How To Prepare For The Procedure
Always ask your doctor about the treatment steps and any special instructions. These can differ by hospital and country.
Instructions may include:
- when to stop certain medications, such as blood thinners
- when to stop eating and drinking before the procedure to prepare for anaesthesia
- when to empty the bladder before the procedure
- when to arrange pain medication after the procedure, if necessarydiscuss this early with your nurse and/or doctor
- arranging for a ride home after your hospital discharge
Before surgery, someone from your health care teamusually the anaesthesiologistwill assess which type of anaesthesia is appropriate for you.
Depending on the country you live in and your hospital, types of anaesthesia can include:
- General anaesthesia
- A local anaesthetic with or without sedation
You may be asked to give a urine sample before the procedure to test for a urinary tract infection.
Stent Removal After Kidney Stone Laser
Similar to ureteral stones, kidney stones can be fragmented and removed with baskets. Occasionally, a kidney stone will fragment with a laser into very small. Jun 26, 2011 · In most patients, stent removal is a relief as their stent discomfort goes away. However, in some patients, severe pain may occur for several hours.
The stent is usually removed after a few days to a few weeks depending on the particular circumstances. Ureteric stents cannot stay in the body indefinitely (.
Following URS, clinicians may omit ureteral stenting in patients meeting all of the.
Index Patient 12: Adult, renal stone with pain and no obstruction.
The ureteral stent is typically removed in the office, usually within 1-2 weeks after the procedure but may be left for longer after complex procedures. If you have any questions, to schedule a consultation or if you need a second opinion, please contact us or call: 646-663-4421. Dr. Alex Shteynshlyuger is a board certified urologist in NYC who.
If you have had a stent inserted after kidney stone surgery, it is temporary and only needed for a short period of time. There are two main methods for removal. For most patients, the stent will only stay in place for 5-7 days. Is a stent necessary after kidney stone removal? The routine placement of a ureteral catheter or stent following.
The stent removal does not hurt at all, I removed mine myself. The after effect of bladder spasms and kidney pain had me going back to the emergency room.
What Can Cause A Blocked Ureteral Tube
Kidney stones are the most common reason for placing a ureteral stent. Other reasons include stricture , and outside forces such as a tumor pushing on the ureter and causing a blockage.
Inflamed, swollen, or damaged ureteral tubes in need of healing may have a stent placed to keep the kidney draining during the healing process.
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What To Expect From A Ureteral Stent
Ureteral stents are an implant used to correct a blockage in one of the ureters in your body. The ureters are tubes that allow urine to drain from the kidneys and enter the bladder. When blockages occur, urine backs up in the kidneys, which causes swelling that can lead to permanent kidney damage if left unaddressed.
Blockages can be caused by kidney stones, a tumor or other object pressing on the ureters, or scar tissue that develops in the ureters. A ureteral stent is a thin tube inserted into the ureters to open the passage and allow urine to properly drain from the kidneys.
If your doctor decides this implant is necessary to preserve your kidneys health, youll want to be prepared for what to expect once the stent is implanted and after the stent is removed.
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What Is Ureteral Stent Placement
What to expect after a ureteral stent is placed? What can you do to help your recovery?First, let us review some information about your body and why a stent may be needed. The normal human body has 2 kidneys that are in the middle of the back under the lowest ribs. Kidneys filter and clean blood to make urine. Ureters drain the kidneys to the bladder.
A ureteral stent is a thin, straw-like tube, that is put in a ureter to help drain urine from the kidney to the bladder. A curl at each end of the stent holds it in place.
Stents are most commonly used to treat blockages, especially from kidney stones. If a kidney does not drain it can become damaged. Stents are also placed after surgery involving the ureter to allow it to heal. A stent may be needed for weeks, even months, depending on why it was placed. Ask your Urologist what the plan is for your stent.
Sometimes a string is attached to the end of the stent to make it easier to remove. If you can feel a string, leave it alone, do not pull it. If the stent is accidentally pulled out too soon or pulled out of position, you may need another procedure to put a new stent in.
After a stent is placed you will see red color from blood in your urine, even tiny clumps. You will have some pain in your side and back called flank pain. Some patients have more pain than others. This pain is mostly caused by spasms or cramping of the ureter and bladder. It can be worse when you try to urinate.
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What To Expect If You Receive An Ureteral Stent
A ureteral stent is most often used during the treatment of stone and occasionally with other surgery involving the urinary tract.
The experts at Georgia Urology have lots of experience in placing and removing stents, so check out our guide on this common medical procedure below.
How Do You Sleep With A Ureteral Stent
Here are some methods you can use to improve your sleep with a stent.
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What Happens After Kidney Stone Removal And Stent Placement
You may have a small amount of blood in your urine for 1 to 3 days after the procedure. While the stent is in place, you may have to urinate more often, feel a sudden need to urinate, or feel like you cannot completely empty your bladder. You may feel some pain when you urinate or do strenuous activity.
While You Have Your Stent
After your stent placement procedure, you may feel a pulling sensation when you urinate . You may also have:
- Frequent urination, which is the need to urinate more often than usual.
- Urgent urination, which is a strong, sudden urge to urinate, along with discomfort in your bladder.
- Pelvic pain, which is pain in your lower abdomen .
These symptoms usually go away with time. Your healthcare provider will talk to you about what symptoms you might feel. Your healthcare provider may give you medication to help with bladder symptoms.
You may sometimes see blood in your urine while you have the stent. This may happen for as long as the stent is in place. Sometimes, it happens after increased activity or long car rides. If you see blood in your urine, drink more water than usual until the blood goes away.
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Why Is A Stent Used
A stent is most commonly used to bypass an obstruction of the ureter, to allow the ureter to heal after surgery, and to treat kidney stones. A stent is sometimes placed emergently and can be lifesaving when there is an obstruction of the ureter and an associated infection. If this is due to a stone, the stone is left in place and will be treated later due to the infection.
As an added benefit the stent allows the ureter to passively become larger, which can make the future procedure to remove the stone less traumatic and allow any stone fragments to pass more easily once the stent is removed. A stent is also placed at times during stone surgery to allow the ureter to heal or prevent fragments from obstructing the kidney.
It is most commonly inserted by passing a scope with a camera into the urethra and bladder. The stent is then inserted into the opening of the ureter to the kidney using x-rays to visualize its placement.
Does The Patient Need Anesthesia
Yes, even though there is no incision, there will be pain. You and your doctor will discuss whether light sedation and local or general anesthetics will be used. The choice depends on the technique, the type of stone and the patient. SWL can be delivered with just mild sedation, but in general, some type of anesthesia–either local, regional or general–is used to help the patient remain still, reduce any discomfort, and this improves the breaking of the stone.
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Ureteroscopy With Laser Lithotripsy
We will perform ureteroscopy with laser lithotripsy while you are under general anesthesia . Over the course of about one hour, we will:
After a brief observation period, you will be able to go home that same day.
*Around five percent of the time, the ureter is too narrow for the ureteroscope. If this happens to you, we will leave a stent in place to dilate your ureter. We will reschedule your procedure for two to three weeks later.
What To Expect During Your Procedure
We want to keep you as comfortable as possible. Before your procedure, we give you anesthesia to put you to sleep so you dont feel anything. Dr. Buschemeyer proceeds with meticulous detail, inserting the ureteroscope into your ureter and bladder to examine any issues in your urinary tract.
If you have a small kidney stone, he uses a miniature wire basket to pull the stone out.
For a large stone, he might use a laser fiber that goes through the scope to break it apart. Once that happens, Dr. Buschemeyer can suction all of it out through your urinary tract. He performs the entire procedure without making any incisions.
It can take an hour or two depending on the size of your kidney stone.
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What Are The Potential Risks Or Complications Of Ureteral Stenting
As many as eight out of 10 people with ureteral stents experience:
- Bladder irritation, bladder spasms and frequent urination.
- Blocked, broken or dislodged stents.
- Blood in urine or painful urination.
Your healthcare provider will talk about your likelihood of risk. They will also tell you how to handle any worrying signs while the stent is in place.
What Does The Treatment Involve
You will be positioned on an operating table. A soft, water-filled cushion may be placed on your abdomen or behind your kidney. The body is positioned so that the stone can be targeted precisely with the shock wave. In an older method, the patient is placed in a tub of lukewarm water. About 1-2 thousand shock waves are needed to crush the stones. The complete treatment takes about 45 to 60 minutes.
Sometimes, doctors insert a tube via the bladder and thread it up to the kidney just prior to SWL. These tubes are used when the ureter is blocked, when there is a risk of infection and in patients with intolerable pain or reduced kidney function.
After the procedure, you will usually stay for about an hour then be allowed to return home if all goes well. You will be asked to drink plenty of liquid, strain your urine through a filter to capture the stone pieces for testing, and you may need to take antibiotics and painkillers. Some studies have reported stones may come out better if certain drugs are used after SWL.
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What Is Shock Wave Lithotripsy
Shock Wave Lithotripsy is the most common treatment for kidney stones in the U.S. Shock waves from outside the body are targeted at a kidney stone causing the stone to fragment. The stones are broken into tiny pieces. lt is sometimes called ESWL: Extracorporeal Shock Wave Lithotripsy®.
These are what the words mean:
- extracorporeal: from outside the body
- shock waves: pressure waves
- lithotripsy
So, SWL describes a nonsurgical technique for treating stones in the kidney or ureter using high-energy shock waves. Stones are broken into “stone dust” or fragments that are small enough to pass in urine. lf large pieces remain, another treatment can be performed
When To See Your Doctor
Your doctor will probably schedule a follow-up appointment a week or two after removing a kidney stone. At this appointment, the doctor will make sure youre recovering as planned, and if you have a stent, it will probably be removed at this time. Always keep your follow-up appointments.
After kidney stone removal, complications may occur. Common complications include blood clots near the kidneys, nerve palsies, pancreatitis and obstruction caused by leftover kidney stone fragments. You should see a doctor if you suspect any of these complications. You should also see a doctor immediately if youre having trouble urinating, you have an increasing amount of blood in your urine, your pain is unmanageable, you have chest pain, you have a fever or youre vomiting.
References
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What Are The Advantages And Disadvantages Of This Treatment
The main advantage of this treatment is that it treats kidney stones without an incision. As a result, hospital stays and recovery time are reduced.
But, while SWL can work, it doesn’t always work. After SWL, about 5O% of people will be stone free within a month. In others, stone fragments of various sizes remain. Sometimes a repeat procedure is needed.
SWL has the potential to cause kidney injury. Whether or not SWL causes or leads to the development of high blood pressure and diabetes remains controversial. These possibilities are still being studied. You should ask your doctor about risks and benefits of SWL in your situation.
Percutaneous Nephrolithotomy Or Percutaneous Nephrolithotripsy
If your stone is large or lithotripsy doesn’t break it up enough, this surgery is an option. PCNL uses a small tube to reach the stone and break it up with high-frequency sound waves.
You will be given something so that you wonât be awake during this surgery. Your surgeon will make a small cut in your back or side and place a thin scope into the hole.
The surgery can be done in one of two ways:
Nephrolithotomy: Your surgeon removes the stone through a tube
Nephrolithotripsy: Your surgeon uses sound waves or a laser to break up the stone and then vacuums up the pieces with a suction machine.
The surgery takes 20 to 45 minutes. You’ll typically have to stay in the hospital for a day or two afterward. Usually, a stent will have to stay in your kidney for a few days to help urine drain.
Your doctor might do an X-ray or ultrasound a few weeks later to see whether any parts of the stone are left. They might also send the stone fragments to a lab to find out what they’re made of.
Risks from this surgery include:
- Infection
- Damage to the bladder, bowel, ureter, kidney, or liver
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Should We Place A Stent Or Not After Stone Removal
Review question
For patients with stones in the kidney or in the tube draining urine from the kidney to the bladder that have been removed from the inside by a ureteroscope , how does placing a stent compare to not using a stent?
Background
Urologists use small scopes and other tools to find, break up, and remove stones. Afterwards, swelling and blockage of the ureter can cause discomfort. To prevent that from happening, urologists often leave a temporary stent. It is unclear whether a stent makes things better or worse.
Study characteristics
We included 23 trials with 2656 people who either had a stent or not. Whether they received a stent or not was decided by chance.
Key results
A stent may make people come back to the hospital for problems less often, but we are very uncertain of this finding. Pain on the day of surgery and on days one to three after surgery may be similar. People with a stent may have more pain in the long term , but we are also very uncertain about this. The need for another procedure may be similar.
People with a stent may be less likely to need narcotics , but we are very uncertain about this. There may be no difference in the risk of a urinary tract infection. Stenting may make people a little less likely to develop a narrowing of the ureter because of scarring and may make them slightly less likely to be admitted to the hospital. However, we are very uncertain of both findings.
Certainty of the evidence
What Symptoms Can Be Caused By A Stent
Normal symptoms you may experience when a stent is in place include:
- Blood in urine Can range from light pink tinged urine, to a darker color similar to red wine.
- Dysuria this can be mild to moderate. Dysuria can usually be relieved by increasing fluid intake and avoidance of certain drinks, food, and some medications.
- Urgency the feeling/sensation you get when you have to go
- Frequency going to the restroom more often than normal. Frequency can range from every few minutes, to once an hour. Frequency will increase when increasing fluid intake.
- Spasms of the ureter or bladder. A cramping-like sensation in the mid to low abdomen, often described as feeling like a muscle cramp
Some symptoms are not normal with a stent in place, and you should see your doctor. These include:
- Constant dark bloody urine that does not ease up with increased fluid intake.
- Thick clots or tissue in the urine that is causing any difficulty urinating
- Urinary retention, meaning you are unable to urinate at all. Small dribbles of urine with an increasing discomfort in your lower abdomen can suggest the beginning of retention, and you should notify your doctor.
- Severe pain of any kind not relieved with any medications, either over-the-counter or prescription medication.
- Persistent fever over 101.8 °
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