Insertion and Removal of Ureteric Stents

What does the procedure involve?

Telescopic inspection of the bladder and urethra combined with insertion, removal or changing of a soft plastic tube placed between the kidney and the bladder. The procedure is usually performed under X-ray control.

What are the alternatives to this procedure?

Alternatives to this procedure include observation, placement of a tube directly into the kidney through the back (nephrostomy) and open surgical treatment.

What should I expect before the procedure?

You will usually be admitted to hospital on the same day as your surgery.

You will be asked not to eat and drink for six hours before surgery. Immediately before the operation, the anaesthetist may give you a pre-medication, which will make you dry-mouthed and pleasantly sleepy.

Please tell your surgeon (before your surgery) if you have any of the following:

• An artificial heart valve.
• A coronary artery stent.
• A heart pacemaker or defibrillator.
• An artificial joint.
• An artificial blood-vessel graft.
• A neurosurgical shunt.
• Any other implanted foreign body.
• A regular prescription for a blood thinner e.g. Warfarin, Coumadin Xarelto®, Pradaxa®, Clopidogrel (Plavix®), Brilinta®, or Aspirin.
• Previous or current infection with an antibiotic resistant organism such as MRSA, VRE, etc.

What happens during the procedure?

Either a full general anaesthetic (where you will be asleep) or a spinal anaesthetic (where you are unable to feel anything from the waist down) will be used. All methods minimise pain. Your anaesthetist will explain the pros and cons of each type of anaesthetic to you. You will usually be given injectable antibiotics before the procedure, after checking for any allergies.

A telescope is inserted through the water pipe (urethra) to inspect both the urethra itself and the whole lining of the bladder. A stent (pictured) is then inserted into the ureter, using the telescope, under X-ray guidance.

What happens immediately after the procedure?

You will normally be allowed home on the day of surgery once you have passed urine satisfactorily.

Are there any side-effects?

All procedures have the potential for side-effects. Although these complications are well recognised, the majority of patients do not have problems after a procedure.

Risks of the anaesthetic need be discussed with the anaesthetist who will be looking after you during the operation, and who will visit you beforehand.

There are specific risks with this surgical procedure, and these will be discussed with you before your procedure. As a guide to complement that one-on-one discussion with your surgeon, these include:

Common (greater than 1 in 10)

• Mild burning or bleeding on passing urine for short period after operation.
• Discomfort/pain during physical activity or urination, urinary frequency and occasional blood in urine. These symptoms are usually mild.
• Temporary insertion of a catheter.
• Further procedure to remove stent if inserted.

Occasional (between 1 in 10 and 1 in 50)

• Infection of bladder requiring antibiotics.
• Stent can get blocked or encrusted.
• Occasionally we cannot pass the stent requiring alternative treatment.
• Permission for telescopic removal / biopsy of bladder abnormality / stone if found.

Rare (less than 1 in 50)

• Infection in the kidney (pyelopnehritis), which can be serious and require intravenous antibiotics.
• Damage to the ureter with need for open operation to repair it.
• If the ureter is damaged, occasionally a tube needs to be placed into kidney directly from the back to allow the leak to heal.
• Scar or stricture of the ureter requiring further procedures.
• Stents can occasionally become dislodged and require replacement.

What should I expect when I get home?

When you get home, you should drink twice as much fluid as you would normally for the first 24 - 48 hours to flush your system through. When you first pass urine, you may find that it burns and is lightly bloodstained. In six out of ten (60%) patients, discomfort similar to cystitis persists until the stent is removed. Simple painkillers will usually help this but here is nothing to be gained from treatment with antibiotics unless there is a proven urinary infection. Occasionally, this pain can be severe enough to result in early removal of the stent.

What else should I look out for?

If you develop a fever, severe pain on passing urine, inability to pass urine or worsening bleeding, you should contact your Surgeon or GP immediately. In case of an emergency attend your nearest emergency department or call ‘000’.

Are there any other important points?

Stents do not normally need to remain in place for more than six weeks.

Disclaimer

This information is intended as a general educational guide and may not apply to your situation. You must not rely on this information as an alternative to consultation with your urologist or other health professional.

Not all potential complications are listed, and you must talk to your urologist about the complications specific to your situation.