Henan Cancer Hospital Zhengzhou University Cancer Hospital Department of Urology Li Jing Ren Junkai Feng Chaojie Yang Tiejun Zhao Pengcheng Yang Dong Ma Jing Tian Pei Zhao Shiming Li Yunpeng Li Xing Ma Yongkang He Chaohong Objective: To investigate the value of clinical application of DSA-guided paralleling ureteral stent tube placement in patients with obstructive hydronephrosis. He Chaohong, Department of Urology, Henan Cancer Hospital METHODS: To retrospectively analyze 30 patients with cystoscopic ureteral stent tube placement failure for ureteral obstruction, totaling 42 sides, we used DSA-guided paralleling ureteral stent tube implantation. There were 21 cases with 30 sides in women and 9 cases with 12 sides in men. There were 25 patients with hydronephrosis after radiotherapy and 5 patients with hydronephrosis due to recurrence of tumor after surgery. RESULTS: All patients first tried to perform ureteral stent tube implantation under cystoscopy and failed. The patients then underwent percutaneous renal pelvic aspiration DSA-guided paracentesis for ureteral stent tube placement in our interventional department, with 37 successful and 5 failed cases. The failed patients were converted to percutaneous pyeloplasty and fistula in 4 cases. The procedure was terminated in one case due to bleeding from failed puncture. Postoperatively, all patients had relief of hydronephrosis and improvement of renal insufficiency. Most of the complications due to intraoperative puncture were sarcoid hematuria, which were spontaneously relieved after symptomatic treatment and advice to drink more water. Conclusion: DSA-guided paracentesis ureteral stent tube placement is a safe and effective treatment for obstructive hydronephrosis, which can effectively relieve obstruction, protect renal function, prevent patients from carrying nephrostomy tubes for life, and improve patients’ quality of life.