Ureteral Stent Placement: Procedure, Video, Steps & Indications

Anatomy and Physiology of Ureters

1. Two ureters in the human body connect the kidneys to the bladder. These ureters are long tubes that carry urine from the kidney to the bladder, which then gets excreted from the body. 
2. The muscles in the ureters tighten and relax continually to force the movement of urine towards the bladder. These muscles also prevent the urine from flowing back to the kidney. 
3. The ureters transport small amounts of urine to the bladder every 10-15 seconds. If their normal functioning is affected or obstructed due to any blockage, it can lead to pain, fever, and infection.
4. If the blockage remains untreated, it can lead to kidney damage. 
5. Urethral stent placement is an effective solution to treat the blockage and avoid any complications. 

1. Removal of Ureteral stone
2. To bypass the growth of a tumour
3. Resolve Ureteral Obstruction or blockage 
4. Removal of Kidney stone
5. Ureterocele
6. Removal of Blood Clots
7. Endometriosis in Females

1. Kidney Stone: Most commonly, urethral stents are used to allow the urine flow prevented by a kidney stone. After a kidney stone removal surgery, ureter stents may be placed to avoid the swelling of the ureters. Sometimes stents also need to be placed when there is a risk of ureter blockage because of the stone’s fragments. 
2. Ureterocele: In this condition, the ureter becomes too narrow due to the development of a tiny bulge in the ureter (ureterocele). It usually occurs near the bladder blocking the urine from passing through. It may even lead to the backflow of urine to the kidney.

1. Blood clots
2. Enlarged lymph nodes
3. Cancerous or non-cancerous tumours
4. Internal tissue build-up, such as endometriosis in females. 

1. In this procedure, the urologist inserts a cystoscope (a thin long metallic tube with a camera) through the urethra into the bladder and other parts of the urinary tract.
2. It helps to view the urinary tract and identify where the blockage is. 
3. Once the blockage is identified, the urologist makes an incision at the ureter’s blocked part and inserts a soft hollow tube (stent) to keep it open. 

Before the Surgery

1. The patient needs to inform the doctor about all the medicines they have been taking, including non-prescriptive medication such as Aspirin.
2. Blood thinners, including certain anti-inflammatory medicines and vitamin supplements, should be avoided before the surgery as per the doctor’s advice, as they can increase bleeding. 
3. If required, the doctor advises the patient to fast before the surgery.
4. The doctor may also ask the patient to take blood tests to check kidney function. 
5. The doctor advises a pre-anaesthesia checkup and other diagnostic tests based on the patient’s medical history.
6. It is beneficial to quit smoking (if a smoker) to increase the chances of a successful recovery after the surgery.

On the Day of Surgery

1. The patient first signs all the consent forms after checking in at the hospital
2. They are made to change into a hospital gown.
3. The healthcare providers monitor the patient’s vitals to check blood oxygen level, heart rate and blood pressure. Then they transfer them to the OT room.

During the Surgery

1. The anaesthesiologist induces general or local anaesthesia so the patient is asleep and doesn’t feel any pain during the surgery.
2. An IV (intravenous) line is started in the patient’s arm or hand. The fluid will be transferred to the body through the IV line. 
3. Healthcare providers monitor the patient’s vitals before the surgery.
4. They use X-ray imaging or a kidney ultrasound to locate the blockage. 
5. After identifying the blockage, a cystoscope is inserted through the urethra into the bladder. The urethra is a tube which removes urine from the body while peeing. 
6. The cystoscope locates the opening where the ureter connects to the bladder. 
7. Once the opening is visible, the urologist inserts a catheter (thin tube) with an attached balloon over a wire. The balloon is inflated to widen the urethra so that the stent can be placed in the area of blockage. 
8. To place the stent, the urologist threads it through the cystoscope into the bladder. 
9. Both ends of the stent are curled, which helps it to sit in place. One end lies in the kidney, while the other is placed inside the bladder. 
10. Once the stent is placed in the right position, the cystoscope and the guidewire are removed. 

After the Surgery

1. The healthcare providers shift the patient to a recovery room where he/she is kept under observation to check the vitals and the effect of the anaesthesia. 
2. Urethral placement is typically an outpatient surgery, meaning the patient can go home the same day after the surgery. 
3. The patient may feel some pain after the surgery. In that case, the healthcare provider gives medication to ease the pain. 
4. Once the doctor approves that the patient’s condition is stable, they are discharged, along with follow-up instructions. 

At Home

1. After returning from the hospital, the patient must drink lots of water (8-10 glasses) after the first 24 hours of the procedure to help with the kidney and bladder function. 
2. Discomfort while passing the urine or bleeding in the urine is not uncommon after the procedure. These symptoms usually improve in a few days. 

1. An urge to urinate more often. 
2. An urgent and vital need to urinate. The patient may also experience discomfort in the bladder. 
3. Pain in the abdomen or pelvic pain causing a pulling sensation while peeing. 
4. The doctor provides instructions and certain medicines to reduce pain and help with bladder symptoms. 

1. Avoid lifting heavy weights (objects weighing more than 6.8 kg)
2. Avoid physically demanding activities that especially require using abdominal muscles. 
3. The doctor may also advise not to have sex for the first week after the procedure to avoid the risk of urinary tract infection. 

First Follow-up Appointment

How Long Does the Ureter Stent Remain Placed? 

1. In most cases, ureter stents are temporary and once the problems that caused a blockage in the ureter clear up, the doctor performs another procedure to remove the stents.
2. Depending on the patient's condition, the stents remain for a few days or weeks. 
3. Patients with narrowed ureters or tumours that press on the ureters may need urethral stents for several months or even years. In this case, the stent must be replaced every three to six months to reduce complications. 

Stent Removal or Replacement

1. The stents meant to be placed for a short duration have strings attached that hang out from the urethra (from where urine passes out of the body).
2. When the doctor considers it safe to remove the stent, he/she pulls out the string to get it out of the body.  
3. If the patient needs stents for a longer duration, those stents don’t have a string attached. But the stents need replacement every three to six months.
4. To remove these stents, the doctor first confirms through an X-ray or other imaging procedure that the kidney stone or whatever the issue was creating a blockage is resolved. Then the doctor:
   1. Inserts a cystoscope through the urethra inside the bladder
   2. Removes the stent with the help of tiny clamps attached to the scope
   3. Gently pulls out the stent

1. Keeps the ureter open and functioning
2. Allows free flow of urine to the bladder
3. Reduces pain while passing the urine due to any blockage
4. Helps in restoring the kidney's normal functioning 
5. Minimally Invasive Procedure
6. It is a safe Procedure

1. Bladder irritation and spasms (painful cramps) 
2. Blocked or broken stents
3. Painful urination or hematuria (blood in urine)
4. Urine may leak after urination
5. Infections
6. Painful erection
7. Stent can loosen 
8. A stone may form - further leading to a decreased kidney function
9. Despite these symptoms, urethral stents are safe as they don’t cause any long-term problems. 

When is a doctor's consultation needed? 

1. Burning pain during urination
2. Clots of tissue in urine
3. Fever over 101°F or higher
4. Dark, cloudy, or foul-smelling urine
5. Pain in the kidney area (left or right side of the abdomen)
6. Nausea and vomiting

1. If the urinary obstruction is not treated in time, it can cause urinary tract infection and kidney damage that cannot be reversed.
2. It can even cause kidney failure and sepsis. 
3. Sepsis is a life-threatening condition caused when the body responds to an infection leading to uncontrolled inflammation in the body.

1. Technique and equipment used
2. Age of the patient.
3. Other medical conditions that the patient may have.
4. The type of hospital facility availed - individual room or shared.