What are Ureteral Stents?
Urine is normally carried from the kidneys to the bladder through long, narrow tubes called ureters. The ureter can become obstructed due to conditions such as kidney stones, tumors, infection, or blood clots. When this happens, we can use image guidance to place stents or tubes in the ureter to restore the flow of urine to the bladder.
A ureteral stent is a thin, flexible tube threaded into the ureter. When it is not possible to insert a ureteral stent, a nephrostomy tube is usually placed instead.
What are the benefits vs. risks?
● A ureteral stent will allow urine to flow again from the kidney to the bladder and permit the kidney to function normally.
● Any procedure where the skin is penetrated carries a risk of infection. The chance of infection requiring antibiotic treatment appears to be less than one in 1,000.
● Rarely, you may experience an ongoing spasm of the bladder after placement of a ureteral stent. If this happens, notify your doctor. This spasm may be treated with medication.
● Because the kidney is an organ with a substantial amount of blood flow to it, bleeding is a possible, but rare complication. There is also a small risk of damage to surrounding organs. Image guidance is used to minimize this risk.
● There is a very slight risk of an allergic reaction if contrast material (the dye used to help visualize the anatomy) is injected.
How are ureteral stents placed?
Your procedure will be done at El Camino Hospital where you will be set up with an IV to allow access for moderate, also known as “twilight” sedation. You will then be taken to the procedure room where you will have a team of two nurses, a radiology technician, and your interventional radiologist. You will be connected to heart, blood pressure, and oxygen monitors during the entire procedure. IV medication will be administered to make you comfortable (moderate sedation). Using x-ray (fluoroscopy) guidance, your kidney(s) are visualized.
The area of your body where the catheter is inserted will be sterilized and covered with a surgical drape. Your interventional radiologist will use x-ray guidance to slide a guidewire through your nephrostomy tube and into your kidney. Contrast material will be injected through the tube to visualize the kidney and the ureter. The guidewire will then be passed down through the ureter to your bladder. Then a stent is run over the guidewire and placed in its permanent position within the ureter. Once the stent has been placed, the guidewire is removed.
Your nephrostomy catheter may be left in place for a few days, but capped (not connected to a drainage bag). This is to make sure the stent remains open and urine flows properly from your kidneys, through the ureteral stent, and into the bladder. Though in some cases the ureter and stent appear wide open and there is no longer a need for the nephrostomy tube and is therefore removed.
What can I expect after the procedure?
You will recover after your procedure for about 1 hour where your procedure site, heart rate, blood pressure, and oxygen saturation will be monitored. Your family will be able to see you soon after the procedure in the post-operative area and you will be able to eat and drink once you are awake and able to. You may have mild pelvic discomfort where the stent is for the next 2-3 days.
I still have a capped nephrostomy tube in place, when is it removed?
We usually remove them under x-ray guidance because we like to check the kidney, stent and ureter to be sure everything looks good and there is no more residual obstruction before we remove it. Also this way we can make sure there is no significant bleeding from the drain site.
When should you call your physician?
● Fever or chills > 101 F
● Worsening of redness or worsening of pain in the procedure area
● Significant bleeding in your urine >24 hours
● Leakage from your nephrostomy tube site.
You can reach your Interventional radiologist at 650-404-8445 (ask for the Interventional Radiology Clinic).
If you received sedation, you should not drive, consume alcohol, operate heavy machinery or make any important decisions for the remainder of the day.
You may resume your regular activities (including driving) after 24 hours, unless you have been restricted for another reason.
No exercising, lifting heavy objects or strenuous activity for the next 24 hours.
You may use over the counter medication such as Acetaminophen (Tylenol) or Ibuprofen (Advil /Motrin) for minor discomfort, unless you are restricted from taking these medications.
For more severe pain, we will prescribe Norco (Hydrocodone + Tylenol), which is a narcotic medication.
You should also take Colace (stool softener) daily while taking the narcotic medication to prevent constipation, which is a common problem while taking these medications.
You can resume your normal diet. Some patients may develop nausea after the sedation. Therefore light meals are recommended until you know that you can eat without problems.
You can take a shower tonight.
DO NOT WORRY IF THE TUBE GETS WET (if you have a tube).
After the shower, you should remove the dressing, dry the area and apply a new dressing.
You should not soak the tube insertion site in water (eg. bath and swimming pool)
Blood in the urine
It is normal to have some bloody urine for up to a week after the procedure, and do not be surprised if your urine looks like the color of cranberry juice or rosé wine, as long as it is relatively clear.
Even after a week, you can occasionally have some occasional blood in your urine.
You should call your interventional radiologist if the blood is thick enough that you cannot see through the urine for more than 24 hours.