Placement of double-J (D-J) ureteral stents in patients with high grade hydronephrosis may help relieve ureteral obstruction from both intrinsic and extrinsic causes. However, in some cases, the function of plastic stent is not satisfactory even with placement of double D-J stents or a larger 8 Fr diameter stent, because of severe extrinsic compression. We describe our first experience with a new 6 Fr metallic ureteral stent in a patient with colon cancer. A successful one-stage antegrade ureteral stenting procedure was achieved with creation of a percutaneous nephrostomy as well. An antegrade pyelogram showed well function of the indwelling metallic ureteral stent which was designed to provide long-term urinary drainage. This is our initial experience with antegrade ureteral stenting with a Cook Resonance metallic stent for extrinsic ureteral compression and the first reported case in Taiwan. Follow-up is still warranted to evaluated the long-term patency.