Mr. Kilian Walsh

Patient Information Leaftets

This information is provided by Urology West for patients who are undergoing treatment with Urology West and have been advised of specific conditions and treatments.

- Ureteric Stent

This information sheet has been given to you to help answer some of the questions you may have about having a ureteric stent inserted. If you do have any questions or concerns, please do not hesitate to speak to a doctor or nurse.

What is a ureteric stent?
A ureteric stent is a fine plastic tube inserted into your kidney. It allows urine to drain from your kidney into your bladder when you have a blockage - a stone or growth - in your ureter (a narrow, muscular tube that connects your kidney to your bladder).

What are the benefits of having a ureteric stent inserted?
The blockage that is in your ureter will be relieved. Without the stent, the blockage would cause your kidney to enlarge and in some cases, stop the kidney from working altogether. The procedure is very safe and you recover quickly without the risks of surgery. Having a stent will help prevent infection and permanent damage to your kidney.

Are there any risks associated with having a ureteric stent?

• The stent may irritate your bladder causing you to feel a need to pass urine frequently.

• You may see blood in your urine on some occasions. Sometimes you may feel pain in your back (on the side of your body where the stent is) when passing urine. This is usual as the stent may rub against the wall of your ureter. For most patients the symptoms are minor and can be tolerated.

• Occasionally the 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 sometimes it may even fall out (there is more information on this later on in this leaflet). If this happens, you should contact  your GP or Urology Registrar on Call, UCHG.

• Having a stent, along with the underlying kidney problem, makes it more likely that you could develop 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, which your GP can prescribe for you.

Having a ureteric stent inserted
The operation is performed under general anaesthetic.

Are there any alternatives?
The alternative to having a stent inserted is having what it is called a 'nephrostomy tube', a tube that is put into your kidney draining the urine to the outside. However, this involves carrying a urine collection bag attached to your back, which requires proper care. This is done under x-ray guidance to make sure the tube is put in the right place. You will be awake during this procedure although you will be given a sedative, which makes you feel drowsy and relaxed, and something to take away the pain. This is not a long-term solution and you may eventually have to have a stent inserted. If you would like more information, please talk to your doctor.

What do I need to do to prepare for the procedure?
You may be asked to attend a pre-admission appointment. This is to have blood tests and a physical examination, to make sure you are fit for the procedure.

You must not:
• eat anything for six hours before your procedure;
• drink anything for four hours before your procedure.

If you have food or drink in your stomach when you have the anaesthetic, there is a higher risk of you being sick while unconscious. If you need to take blood pressure tablets, you can do so with small sips of water. You will be seen by an anaesthetist who will discuss the type of anaesthetic you will be given, check that you are fit enough for surgery and discuss the different types of pain relief available to you after the procedure when the anaesthetic has worn off. You should try to avoid smoking as this will increase your risk of developing a chest infection, which means you will have to stay in hospital for longer

How is the ureteric stent inserted?
When you arrive in theatre, you will be given a general anaesthetic. This is given through a small injection in the back of your hand. The anaesthetist will stay with you and monitor you during the procedure. A fine telescope is passed down your urethra (tube that urines passes through from the bladder before exiting the body) and into your bladder. The stent is then passed up the ureter (a narrow muscular tube that connects the kidney to the bladder) and into the kidney. The procedure usually takes approximately 1 hour.

What happens after the operation?
Although you will be awake a minute or two after the procedure is finished, you are unlikely to remember anything until you are back in your bed. You may feel sick or be sick, for up to 24 hours after the operation. This is an after effect of the anaesthetic. If this happens, we will give you some anti-sickness medication. You will be encouraged to start drinking at the earliest opportunity, as long as you are not feeling sick. You may eat a light meal as soon as you feel able to once on the ward. You should be eating and drinking normally after two or three days.

The anaesthetic may make you clumsy, slow and forgetful for about 24 hours. Although you may feel fine, your reasoning, reflexes, judgment, coordination and skill can be affected for 48 hours after your surgery. If you are discharged from the hospital less than 48 hours from your surgery, please rest when you get home and do not go to school or work on the day after your surgery.

For 48 hours after your surgery for your safety please DO NOT:

• drive any vehicle, including a bicycle
• operate any machinery
• attempt to cook, use sharp utensils or pour hot or boiling liquids
• drink alcohol
• smoke
• take sleeping tablets
• make any important decisions or sign any contracts

It is quite normal for your bowels not to open for about a day after the procedure. If your bowels have not opened after two days or you feel uncomfortable, ask the nursing staff for advice. You may have a catheter draining your bladder for a while, which will be monitored by the nurses. Your urine may be bloodstained for a day or two. This is normal. The catheter will be taken out once your mobility returns and the urine is clear.

How will I feel, now I have a stent?
For most of the time, you will not be able to feel anything. The majority of people find that they have a slight discomfort when passing urine. Each person has a different tolerance level of discomfort. As your bladder decreases in size when you pass urine, the lower end of the stent may rub against the sensitive bladder wall lining. Not emptying your bladder completely will lift the stent off the bladder lining, which will ease the discomfort. You may feel that you need to pass urine more than usual or experience urgency in passing urine.

Many of these side effects (especially blood in the urine) can be relieved by maintaining a good fluid intake of around 1.5 to 2 litres of fluid a day. Pain and discomfort in the pelvis and kidney area may be worse at the end of passing urine but it is important to maintain the recommended amount of fluids.

These side effects will decrease in the weeks following insertion of the stent.

When can I go home?
You will go home within 48 hours, if you are comfortable with regular pain medication and have no signs of infection you can go home the next morning. If your pain is difficult to manage you will stay an extra night to allow time to manage the pain effectively and to be monitored. Those who do not have difficulties managing the pain with prescribed medication and have had the stent put in before, they may go home the evening of the procedure on the doctor’s instruction. You will be given some pain medication that you can take at home when in pain; the prescription may be repeated by your GP if required. Before you leave, the nurse will check that your pain is well managed, that you have no signs of infection and that the blood in your urine is not a large amount. It is encouraged that you arrange for a responsible adult to take you home when you are discharged.

What should I look out for when I am at home? You are likely to feel very tired and need to rest after your procedure; however, you should be able to return to your usual level of activity very quickly. It is not unusual to see a small amount of blood in your urine. This may be caused by irritation in your bladder. If the bleeding becomes heavier and bright red/red wine in colour, contact your GP or the hospital, on one of the numbers below, for advice. The blood in the urine may be cleared by drinking the recommended amount of daily fluids and will decrease as the days following the surgery pass. It is highly unlikely that the stent will fall out but very rarely does it become dislodged from its position. If you experience discomfort, colic pain (pain in your intestines) or find it more difficult to pass urine that you did before, it may mean that the stent has become dislodged. Contact your GP or the hospital. If you are unable to reach anyone then go to your nearest Accident and Emergency (A&E) department. If you develop a temperature above 38°C/100.4°F please call your GP or one of the emergency numbers listed below immediately.

Will I be able to have sex?
You can have sex as soon as you feel able to.

Will I be able to drive?
You must not drive for 48 hours after the procedure. This is to make sure that the effects of the anaesthetic have fully worn off.

When can I return to work?

Returning to work will depend on what you do for a living. If you do light office work, you can return to work as soon as you feel ready to. Avoid manual work if it involves carrying, digging, climbing or building until you are given permission to do so by your consultant.

You can download this information in PDF format here: Ureteric Stent.pdf

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