Having a Ureteric Stent - What to Expect and How to Manage
In patients who have, or might have, an obstruction (blockage) of the kidney, an internal drainage tube called a ‘stent’ is commonly placed in the ureter, between the kidney and the bladder. This is placed there in order to temporarily relieve the obstruction.
Your urologist is planning to use such a stent for you
The information presented here explains the benefits to be derived from ureteric stents and mentions some of the drawbacks that patients might experience. It is divided into two parts.
Your urologist will explain the specific details applicable to you
This information is designed for use by patients who are going to have a stent inserted. It will also be of help to health care professionals involved in your care or anyone who wishes to know more about ureteric stents. At the end there is information about your kidney condition and stent.
How can the obstruction be relieved?
What is a Ureteric Stent?
How is a ureteric stent put in place?
How long will the stent stay in the body?
How is a stent removed?
Is there an alternative option to the use of a stent?
What are the possible side effects?
Duration of the side effects - can they improve?
Can the side effects interfere with daily life?
What other complications are possible?
Is there a possibility of a urinary tract infection?
What care do I need to take?
When should I call for help?
The kidneys produce urine. Normally there are two kidneys situated in the upper part of the abdomen,
towards the back. The urine formed in the kidney is carried to the bladder by a fine muscular tube called a ureter.
The urinary bladder acts as a reservoir for the urine and, when it is full, it is emptied via the urethra (water passage).
Common causes of obstruction of the kidneys and ureter are:
Occasionally, obstruction can occur because of diseases of the prostate or tumours of the urinary system. Your urologist will provide further details applicable to you.
Whenever there is an obstruction, pressure builds up behind the kidney. Due to high pressure, the function of the kidneys starts to suffer over a period of weeks. The obstruction can also cause stagnation of the urine, which can lead to infection and further damage to the kidneys. It is, therefore, important to relieve or prevent obstruction of the kidney.
It is not always possible to identify what has caused an obstruction and to treat this immediately. It is therefore essential to relieve the obstruction on a temporary basis before treatment is carried out.
Also, following an operation on the ureters, it takes time for the ureters to heal and a temporary measure to prevent obstruction becomes essential. This is commonly achieved by inserting a ureteric stent to make a channel for the urine to pass and allow the kidneys to drain.
A ureteric stent is a specially designed hollow tube, made of a flexible plastic material that is placed in the ureter. The length of the stents used in adult patients varies between 24 to 30 cm. Although there are different types of stents, all of them serve the same purpose (see Figure 2).
Your urologist can explain in detail about the different types of stents.
The stents are designed to stay in the urinary system by having both the ends coiled. The top end coils in the kidney and the lower end coils inside the bladder to prevent its displacement. The stents are flexible enough to withstand various body movements.
Usually a stent is placed under a general anaesthetic using a special telescope (cystoscope) which is passed through the urethra into the bladder.
The stents are then placed in the ureter and kidney via the opening of the ureter in the bladder.
The stent may be inserted as an additional part of an operation on the ureter and kidney (e.g. ureteroscopy).
Occasionally they are placed from the kidney down to the bladder using special x-ray techniques. The correct position of a stent is checked by taking a x-ray.
There is no hard and fast rule about this. The stent has to be kept in place as long as necessary, i.e. until the obstruction is relieved. This depends on the cause of obstruction and the nature of its treatment. In the majority of patients, the stents are required for only a short duration, from a few weeks to a few months. However, a stent in the right position can stay in for up to three months without the need to replace it. When the underlying problem is not a kidney stone, the stent can stay in even longer. There are special stents, which may be left in for a much longer time. Your urologist will tell you how long he expects your stent to remain in place.
This is a short procedure and consists of removal of the stent using a cystoscope, usually under local anaesthesia. Sometimes a stent can be left with a thread attached to its lower end that stays outside the body through the urethra. The doctors can remove such stents by just pulling this thread.
There is no simple alternative option. In some patients, a tube draining the urine to the outside called a 'nephrostomy tube', may be placed in the kidney. However, this involves carrying a urine collection bag attached to your back, which requires proper care. If you need this treatment your urologist will explain in detail what is involved.
Ureteric stents are designed to allow people to lead as normal a life as possible. However, they may not be without side effects. In placing a stent, there is a balance between its advantages in relieving the obstruction and any possible disadvantages in the form of side effects. Most side effects are not a danger to your health or your kidneys, although they can be a nuisance. Below, we have described all the possible side effects associated with a self-retained ureteric stent. You may experience none, some occasionally, or a few of them.
Many patients do not experience problems with the stents.In the majority of the patients experiencing side effects they are minor and tolerable. However sometimes they can be moderate to severe in nature.
Commonly noted side effects are:
These effects are possibly due to the presence of the stent inside the bladder causing mechanical irritation. These effects resolve when the stent is removed.
Complete understanding of these side effects and their causes is not clear at present. It has also not been possible to predict, before placement of a stent, which patients are likely to experience side effects and what they will be.
There is some evidence that some of the symptoms, such as pain while passing urine and blood in the urine, may improve with time. However, this remains unpredictable.
It has been reported that around 20-70% of patients with a stent experience one or more of these side effects.
Medical science and the stent manufacturers are working to develop a stent that will cause the least possible side effects.
The stents are not expected to cause much disruption to your normal daily life. However, you may experience some side effects that can cause some problems, either directly or indirectly.
Let us look at this in relation to various daily activities:
Occasionally a stent may develop a crystal coating on its surface. Usually this is not a significant problem. Very occasionally a stent may get displaced, usually slipping towards the bladder, and it may even fall out.
If this happens, you should contact the hospital or your GP.
The presence of a stent, along with the underlying kidney problem, makes it more likely that you could get a urinary tract infection. Some of the symptoms that you may experience if you get a urinary tract infection are raised temperature, increased pain or discomfort in the kidney or bladder area, a burning sensation while passing urine and feeling unwell. This usually requires treatment with antibiotics.
You should contact a doctor or a hospital:-
If you would like to know more about ureteric stents here are the details of some relevant articles for further reading:
1. Ureteral stents- Materials; Endourology update: Mardis HK, Kroeger RM: Urological Clinics of North America, 1988, Vol. 15, No.3, 471-479.
2. Ureteral stents – indications, variations and complications: Saltzman B: Endourology update : Urological Clinics of North America, 1988, Vol.15, No.3, 481-491.
3. Self retained internal ureteral stents: Use and complications: Mardis HK: AUA update series, 1997, Lesson 29, Volume XVI.
Authors: Mr. H. B. Joshi (Specialist Registrar in Urology, Cambridge. Formely Research Registrar at Bristol Urological Institute), N. Newns (Staff Nurse), Mr. F. X. Keeley Jr. (Consultant Urologist), Mr. A. G. Timoney (Consultant Urologist)
Bristol Urological Institute, Southmead Hospital, Westbury-on-trym, Bristol BS10 5NB.
Publication Month: February 2000.
Sponsorship (in part): Southmead Hospital Research Foundation
Copyright: Reproduction of this document, whole or in part, will need permission from the authors.