Ureteral stenting

Definition

A ureteral stent is really a thin, bendable tube threaded to the ureter to assist urine drain in the kidney towards the bladder in order to another collection system.

Purpose

Urine is usually transported in the kidneys towards the bladder using a set of long, narrow tubes called ureters each kidney is attached to one ureter. A ureter can become blocked due to numerous problems including kidney stones, tumors, thrombus, postsurgical swelling, or disease. A ureteral stent is positioned within the ureter to revive the movement of urine towards the bladder. Ureteral stents can be utilized in patients with active kidney infection or with diseased bladders. Alternatively, ureteral stents can be utilized throughout or after urinary tract surgical treatments use a mold around which healing may appear, to reflect the urinary flow from regions of leakage, to control kidney stones or avoid stone migration just before treatment, in order to result in the ureters easier identifiable in the course of complicated surgical treatments. The stent may stay in put on a short-term (days to weeks) or long-term (weeks to months) basis.

Demographics

Chronic congestion of the ureter impacts around five individuals of all the 1,000; acute congestion affects one inch every 1,000. Bilateral obstruction is much rarer; chronic congestion impacts one person per 1,000 people, and acute obstruction affects five per 10,000.

Diagnosis/Preparation

A variety of technologies assisted in the proper diagnosis of ureteral blockage. Included in this are:

• cystoscopy (a process when a thin, tubular device can be used to visualize the inside from the bladder)
• ultrasonography (an imaging technique that utilizes high-frequency sounds waves to visualize structures within the body)
• computed tomography (an imaging method that utilizes x-rays to create two-dimensional cross-sections on the viewing screen)
• pyelography (x rays taken from the urinary tract following a contrast dye continues to be inserted right into a vein or to the kidney, ureter, or bladder)

Just before ureteral stenting, the process ought to be completely described with a healthcare professional. No food or drink is allowed after midnight the night time before surgery. The individual wears a hospital gown throughout the process. When the stent insertion is conducted with a cystoscope, the individual will think a situation that's typically utilized in a gynecological exam lying about the back, using the legs flexed and based on stirrups.

Description

The dimensions shape, and material from the ureteral stent for use depends upon the patient's anatomy and also the reason that stent is needed. Most stents are 5-12 inches (12-30 cm) long, and also have a diameter of 0.06-0.2 inches 1.5-6 mm. Either ends from the stent might be coiled (known as a pigtail stent) to avoid it motionless unnatural; an open-ended stent is much better suited to patients who need short-lived drainage. Sometimes, one end from the stent includes a thread mounted on it that extends with the bladder and urethra towards the outside the body; this helps with stent elimination. The stent material should be bendable, durable, non-reactive, and radiopaque visible with an x-ray.

The individual is generally placed directly under general anesthesia for stent attachment; this makes certain problems how the patient will stay comfortable and won't move throughout the procedure. A cystoscope (a thin, telescope-like instrument) is placed to the urethra towards the bladder, and also the opening towards the ureter to become stented is recognized. Sometimes, helpful information wire is placed to the ureter underneath the aid of the fluoroscope (an imaging machine that utilizes x-rays to visualize components on the fluorescent screen). The guide wire supplies a path for that keeping the stent that is superior within the wire. When the stent is within place, the guide wire and cystoscope are eliminated. Patients who are unsuccessful this process of ureteral stenting might have the stent positioned percutaneously (with the skin), to the kidney, and consequently to the ureter.

A stent which has a connected thread might be brought out with a doctor within an office setting. Cystoscopy could also be used to get rid of a stent. Who performs the process and where could it be carried out? Ureteral stenting is usually carried out inside a hospital by an interventional radiologist your physician who focuses on treating medical disorders using specific imaging methods) or perhaps an urologist your physician who focuses on diagnosing and treating diseases from the urinary tract and genital organs.

Risks

Difficulties related to ureteral stenting include:

• bleeding (usually minor and easily treated, but occasionally requiring transfusion)
• catheter migration or dislodgement
• coiling from the stent inside the ureter (could cause lower abdominal pain or flank pain on urination, urinary frequency, or blood within the urine)
• introduction or deteriorating of infection
• penetration of surrounding organs (e.g., bowel, gallbladder, or lungs)

Questions a patient should ask a doctor while meeting for treatment.

• Why is ureteral stenting suggested?
• What diagnostic tests are going to be carried out before the stenting process?
• What method is going to be accustomed to put the stent?
• What kind of stent is going to be used, so when could it be eliminated?
• Are there any options to ureteral stenting?

Normal results

Normally, a ureteral stent re-establishes the pass of urine in the kidney towards the bladder. Postoperative the flow of urine is going to be supervised to guarantee the stent is not dislodged or blocked.

Morbidity and mortality rates

Serious problems exist in approximately 4% of patients going through ureteral stenting, with minor difficulties in another 10%.

Aftercare

Stents should be regularly changed to avoid cracks inside the catheter wall or build-up of encrustation. Stent substitution is suggested around every 6 months; more regularly in patients who form stones.

Alternatives

If patient’s ureter is blocked and ureteral stenting isn't feasible, a nephrostomy might be carried out. In this procedure, a tube is positioned with the skin about the patient's back, to the part of the kidney that gathers urine. The tube might be attached to another drainage bag. In some cases, the tube is hooked up from the kidney towards the bladder.