in a preferred embodiment as shown in the figures the ureteral catheter 1 of the subject invention comprises a flexible plastic tube 2 having apertures 3 along the proximal end 4 . the apertures extend between the outside of the catheter and the lumen 5 . the catheter 1 may be constructed from any plastic material , preferably a soft flexible material provided with conventional indicating means 6 and is more preferably formed from a radiopaque silicone or silastic material of the type conventionally used for ureteral catheters or stents . the catheter should be marked with conventional centimeter markings to indicate the catheter &# 39 ; s position . only the proximal tip 14 of the ureteral catheter need be made of radiopaque material but it is preferable that the entire ureteral catheter including the flange be of radiopaque material to facilitate placement of the device . the distal one third 12 of the flexible plastic tube has an inside and outside diameter wider than that of the proximal end and has a flange 7 that begins about 1 centimeter proximal to the distal end . the distal end of the tube is open . a rigid open ended catheter 8 of the same diameter as the proximal end of the flexible tube is fitted through the flanged end and into the distal end of the flexible plastic tube . the rigid catheter is inserted far enough into the flexible tube to assure secure engagement of the flexible tube . the rigid catheter is held in place by reason of its close fit with the flexible tube . the flange design functions to allow the pusher 16 to disengage the rigid ureteral catheter from the flexible tube by abutting against and immobilizing the flexible tube while the rigid ureteral tube is disengaged . the outside flange diameter is larger than the internal diameter of the pusher . the flange is formed of the same material as the flexible tube . as shown in fig1 a stiffening wire 9 is used to keep the flexible tube stiff while the catheter as a unit is being inserted . the stiffening wire can be passed through a rubber stopper 10 within the distal end of the rigid catheter . the stopper prevents the wire from receding from the distal end of the ureteral catheter during insertion . when the apparatus has been properly placed , withdrawing the rigid wire will also withdraw the stopper . portions adjacent each of the ends 11 and 12 of the flexible tubular member 2 are formed and set in the shape of gentle curls 13 and 14 as shown in fig4 . the insertion of the stiff catheter 8 into the flanged end of the flexible stent straightens the curl or j 14 and holds it in straight alignment as shown in fig2 . a stiffening wire 9 straightens the device including the proximal end 11 of the double j catheter for easy insertion . a thread or suture 15 can be attached to the distal end of the flexible catheter in order to allow easy removal of the device by pulling on the suture . the rigid ureteral catheter 8 is formed of material conventionally used for such catheters and is preferably a stiff polymeric material with a hard smooth surface that glides such as polytetrafluoroethylene or nylon . the rigid ureteral catheter is marked near its distal end . with the rigid ureteral tube inserted in the flexible catheter , the length of rigid tubing between the flange and the marking 17 is equal to the length of the &# 34 ; pusher &# 34 ; 16 . the length of the &# 34 ; pusher &# 34 ; is such that when passed over the rigid ureteral catheter , the flange of the flexible tube will be abutted just as the marking on the rigid ureteral catheter is visualized . this allows the operator to know when the flanged end of the flexible ureteral catheter is immobilized prior to extraction of the rigid ureteral catheter . the device is sterilely packaged assembled . different sizes and diameters can be made available with component sizes scaled appropriately . the sizes , lengths and diameters of the various elements are those conventionally used in the art . as an example of procedure , consider a # 7 french universal stent . the proximal two thirds of the catheter has a size 7 french lumen and the distal third of the catheter has a size 8 . 5 french lumen . the distal end of the silastic catheter has a size 9 french flange that begins 1 centimeters proximal to the distal end . the proximal j is straightened over a o . 038 mm stiff guide wire . this wire also passes through a rigid plastic 7 french ureteral catheter which is inserted into the 8 . 5 french distal third of the silastic catheter . the wire exits the distal part of the rigid ureteral catheter and is held in place securely by a detachable rubber stopper . with the wire in place , the proximal end of the j catheter is straightened and can be inserted through a # 22 french cystoscope and passed up in the ureteral orifice to the renal pelvis . the wire then is removed along with the rubber stopper , allowing the proximal curl to form . the rigid ureteral catheter exits through the urethra and the system can be used for an immediate imaging study if needed . to continuously drain the kidney ( i . e . to monitor urine output , drain purulent debris , or irrigate to free the system of purulent material ) one can secure the rigid ureteral catheter to an indwelling urethral catheter and attach the rigid ureteral catheter to an external drainage bag . once the patient is stable and there is no more need for external drainage , the stent can be internalized . the rigid catheter is then completely cleansed with a topical disinfectant and sterile gloves are donned . packaged separately is a sterile size 8 . 5 french &# 34 ; pusher &# 34 ; ( open ended tube ) which then is lubricated and passed over the rigid ureteral catheter until resistance is met as it abuts the flanged distal end of the silastic ureteral catheter . the operator will also know that the flanged distal end of the silastic ureteral catheter has been abutted because the marking on the rigid ureteral catheter will be visualized . then gently pull the rigid catheter through the pusher , holding the pusher in place . then gently extract the pusher from the urethra . this will allow the distal end of the silastic catheter to form a curl in the bladder and thereby leave a completely internalized stent . the thread or suture can be left attached to the distal end of the silastic catheter to allow easy extraction through the urethra . if desired , the stiffening wire can be inserted first using conventional means . after cutting off the proximal tip of the stent , the stent - ureteral catheter device is passed over the wire in order to insert the catheter combination . also if desired , various adapters can be secured to the external end of the stiff ureteral catheter in order to permit irrigation , application of contrast solutions to the renal cavity etc . the thread or suture is preferably of a synthetic polymer with opaque characteristics . it is attached to the stent at any convenient location . the advantages of the above described device are many . the materials of construction are conventional . the device can be packaged intact and ready to insert . the various elements can be formed in a variety of sizes , lengths and diameters with component sizes scaled appropriately . the device obviates the need for separate externalized and internalized ureteral catheters . further , the device is simple in operation and makes use of concepts and designs proven to be effective and reliable . the device as described in the preferred embodiment specifies insertion of the rigid catheter into the distal third of the flexible tube . however , it is only necessary that the rigid tube be held securely in the stent until it is removed . further , it can be seen that the specific type of connection described is not critical . any method of connection that allows the apparatus to function as described is contemplated . also , as described , the flange , in connection with the stiff pusher , serves only to hold the apparatus in place while the stiff catheter is removed . any structure that serves to prevent the catheter from being pulled out of the renal cavity when the stiff catheter is removed is contemplated . it will be readily apparent to those skilled in the art that a number of modifications and changes can be made without departing from the spirit of the invention . therefore , it is to be understood that the scope of the invention is not to be limited by the foregoing description , but only by the claims .
a combination ureteral stent - ureteral catheter comprising an elongated flexible tubular member which has proximal and distal ends in the form of curls when present in its internalized stent form and which further comprises an elongated tubular rigid extension attached to the distal end of the stent which allows the combination to function as an externalized ureteral catheter . on extracting the rigid extension from the stent while the device is in place , the distal end of the stent reforms itself into a preformed curl and thereafter functions as a double j internalized catheter or stent .