Also Ask About Anticholinergic Medications
Anticholinergic medications are another alternative to alpha-blockers. These medications help reduce some post-stent placement symptoms, such as urinary frequency or urgency.
If these symptoms are keeping you up at night, talk with your doctor about these medication options. An example is solifenacin.
Anticholinergics are commonly used for other conditions like overactive bladder. Side effects may include dry mouth and constipation.
raises concerns about anticholinergics and dementia risk, especially in people over 65. Talk with your doctor with the pros and cons for your specific case.
What If The Doctor Suspects That I Have A High Risk Of Forming New Stones
If the results show that you have a high risk of forming more stones, your doctor will do a metabolic evaluation. This is a series of blood and urine tests to determine the possible causes of your stone formation. Depending on the test results, your doctor will recommend preventive measures or further tests. Besides changes in your lifestyle, you may be advised to take medication that reduces the risk of stones recurring. Generally, the medication will cause few to no side effects.
Can I Work With A Ureteral Stent
Yes, you can continue your normal activities with a stent in place. Though there may be some physical discomfort, a stent will not physically limit you.
Lifting, or reaching your hands above your head repeatedly may cause bleeding, or worsening bleeding that may already be present. This is related to increased irritation of the stent on your bladder.
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How Is The Procedure Performed
The procedure is usually performed with the patient asleep . Sometimes a local anaesthetic, with or without sedation, is administered.
During this procedure, a tube with a tiny optic camera is inserted through the urethra into your bladder. The bladder is inspected, and the ureteric opening is located. The urologist may use x-ray images taken with a contrast agent in the ureters to assess the urinary tract and to locate the obstruction.
The stent is placed during surgery by sliding it over a guidewire placed in the ureter .
What Will I Experience During And After The Procedure
Devices to monitor your heart rate and blood pressure will be attached to your body.
You will feel a slight pinch when the needle is inserted into your vein for the IV line and when the local anesthetic is injected. Most of the sensation is at the skin incision site. This is numbed using local anesthetic. You may feel pressure when the catheter is inserted into the vein or artery. However, you will not feel serious discomfort.
If the procedure is done with sedation, the intravenous sedative will make you feel relaxed, sleepy and comfortable for the procedure. You may or may not remain awake, depending on how deeply you are sedated.
You may feel slight pressure as the catheter is inserted into the kidney and down the ureter. During placement of a ureteral stent, until the stent is positioned, you may feel pressure as the guide wire is inserted into the bladder resulting in a sensation to urinate. You may experience blood-tinged urine for several days following the procedure, which will usually clear up on its own.
You will remain in the recovery room until you are completely awake and ready to return home.
You will not feel when the contrast is excreted into the urine.
You should be able to resume your normal activities within a few days.
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How To Remove Your Stent
Once the stent is removed you will probably experience some pain the next time you pass urine and you may also notice blood in your urine. This is quite normal and it will pass.
Make sure you drink enough fluid to keep your urine a pale yellow colour. This will reduce the likelihood of blood clots in your urine.
If you feel that you are unable to remove the stent by yourself, dont be concerned. Contact Urology Associates and arrange a time to have the stent removed by a nurse.
Ureteroscopy And Laser Lithotripsy
Kidney stones affect 1 in 500 Americans each year, causing significant pain and healthcare expense.
Surgical options for patients with symptomatic kidney stones include extracorporeal shock wave lithotripsy , ureteroscopy, and percutaneous nephrolithotomy . Your renal anatomy, stone composition, and body habitus all play major roles in determining outcomes and operative approach.
The role of ureteroscopy over the last ten years has undergone a dramatic evolution, due to improvements in the ureteroscope size and deflection capabilities, video-imaging, miniature baskets and instruments, and in lithotripsy with the advent of holmium laser. Over 25% of all kidney stone surgeries are now done using small ureteroscope technology.
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How Is A Stent Removed
Stents can be removed two different ways. Sometimes a string has been left attached to the end of the stent. This string is allowed to come out of the patients urethra . The string can be used to pull on the stent and remove it. If a string is not attached, numbing medication is usually administered, and a small camera called a cystoscope is inserted into the urethra. The cystoscope is advanced into the bladder along with a grasping instrument, which grasps and removes the stent.
What Is The Best Sleeping Position
While doctors havent established a single best position for reducing stent-related discomfort when sleeping, there are some reports that people feel better sleeping on the opposite side where their stent is placed.
However, this isnt backed up by research. You may have to try different sleeping positions to determine how you can get more comfortable.
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How Is Ureteral Stent Placed
Urologists place stents at the time of surgery only. For this, they slide the stent on a soft wire and later on, place it over the ureter, which refers to a tube that drains into the kidney. During the end of surgical process, doctor places a stent within the ureter by the help of an X-ray or a scope. Stent in case of an adult is of 22cm to 30cm in length and it extends to the bladder from the kidney by using a coil on each end for holding the kidney stent in its place. Stent thus dilates the ureter to help in passing of the urine towards the bladder from kidney. In this case, doctors may leave an attached string to the kidney stent to remove it following surgery and may tap it to the stomach or leg.
Ureteral Stents Why And How They Are Placed
A ureteral stent is a small plastic tube that is placed inside a ureter to aid the flow of urine. As part of the urinary tract, the kidneys function to filter blood and process waste out of the body as urine. This urine passes through small tubes into the bladder before being expelled. Under certain circumstances, the ureters can become blocked inhibiting the flow of urine. Stent placement is a minimally invasive solution to allow urine to pass through to the bladder.
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To Deal With Inoperable Tumors
Most of the times, 12 months or higher indwelling times indicate keeping of the ureters in open condition, which further gets compressed due to tumor present in the nearby region of the ureter or because of the ureteral tumor itself. In most of the cases, these are of inoperable tumors and hence, to come up with an appropriate solution, doctors place stents to make sure easy drainage of the urine from the ureter. Reason for this is very simple, if patients and doctors compromise the drainage for a long time, it may cause damage to the kidney.
What To Expect Back Home
At hospital discharge, your doctor or nurse will give you instructions for rest, driving, and doing physical activities after the procedure.
Because surgical instruments were inserted into your urinary tract, you may experience urinary symptoms for some time after surgery. These symptoms usually disappear in a few weeks.
Symptoms may include:
- a mild burning feeling when urinating
- small amounts of blood in the urine
- mild discomfort in the bladder area or kidney area when urinating
- need to urinate more frequently or urgently
- pain resulting from an internal abrasion that needs time to heal
Try to drink fluids often but in small quantities. Sometimes a blood clot can cause pain . The urine contains a substance that will dissolve this clot.
If the pain remains despite the use of pain medication, contact the hospital or your doctor.
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To Avoid Spasm Of The Ureter
Urologists place stents inside a scratched or irritated ureter at the time of performing ureteroscopy procedure, which involves the removal of stone i.e. a basket grab process. In this case, doctors place the stents for one week to make sure about avoiding the problem of spasm in the ureter and end it after the trauma ends associated with the complete procedure.
Why Is A Stent Needed
Stents are used for various reasons in patients with kidney stones. They can be placed to help reduce sharp pain from a stone or to allow drainage when infection is present or when a stone prevents a kidney from working adequately. Stents are commonly placed after surgery for stones to allow healing and to ensure that swelling does not block the drainage of urine after the procedure.
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What Are Ureteral Stenting And Nephrostomy
Urine is normally carried from the kidneys to the bladder through long, narrow tubes called ureters. The ureter can become obstructed due to conditions such as kidney stones, tumors, infection, or blood clots. When this happens, physicians can use image guidance to place stents or tubes in the ureter to restore the flow of urine to the bladder.
A ureteral stent is a thin, flexible tube threaded into the ureter. When it is not possible to insert a ureteral stent, a nephrostomy is performed. During this procedure, a tube is placed through the skin on the patient’s back into the kidney. The tube is connected to an external drainage bag or from the kidney to the bladder for internal drainage.
How Is The Stent Removed
If the string is visible outside the body, it can be simply removed in office without the use of any procedures or specialty equipment. This is used for short term stents . A nurse practitioner can do this in the office within days of your surgery.
Ureteral stents that do not have a visible string, or were placed to allow a longer healing period, will require a minor in-office procedure.
A small, flexible scope called a cystoscope is placed into the urethra that allows the doctor to visualize the stent from inside the bladder. Then, the doctor grasps the stent with tiny clamps attached to the scope and removes the stent.
A physician must do this procedure, and it must be scheduled ahead of time. An X-ray may be required prior to removing the stent to ensure no large stone fragments are visible. Large fragments that havent passed may require additional procedures. In these cases, the stent would remain in place.
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What Does The Equipment Look Like
During ureteral stenting, a fluoroscope and a guide wire are used to place a stent into the ureter.
A guide wire may be inserted with the aid of a fluoroscope, an imaging device that uses x-rays to see structures on a fluorescent screen.
A stent is 10 to 15 inches long and less than a quarter inch thick.
During a nephrostomy, a fluoroscope, or an ultrasound, and a needle are used to place a catheter in the kidney.
A catheter is a long, thin plastic tube that is considerably smaller than a “pencil lead”, or approximately 1/8 inch in diameter.
Ultrasound scanners consist of a computer console, video display screen and an attached transducer. The transducer is a small hand-held device that resembles a microphone. Some exams may use different transducers during a single exam. The transducer sends out inaudible, high-frequency sound waves into the body and then listens for the returning echoes. The principles are similar to sonar used by boats and submarines.
Other equipment that may be used during the procedure includes an intravenous line , ultrasound machine and devices that monitor your heart beat and blood pressure.
What Can I Expect After I Have My Ureteral Stent
After a stent is placed, you may have a string coming out of the urethra. This will be used to remove the stent in the future and should not be pulled on. In most cases, it will be okay if it accidentally is pulled out.
The side effects after a stent are placed can vary. If it was placed because of severe pain from a stone, stent discomfort is usually significantly less. Most patients will experience some discomfort which may include pain in the back, flank and pelvis, urinary urgency and frequency, and intermittent blood in the urine. You can continue your regular activities if you are not having significant pain or taking narcotic pain medications. You should notify your physician if there are any fevers or significant clots in the urine.
The stent is temporary and will need to be removed. Your physician should be able to tell you an approximate length of time the stent will be left in place, but this can vary significantly. Most stents after treatment for medium to small stones are kept in place for less than two weeks. Stents that have a string attached to them will be removed with the string on a follow-up appointment in the office. Stents without a string will require a minor procedure in the office. A flexible scope will be passed into the bladder and a grasper will be used to pull the stent out. After this most will have minimal urinary discomfort for 1-2 days.
If you have any more questions or concerns regarding ureteral stent, contact our urological experts.
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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.
What Can I Do The First Week After Surgery
- Try to drink enough fluids: 1.5 litres daily throughout the day to facilitate urine flow and the spontaneous loss of small stone fragments.
- Try not to have sex within the first week after the procedure to avoid urinary tract infections.
- Eat more vegetables and less meat to have softer stoolthe inner healing process will be helped if you do not have to squeeze when using the toilet.
- Allow your body to rest during the first week after the procedureyou are allowed to lift a maximum of 5 kg and to go for walks. You can start cycling and exercising after this period.
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Are There Any Restrictions
Your doctor will let you know if you have any restrictions following urinary stent placement.
Typically, you can perform most activities, work, and even sexual activity with a stent in place, providing it doesnt cause you great discomfort to do so.
There is one exception: when you have a stent with an extraction string. This is a special stent designed so you can remove the stent yourself after its been in place for a certain amount of time.
Stents with strings have a slightly higher rate of dislodgment. Avoid sexual activity while you have one in place to prevent dislodging the stent.
According to a 2015 study , people with stent strings also reported a bit more sleep disturbances than people who had stents without strings.
When you sleep, make sure the string is in a place where you can locate it easily. Sometimes, your doctor will tape the strings down to your leg or groin until you remove it.
Stent-related irritation can cause a lot of different symptoms including discomfort. Examples include:
- visible blood in urine
- incontinence, or loss of control over urine
- pain when urinating
Ideally, these symptoms will subside within a few days after the stent placement when youre more used to the stents presence.
A urinary stents presence can increase the risks of a urinary tract infection . Call your doctor if you experience some of the following symptoms, as they can indicate you may have an infection:
When Kidney Fails To Operate Adequately
Urologists recommend a stent for kidney stones in patients, when the presence of a stone in a kidney prevents the kidney to work in an adequate manner. Placement of ureter stents takes place after kidney surgeries for stones, as in the case of ureteroscopy to help in both healing and prevention of ureters swelling.
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Changes In Your Lifestyle
Even if you have a low risk of forming another stone, your doctor and nurse will advise you to make some lifestyle changes.
Lifestyle changes may include:
- Increasing fluid intake: Drink 2.5-3.0 litres per day to neutralise the pH of your urine
- Adopting a balanced diet with less meat and alcohol and more vegetables and fibre to have normal calcium levels and less intake of animal proteins
- Maintaining a healthy weight and adequate physical activity