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Introduction Fluoroscopic-guided retrograde ureteric stent exchange is a commonly performed procedure at our institution for patients with treated gynaecological malignancy. Technical challenges are often met during the procedure. This approach is well-tolerated and does not require general anaesthetic. Routine exchange is required every 16–20 weeks. Presentation of cases We describe the technique of fluoroscopic-guided retrograde transurethral ureteric stent exchange and outline potential technical pitfalls through a series of recent cases at our institution. Challenges encountered include stent encrustation, stent malposition, tangled stents and loss of access. Discussion The case series demonstrates a variety of solutions to challenging technical situations including manual breakdown of luminal debris, stent repositioning and snaring techniques, and methods for overcoming loss of access. Successful outcomes were achieved in the majority of cases. Conclusion Fluoroscopic-guided retrograde ureteric stent exchange is a challenging technique, not universally performed in all interventional departments. The technique is generally well tolerated and avoids the need for general anaesthesia. Highlights

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