445. doi:10.1002/14651858.CD013445.pub2

4. Rutner AB, Fucilla IS. "Flexible-tip ureteral catheters in clinical practice." J Urol. 1976;115(1):18–21. doi:10.1016/s0022-5347(17)59052-7

5. Bundrick WS, Bickel A, Mata JA, Culkin DJ, Venable DD. "Ureteral catheter tip separation: potential risk using the open-end flexi-tip ureteral catheter." J Urol. 1991;145(6):1254–5. doi:10.1016/s0022-5347(17)38592-0

6. Krantz TE, McFerren SC, Riley JM, Dunivan GC, Alba FM. "Tips and tricks for performing a retrograde pyelogram." Urology. 2019;129:234. doi:10.1016/j.urology.2019.03.027

7. Aungst MJ, Sears CL, Fischer JR. "Ureteral stents and retrograde studies: a primer for the gynecologist." Curr Opin Obstet Gynecol. 2009;21(5):434–41. doi:10.1097/GCO.0b013e32832fd23a

8. Sadiq AS, Atallah W, Khusid J, Gupta M. "The surgical technique of mini percutaneous nephrolithotomy." J Endourol. 2021;35(S2):S68–74. doi:10.1089/end.2020.1080

9. Gönen M, Arslan ÖE, Dönmez Mİ, Halat AÖ, Sezgin T. "Ureteral catheter versus nephrostomy tube for patients undergoing percutaneous nephrolithotomy under spinal anesthesia: a prospectively randomized trial." J Endourol. 2019;33(4):291–4. doi:10.1089/end.2018.0875

10. Zhou Y, Zhu J, Gurioli A, et al. "Randomized study of ureteral catheter vs double-J stent in tubeless minimally invasive percutaneous nephrolithotomy patients." J Endourol. 2017;31(3):278–82. doi:10.1089/end.2016.0759

11. Linder BJ, Occhino JA. "Cystoscopic ureteral stent placement: techniques and tips." Int Urogynecol J. 2019;30(1):163–5. doi:10.1007/s00192-018-3762-8

12. McFarlane JP, Cowan C, Holt SJ, Cowan MJ. "Outpatient ureteric procedures: a new method for retrograde ureteropyelography and ureteric stent placement." BJU Int. 2001;87(3):172–6. doi:10.1046/j.1464-410x.2001.02039.x

13. Amendola MA, Banner MP, Pollack HM, Gordon RL. "Fluoroscopically guided pyeloureteral interventions by using a perurethral transvesical approach." AJR Am J Roentgenol. 1989;152(1):97–102. doi:10.2214/ajr.152.1.97

14. Sali GM, Joshi HB. "Ureteric stents: overview of current clinical applications and economic implications." Int J Urol. 2020;27(1):7–15. doi:10.1111/iju.14119