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Impassable ureteric obstruction (benign or malignant) can cause a real challenge to every endoluminal endourologist. Usually a percutaneous nephrostomy is the initial approach to drain the obstructed kidney and often becomes the long term option if reconstruction is not possible. We describe the case of a patient awaiting cardiovascular repair for severe valvular disease who was denied surgery due to his long term nephrostomy for an impassable ureter. His nephrostomy was internalised via an extra-anatomical subcutaneous tract into the bladder using a Patterson-Forrester stent ridding him of the tube and allowing him to be listed for life saving heart surgery. Following heart surgery his fitness will be reassessed and definitive treatment will be planned accordingly.

“Caught between a Rock and a Hard Place” – Until the Patterson Forester Extra Anatomic Stent Bailed Us Out