Ureteral Stent

Kidney stones.. A.D.A.M

What is a ureteral stent?  Say you just met with your urologist and you need surgery and he/she said after explaining the surgery, you'll also need a ureteral stent.  A stent is a flexible plastic tube that  curls into the urine collecting portion of the kidney, travels down the ureter and then curls into the bladder.  A stent keeps the ureter open.  Why do you need one?  The most common reason a urologist puts a stent in is to help with swelling from kidney stone blockage.

 If you have sound wave surgery (ESWL) or ureteroscopy with laser lithotripsy (laser destruction of the stone), the stone pieces can get plugged up in the ureter and cause a blockage as painful as the original stone.  Also, if the urinary tract gets infected and blocked, and there's no stent in place, you can die from the blockage.  Urologists also put stents in to keep open the ureter from scar tissue, called stricture, or even from cancers.  Common cancers that may obstruct the ureter include gynecologic cancers such as cervical, ovarian or uterine, colon cancer, prostate cancer, lymphoma, testicular cancer, bladder cancer and other less common malignancies.

Side effects of ureteral stents:

The most common side effect of ureteral stents is the constant need to pee.  Stents irritate the bladder lining and the brain interprets this irritation as the urge to pee.  Many people will not know they even have a stent in place because they have no symptoms.

 The crucial thing to remember here is, you have to get your stent removed at some point after the original surgery.  Stents can crust over and form stones that make removing them very difficult and even dangerous.  Some people have such severe urinary tract pain, they can't even keep the stent in place.

 These people are rare but make it very difficult for the urologist to treat.  We don't put stents in just for fun but rather because we think there is a medical necessity.  So if someone can't tolerate the stent and it has to come out, it makes us nervous that they could have more serious complications as discussed earlier.

How does the stent go in?

Urologists most often place stents in the operating room under general anesthesia.  The surgeon places a cystoscope through the urethra and into the bladder.  He/she then identifies the opening of the ureter into the bladder called the ureteral orifice and places a flexible guide wire up into the kidney using X-ray to guide the wire safely.  The stent is then placed over the wire into the kidney and the wire is then removed--this deploys the stent curls to keep the stent in place in the kidney and bladder.

How and when does the stent come out?

Stents usually are removed when the urologist determines the swelling and blockage improve--usually within 2 weeks after stone surgery.

 Stents are easier and less painful to remove so most often, the urologist removes the stent under a local anesthesia in the office with a flexible fiber optic or digital camera cystoscope and a small grasper that fits into the scope.  The urologist visualizes the stent in the bladder and removes it--usually in about 90 seconds or less.  If you have a chronic condition like scar tissue that can't be repaired or a cancer that requires the stent to be in for more than three months, you'll need the stent changed so it doesn't crust over.  Most often, stent changes are also performed under general anesthesia in the operating room.

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