A 56-year-old women underwent total abdominal hysterectomy because of the ovarian cancer and endometrial cancer on Jan. 17, 2017.

She felt flank pain in the left side and CT scans showed presence of bilateral hydronephrosis, which is more severe in the left side than the right one.

We tried first retrograde insertion of a DJ stent in the left side, however, it was impossible because of the severely-kinked ureter. The superstiff guidewire formed an angle in the pelvic cavity.

We decided to maintain the PCN for several days to decompress the hydronephrosis and straighten the ureter. However, antegrade insertion of a DJ stent was not available.

After decompression of the hydronephrosis, we tried to put in a DJ catheter with a soft terumo guidewire. For this, we placed the cystoscope just below the ureteral orifice because the soft guidewire can be maintained straight during the insertion of a DJ stent.