Ureteric Stent
Figure 1: JJ stent in the ureter with a curl in the kidney and bladder.
What are the indications for a ureteric stent?
Ureteric stent procedures are normally carried out because of blockage to one or both of your ureters (tubes that drain urine from the kidney to the bladder). The causes of the blockage may include kidney stones, stricture (narrowing) of the ureter and after surgery or instrumentation of the bladder or ureters.
The stent is a specially- designed, hollow tube made of a flexible material, which is designed to stay in the urinary system by having both ends coiled to stop it moving.
What pre-operative work up is needed?
Your urologist will organise any necessary urine and blood tests and imaging scans at your consultation prior to your procedure.
If you take any blood thinning medication such as warfarin, plavix (clopidogrel) or anticoagulants, you should discuss with your urologist if these need to be stopped before your procedure.
Please ensure you return any admission forms given to you to be filled out back to the hospital.
What happens on the day of the procedure?
You will be given fasting instructions prior to your admission (usually for 6 hours prior to the procedure). You should bring a list of your medications, any recent scans or reports with you to the hospital. After you are admitted from the admission lounge, your urologist will see you to discuss the surgery. An anaesthetist will see you to discuss the anaesthetic (either general or alternative options) before you are taken to the operation theatre.
After a general anaesthetic and an injection of antibiotic, a small telescope is passed along your urethra into your bladder to view the whole lining of the bladder. After putting dye up the ureter, a wire is passed to the kidney and the stent (picture) is inserted between your kidney and bladder. We normally use X-ray control to be sure the stent is positioned correctly.
If your stent only needs to stay in place for 24 to 48 hours, we often use a stent, which has a thread attached to its lower end that hangs out through your urethra. These stents can be removed easily by pulling on the thread. If it needs to stay in for longer, it is internalised completely and will need to be removed by a telescope. Most patients will be discharged on the same day as your procedure.
Are there any risks or side-effects of a ureteric stent insertion?
Mild burning and frequency on passing urine, and kidney discomfort until the stent is removed >50%
Mild bleeding into your urine 10-20%
Delayed bleeding requiring removal of clots or further surgery 1-2%
Failure to get the stent into the ureter requiring n alternative procedure 1-2%
Injury to the urethra causing delayed scar formation 1-2%
Major anaesthetic or cardiovascular problems – rare
What can I expect when I get home?
You will have some discomfort and bleeding when you pass urine; this may last several days and in some patients, this may continue until the stent is removed. You should drink twice as much fluid as you would normally for the first 24 to 48 hours, to flush your system off any blood or debris.
You can commence your usual activities the next day after discharge. If you engage in strenuous work or exercise, the discomfort or bleeding in the urine may worsen.
If you develop a fever, severe pain on passing urine, inability to pass urine or worsening bleeding with clots, you should go to the emergency department.
You urologist will give you a date for removal of the stent. Some stents need to remain in place for a longer period and are changed periodically. Contact your urologist or specialist nurse if you have not heard about removal of your stent within four to six weeks.
What follow-up is needed?
If your stent was placed with a thread attached to its lower end that hangs out through your urethra, you will be asked to come to the clinic in the next 2-3 days to get it removed by pulling on the string. In other cases, your stent will be removed under local anaesthetic using a lubricant gel that numbs your urethra. A small, flexible telescope is passed along your urethra, into your bladder, and the end of the stent is grasped with small forceps passed through the telescope. The procedure takes only a few minutes and you can go home straight after.