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Re: Improvised method to retrieve a proximally displaced ureteral stent in a remote surgical setting. (From: Fisher JD, Monahan M, Johnston WK III J Endourol 2013; 27:922-4).

I read with keen interest the article by Fischer and associates. The authors need to be congratulated for an interesting and a novel method to remove a proximally migrated stent in a remote hospital setting where access to a ureteroscope is not available. They have presented a single case experience of this technique. I want to voice my reservations about this technique. The experience of proximally migrated stents has shown that the alignment of the stent’s lumen in relation to the distal ureter is dependent on the location of the stent’s distal end and not to the make and strength of the coil of the stent. If the stent has migrated only to the intramural part of the ureter, then the stent remains parallel to the ureteral lumen (Fig. 1). Once the stent migrates to the mobile extravesical portion of the lower ureter, it tends to kink and hook the ureter toward its coil (Fig. 2). We do not agree with the author’s hypothesis that stent alignment to