Have you been told to have a 'ureteral stent'? (Ureteral Stent) - Don't worry, let's talk about this!

You may be a little nervous when your doctor tells you that you need a ureteral stent. When most of us think of a stent, we think of a stent that is placed in the heart. But this is something completely different. It is a small device that helps your kidney system function properly. So there is no need to be afraid. Today, we will talk about this in a very simple way that you can understand.

Simply put, what is a ureteral stent?

Think of the two kidneys in our body as two water filters. These filters have two small tubes that carry the urine (pee) that is cleaned by these two filters to the bladder. These two tubes are what we call the 'ureters' or urinary tract.

A ureteral stent is a very thin, flexible tube made of silicone or polyurethane. It is placed inside the ureter, the tube that carries urine, to help keep it open and unblocked. It's like putting a small tube through a blocked water pipe to help clear the way.

This stent is about 10-15 inches long. It is designed so that one end of it remains inside the kidney and the other end inside the bladder. This is also called a 'Double-J stent'.

Why do we need to put in this stent?

The main reason is that the ureter becomes blocked for some reason (ureteral obstruction). When this happens, urine does not flow from the kidney to the bladder. This can cause damage to the kidney and lead to infections. The stent works by bypassing the blockage and creating a path for urine to flow.

See the table below for the main reasons for placing this stent.

Is stent placement a major surgery? How do I prepare for it?

No, this is not usually a major operation . This is a minimally invasive operation. That means it is done through a natural opening, without making a large incision. In most cases, you can go home the same day. However, because you are under anesthesia, you will need someone to take you home.

Before the surgery, the doctor will tell you the following:

• Tell us about your complete medical history and any allergies you may have.
• Tell your doctor about all the medications you take (including vitamins) . Some medications can increase bleeding.
• They say to do a blood test (eGFR) to check kidney function.
• You will be asked not to eat or drink anything for about 8 hours before the surgery. If there is any essential medication, you will be allowed to take it with a sip of water.

How does the stent insertion process work?

This is usually done by a urologist. You will be given general anesthesia, so you won't feel anything and will be asleep.

After you fall asleep, the doctor will follow these steps:

1. First, a scan (fluoroscopy or kidney ultrasound) is used to find the exact location of the blockage.

2. Then, a thin, long instrument with a camera attached (a `cystoscope`) is passed through your urethra and into your bladder.

3. Through this `cystoscope`, an even thinner wire-like device (`guidewire`) is passed into the blocked urethra.

4. The stent is inserted into the correct location along that guidewire.

5. Once the stent is in place, the guidewire and cystoscope are carefully removed. The stent remains inside the body.

What happens after the stent is placed? What to expect?

After the surgery, you will feel a little sluggish when you wake up. You will be given medication to control the pain. The doctor will tell you to drink plenty of water . This will help flush out your kidneys and bladder.

These things are normal in the first few days:

• A little blood in the urine (hematuria): This will gradually decrease.
• A slight discomfort or burning sensation when urinating: This will also subside in a few days.
• Needing to urinate frequently: This can happen because the stent stimulates the bladder.
• Feeling a slight pain in the area where the kidneys are (on either side of the lower back) when urinating: This can also occur in some people.

These discomforts may persist for as long as the stent is in place. However, if you experience unbearable pain or excessive bleeding , inform your doctor immediately.

How long does the stent need to be in place?

It depends on your condition. Most of the time, these are temporary . They can be left in place for a few days to a few weeks. Your doctor will remove them once your condition improves.

However, some people (for example, those whose arteries are blocked by a tumor) need to have the stent in place for a long time. In such people, the old stent is removed and a new one is inserted every 3-6 months to prevent infection.

How do you remove the stent? Is it painful?

Removing the stent is very simple.

• Stent with a thread: Some short-term stents have a visible thread that the doctor pulls on to remove the stent.
• Threadless stents: These are removed using a cystoscope as they were inserted. A numbing gel is applied to the area, so you won't feel much pain. You may feel a little discomfort.

There may be some slight burning or discomfort for a day or two after removal. This is normal.

What are the benefits and possible complications?

As with any medical procedure, there are benefits as well as minor disadvantages/complications.

How to reduce the pain caused by the stent?

These discomforts can usually be controlled with painkillers. However, do not take any painkillers (such as `NSAIDs`) without asking your doctor. Sometimes your doctor may prescribe a special medicine like `tamsulosin` to reduce this discomfort.

If you have these symptoms, see a doctor immediately!

If you experience any of the following while you have the stent in place, call your doctor immediately or go to the hospital's Emergency Department (ETU).

• High fever or chills (may be a sign of infection).
• Unbearable, severe pain in the kidney area, lower abdomen, or when urinating.
• Dark red blood or blood clots in the urine.
• Inability to urinate or decreased urine output.
• Dark brown urine, foul smell .
• Nausea and vomiting .

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