Antegrade Ureteric Stent Insertion - A guide for patients

Introduction

This leaflet is designed for patients who have been advised to have an antegrade ureteric stent inserted.

Contents

• What is an antegrade ureteric stent?
• Why do I need an antegrade ureteric stent?
• Who has made the decision for me to have an antegrade ureteric stent?
• What are the benefits?
• What happens before the procedure?
• Who will be performing the ureteric stent insertion?
• What happens during the ureteric stent insertion?
• Will the ureteric stent insertion hurt?
• How long will the ureteric stent insertion take?
• What will happen after the ureteric stent insertion?
• What are the possible risks?
• Radiation
• Conclusion
• Privacy and dignity

What is an antegrade ureteric stent?

• Urine normally runs through a narrow tube called the ureter from the kidney into the bladder. The ureter can get blocked for several reasons or can sometimes leak. A ureteric stent is a plastic tube that runs inside the ureter from the kidney to the bladder. This helps the urine drain correctly to the bladder.
• When a ureteric stent is placed through the kidney down the ureter into the bladder it is called antegrade. When the ureteric stent is placed through the bladder up the ureter to the kidney it is called retrograde.

Why do I need an antegrade ureteric stent?

• Other imaging tests usually have shown that the ureter running from the kidney to the bladder is blocked. This can be for a number of different reasons including a stone or a tumour. The ureteric stent will allow urine to drain normally from the kidney to the bladder.

Who has made the decision for me to have an antegrade ureteric stent?

• The consultant in charge of your case and the radiologist performing the ureteric stent will have discussed the situation and concluded that this is the best way of treating your condition.
• However, you will also have the opportunity for your opinion to be considered, and if, after discussion with your doctors, you do not want the procedure carried out, you can decide against it.

What are the benefits?

• The ureteric stent will allow urine to drain normally from the kidney to the bladder.

What happens before the procedure?

• You will be admitted to hospital on the day of the procedure.
• A doctor will take a history from you.
• You may have a small needle put into a vein in your arm for painkillers and antibiotics to be given if necessary.
• Standard blood tests may be carried out.
• You may eat a light meal before your procedure
• If you have any allergies you must let your doctor know.
• If you take any medications to thin the blood (anticoagulants or antiplatelets) please let us know beforehand, as these will need to be stopped at a certain length of time before the procedure.
  • Examples include: warfarin, dalteparin, enoxaparin, tinzaparin, dabigatran, rivaroxaban, apixaban, clopidogrel, ticagrelor.
  • Low dose aspirin (75mg) is safe to continue.
  • Please discuss with a doctor before stopping any medicines, as sometimes other treatment will need to be given.
• If you have previously reacted to intravenous contrast medium (the dye used for CT scans), you must also tell your doctor about this.

Who will be performing the stent insertion?

• A specially trained doctor called an interventional radiologist will be performing your ureteric stent insertion
• Radiologists have special expertise in using x-ray equipment and interpreting the images produced.
• They will look at these images while carrying out the procedure.
• The radiologist will be assisted by a radiographer and nurses.

What happens during the stent insertion?

• You will lie on the x-ray table, generally flat on your front. In some cases the insertion can be performed lying on your side.
• You will have a monitoring device attached to your finger and will have a blood pressure cuff placed around your arm.
• The procedure is performed under sterile conditions and the radiologist and scrub nurse will wear sterile theatre gowns and operating gloves.
• Antiseptic solution will be used to clean the skin and then local anaesthetic will be injected to make the skin go numb.
• You may already have a nephrostomy (plastic tube into your kidney) in position which will be used as access to the kidney. If not, then the radiologist will use a combination of ultrasound and x-rays to accurately guide a small needle into your kidney. Once in position a guide wire will be placed down the ureter into the bladder then the plastic stent will be inserted.
• Sometimes it may be necessary to leave a plastic tube coming out of the kidney (a nephrostomy) but usually all plastic tubes used through the skin into the kidney will be removed.

Will the stent insertion hurt?

• Some discomfort may be felt in the skin and deeper tissues during injection of the local anaesthetic. You will often be given intravenous painkillers to help prevent pain in the ureter or bladder during the procedure.
• There will be a nurse, or another member of the clinical staff, in the room looking after you. If the procedure does become uncomfortable, please let a member of staff know.
• After the procedure most patients do not get significant pain. Painkillers will be provided as needed.

How long does the stent insertion take?

• Every patient’s situation is different, and it is not always easy to predict how complex or how straightforward the procedure will be.
• Generally, the procedure will last approximately 45 minutes.

What will happen after the stent insertion?

• You will be taken back to your ward/ radiology day unit.
• Nursing staff may carry out routine observations including taking your pulse and blood pressure and will also check the treatment site.
• If you experience pain or sickness let the nursing staff know.
• You will need to stay in bed for up to six hours.
• Most patients will go home the same day of the stent insertion. Some patients might need to stay in hospital overnight.
• If you were told to stop any medication before the procedure, your doctor will tell you when to start it again.

What are the possible risks?

• A ureteric stent is a safe procedure, but as with any medical procedures there are some risks and complications.
• The main risk is failing to get through the blockage in the ureter. If this happens you may need to have a plastic tube placed into your kidney (a nephrostomy). A second attempt on another day may be needed or another operation might be required.
• There may be some bleeding from the kidney and sometimes you will see blood in your urine. This should settle within 24 to 48 hrs. Rarely, the bleeding will be so significant that another procedure may be necessary.
• As there is a chance of infection following the procedure, you will be given antibiotics before the start of the procedure.
• There is a very small chance of injury to nearby organs during the stent insertion.
• Some people may get some discomfort within the bladder and frequency of urination initially following stent insertion.

Radiation

• You have been referred for an Interventional Radiology procedure to help deliver your treatment. A specialist in radiology agrees that this is the best procedure to treat your clinical condition and that the benefit of the examination is greater than the risk.
• The x-ray involves a dose of ionising radiation equivalent to a few months or years of natural background radiation which we are all exposed to every day.
• Ionising radiation can cause cell damage that may turn cancerous however the risk of this happening from your examination is considered low.
• Depending on the length of the procedure there may also be a small risk of an excess radiation dose to the skin leading to short term and long term effects (e.g. reddening of the skin and burns).
• If this happens as a result of this procedure, you will receive further advice following the procedure. The dose delivered will be kept as low as is practicable.
• For further information please see the Imaging (Radiology) page on the Trust’s website

Conclusion

• Some of your questions about your procedure should have been answered by this leaflet, but remember that this is only a starting point for discussion about your treatment with the doctors looking after you.

This document has been adapted from one prepared by the British Society of Interventional Radiology (BSIR).

Privacy and Dignity

We are committed to treating all patients with privacy and dignity in a safe, clean and comfortable environment. This means, with a few exceptions, we will care for you in same sex bays in wards with separate sanitary facilities for men and women.

In some areas, due to the nature of the equipment or specialist care involved, we may not be able to care for you in same sex bays. In these cases staff will always do their best to respect your privacy and dignity, for example with the use of curtains or, where possible, moving you next to a patient of the same sex. If you have any concerns, please speak to a member of the radiology team, ward sister or charge nurse.