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Open-Ended Ureteral Catheters

An open-ended ureteral catheter provides temporary access for contrast injection, upper-tract fluid collection or drainage, irrigation, and guidewire passage or exchange. It has no Double-J retention curls. An externalized catheter left for short-term drainage is a use of this device family, not necessarily a different catheter design.[1][2]

Choose the Actual Device​

Caliber, length, side holes, tip flexibility, material and wire compatibility vary. A 5 Fr catheter is common, but is not the only appropriate size. For example, Cook's current Open-End product list includes 3 Fr accepting 0.018-inch instrumentation, 4 Fr accepting 0.025 inch, and 5–8 Fr accepting 0.038 inch. A universal 0.035-inch wire instruction would therefore be incorrect.[2]

Distinguish an open end from a closed or occluding tip. Cone-tip and wedge catheters used to seat at the ureteral orifice have their own instructions; they should not be assumed to accept a guidewire or pass through a stricture like an open-ended catheter.[1]

Tip typeDescriptionPractical point
End-holeSingle distal openingSimplest design; the end hole can suck up urothelium or debris and occlude during aspiration.[3]
End-hole plus side-holeAdds a lateral hole near the tipAspirated more fluid than end-hole only (5.1 vs 2.6 mL initially, p < 0.001; 22 patients, randomized order, blinded operator).[3]
Flexible tip (Flexi-Tip)Soft, tapered distal portionDesigned to pass tortuous or obstructed ureters; tip separation within the collecting system has been reported in two cases and needed endoscopic retrieval.[11][8]
Cone-tip or wedgeRounded or tapered end that seats at the orificeUsed for occlusion during pyelography; follow the product instructions.[1]

The side-hole trial supports a design distinction for urine sampling. It does not establish a universal preference for every indication or permit modifying a catheter outside its instructions.

Clinical Uses​

UsePractical distinction
Retrograde pyelography (RPG)Opacifies the ureter and collecting system to assess anatomy, obstruction or injury. RUG refers to retrograde urethrography and is not the name of this examination.[4]
Upper-tract urine samplingObtain a specimen from the intended site and label side/location; minimize contamination and avoid forceful aspiration against occluded mucosa.[3]
Guidewire positioning/exchangeSupports a wire or provides contrast assessment during stent placement or another endourologic procedure; every case need not follow the same wire-first sequence.[1][5]
PCNL accessCan opacify the collecting system or assist drainage; selected techniques use other catheters or image-guided access without this step.
Difficult pelvic dissectionA conventional, lighted or other visualization catheter may assist ureteral identification in selected high-risk operations. It does not replace dissection or guarantee prevention of ureteral injury.[5][7]

EAU 2026 gives a weak recommendation for prophylactic stents in patients at high risk of ureteral injury, while emphasizing visual identification. Routine bilateral catheterization for every prolapse, fistula or gynecologic operation is not established by that recommendation.[7]

Placement and Handling​

Use the model-specific instructions and appropriate endoscopic or imaging guidance. Cook's open-ended-catheter instructions describe introducing the catheter through the cystoscope, passing a compatible wire through it into the ureter, then advancing the catheter over the wire. Other procedural sequences depend on the intervention. Confirm location before contrast injection or exchange.[1][5]

  • Flush and inspect the catheter; avoid kinking or damaging the tip.
  • Stop if resistance develops during advancement or withdrawal, and determine the cause.
  • Avoid withdrawing the catheter while it is deflected in the scope, and avoid overtightening an adapter that can occlude its lumen.
  • Use controlled injection; a catheter wedged in an obstructed or infected collecting system can create harmful pressure.
  • Confirm the device is intact after removal, and investigate a missing component rather than assuming it passed spontaneously.[1][8][9]

Temporary Postoperative Drainage​

An externally secured ureteral catheter may provide short-term drainage after selected uncomplicated PCNL or ureteroscopic procedures. This requires an explicit fixation, drainage and removal plan. It is not interchangeable with a self-retaining internal stent for prolonged drainage.[10] The EAU 2026 urolithiasis text notes that a ureteral catheter left for one day after uncomplicated ureteroscopy gave results similar to a stent, and that in a systematic review of six randomized trials of tubeless PCNL an externalized ureteral catheter, used instead of a double-J stent, reduced stent-related symptoms without changing other outcomes. These are evidence statements in the text, not graded recommendations.[6]

In a randomized trial after PCNL under spinal anesthesia (30 patients per group, stones larger than 2 cm), an overnight 6 Fr open-ended ureteral catheter removed at 12 hours produced lower 24-hour pain scores than a 14 Fr nephrostomy tube removed at 48 hours (VAS 3.37 vs 6.17, p < 0.001), less tramadol use and a shorter hospital stay, with similar stone-free rates (90% vs 83%, p = 0.391).[12] In a 109-patient randomized tubeless mini-PCNL study, externalized catheters produced fewer stent-related symptoms and less severe reflux than Double-J stents, without statistically significant differences in the other reported short-term outcomes. This selected study does not establish equivalence for reconstructed ureters, infection, ureteral injury or prolonged drainage needs.[10]

Removal of an externalized catheter is usually by planned withdrawal; internal stent removal may be cystoscopic or use another device-specific retrieval method. Avoid the blanket statement that every Double-J requires cystoscopy.[6]

Safety and Limits​

Potential complications include ureteral trauma, perforation, extravasation, bleeding and infection. Tip separation of a flexible-tip catheter has been reported, but its frequency cannot be quantified from case reports.[1][8]

A radiologic series of 180 pyeloureteral interventions through a perurethral transvesical route, using ureteral catheters placed at cystoscopy, had 12 failures (8 from caudal migration of the catheter into the bladder) and significant complications in 5% (urosepsis in 2, ureteral perforation in 5, false lumen in 2), all resolving with conservative management. This is a 1989 mixed-procedure series and does not give a device-specific modern risk.[13] End-hole catheters can suck up urothelium during aspiration, which the side-hole design reduces.[3]

Open-Ended Catheter Compared With Other Ureteral Drainage​

FeatureOpen-ended catheterDouble-J stentExternalized ureteral catheter
Self-retainingNoYes (pigtail curls)No; fixed and exits through the urethra
Usual dwellMinutes to hoursDays to monthsHours to days
Main usePyelography, urine collection, wire access, intraoperative identificationIndwelling drainageShort-term drainage after selected PCNL or ureteroscopy
Stent-related symptomsMinimal because of short dwellCommonFewer than with double-J in one randomized trial[10]

Limitations: an open-ended catheter is not a substitute for a double-J stent for medium- or long-term drainage, and its caliber limits drainage compared with the largest stents or nephroureteral devices.[14]

For infection, source control and antibiotics, use the UTI treatment hub. See Double-J Stents, Ureteral Access Sheaths, PCN and PCNU for their distinct drainage and access roles.

References​

1. Cook Medical. Ureteral Catheters: Instructions for Use, T_URECAT_REV1. English pages 3–4; version linked from the US Open-End product page.

2. Cook Medical. Open-End Ureteral Catheter: current specifications.

3. 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

4. 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

5. 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

6. European Association of Urology. EAU Guidelines on Urolithiasis, 2026 (limited update, March 2026). Section 3.4.6 (stenting before and after URS) and 3.4.7 (PCNL postoperative drainage).

7. Waterloos M, Campos-Juanatey F, Hallscheidt P, et al. EAU Guidelines on Urological Trauma. Limited update, March 2026. Sections 4.2.3–4.2.5 (ureteral trauma: prevention and management).

8. 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

9. Ryan AG, Irvine I, Bardgett H, et al. CIRSE Standards of Practice on Nephrostomy and Ureteric Stent Placement and Exchange. Cardiovasc Intervent Radiol. 2026;49:464–479. doi:10.1007/s00270-025-04328-9

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. 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

12. 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

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