Insertion of Ureteric Stent
The ureter is a fine structure that conducts urine from the kidney to the bladder. If the ureter becomes obstructed by a stone or narrowed due to the presence of a tumour, severe pain can result and kidney function may be damaged. In order to relieve the blockage, we may need to pass a special tube called a stent into the ureter. The stent is not visible externally. One end sits in the kidney and the other end in the bladder, allowing urine to flow freely out of the kidney.
The stent will relieve pain caused by the ureteric blockage, and help preserve kidney function.
When a ureteric stone is present and causing pain it is understandable that most patients wish to have the stone removed as soon as possible. However, if the ureter is too narrow or if there is evidence of an infection, it may be unsafe to pass a telescope (ureteroscope) into the ureter to retrieve the stone immediately. Attempts to do this may result in damage to the ureter. Rather than immediately attempting to pass a telescope into the ureter to retrieve the stone, we initially insert a stent which stays inside for a few weeks. This allows the ureter to relax and dilate, allowing the safe insertion of a ureteroscope into the ureter and stone removal at a later date.
A stent is only a temporary measure. While it may be necessary to leave a stent for a long period of time in patients with a blockage caused by a tumour, it must be changed regularly to avoid infections and stent blockage. For patients in whom the stent is placed to relieve blockage caused by a stone, it is generally only in place for a few weeks until a ureteroscopy to remove the stone can be safely performed.
Stents may also be required after removal of a kidney or ureteric stone to facilitate healing of the ureter after surgery.
Please refer to the detailed instructions provided by the rooms, or download these from the website.
Before the procedure is performed, you may be asked to provide a urine specimen to detect the presence of any infection, which will be treated before the cystoscopy is performed.
*For women of child-bearing age, it is important that you inform us whether you may be pregnant.
The Procedure Itself
The actual procedure typically takes 15-30 minutes. Your legs will be placed in stirrups (holsters). A cystoscope is passed into the bladder. The point at which the affected ureter opens into the bladder is identified. A wire is placed into the affected ureter followed by a very fine catheter. A special x-ray called a retrograde pyelogram is performed to correctly identify the point of obstruction. The stent is then placed over the wire so that one end sits in the kidney and the other in the bladder. The wire is then removed.
After the procedure, you might have a little stinging in the urethra until the next time you urinate. In some patients, it may last a bit longer. You may see blood in the urine when you urinate. This is more common in men with large and obstructing prostates, in situations where the urethra contains a stricture (narrowing due to scar tissue), or again in cases of stent removal.
Possible Complications of the Procedure
The vast majority of patients will not experience any major problem after a stent insertion. However, any procedure, regardless of complexity or time, can be associated with unforeseen problems. They may be immediate or even quite delayed in presentation. These may include, but are not limited to:
- Stent pain
Whilst the stent will relieve pain caused by blockage of the ureter, the stent may itself cause discomfort. Typically, this includes pain felt in the upper back when urinating, pain in the groin or in the penis. This pain may be mild or quite severe and require strong analgesics and antispasmodics. This pain will resolve when the stent is removed.
- Blood in the Urine
Rarely, the scope can rub against a blood vessel on the surface of the prostate or less commonly in the bladder. In this instance, you may develop haematuria (blood in the urine). The stent may also cause bleeding as a result of inflammation in the ureter and irritation within the bladder. This bleeding will stop when the stent is removed.
- Urinary Tract Infection
f a stent is present for a prolonged period (weeks or months), it may become a nidus for infection. This is treated by antibiotics and removal or changing of the stent.
- Stent Blockage
If a stent is left in place for too long (more than 3 to 6 months), it may become encrusted with stone and blocked. Rarely, if the stent becomes too stiff it may be difficult to remove and a major procedure may be required to remove it.
It is of utmost importance that you comply with all follow-up instructions in order to avoid this problem.
Please contact the office within 3 days of discharge. You should make an appointment to see Dr Sved as directed in the hospital. You may see him in his rooms at RPA, Bankstown Hospital or Strathfield Private Hospital. Do not hesitate to call at any time if you have any concerns.