A ureteric or "kidney stone" stent can be a must when "calculus" or inflammation blocks the passage of urine out of the kidneys into the bladder and out of the body. Before we get too far into the discussion, defining some terms may help:
- The ureters are tubes made of small muscle fibers that force urine from the kidneys into the bladder. There is one ureter for each kidney. The ureter in men is longer than the ureter in women.
- A stent is a tube that keeps a passageway, such as a blood vessel, open and functional. Ureteric stents are usually made of plastic. A ureteric stent keeps a ureter open when there are kidney stones or growths.
- Ureteric stents are put in place with the help of a cytoscope, which gives the doctor a visual image of the urinary tract. Usually the stent is held in place by springs at the distal (far) end. The stent is removed by pulling at a string attached to it that hangs outside the body. The string itself can be a nuisance, catching on clothes or in zippers, and interfering with the stream of urine. Some stents have a tiny magnet on the end that makes it possible to pull out the stent by inserting another tube with a corresponding magnet on its far end. The two magnets connect, and both stents can be pulled out at the same time.
- Pain during removal of a ureteric stent is usually controlled with lidocaine placed into the urethra, the canal that leads from the bladder outside the body. There is no intravenous line, and it is OK to eat and drink before the procedure.
- Stents that are left in too long (usually, more than six months) can calcify so they have to be removed surgically.
What can go wrong with ureteric stents? Usually, not very much, but there are some occasional complications:
- The stent can irritate the bladder so you need to go to urinate more often.
- The stent can transfer an infectious microorganism to the kidneys. This can be very serious. Blood in the urine and/or fever are a sign to seek medical care immediately.
- Colicky, spasmodic pain in the abdomen with or without the ability to pass urine are a sign that the stent may have come dislodged.
Sometimes, however, managing ureteric stents gets complicated. The guidewire can break off. Chronic inflammation of the ureter may have to be addressed with balloon dilation, inflating a balloon inside the ureter to keep it open. If the stent results in inflammation that causes stricture, or narrowing, or the ureter when it is removed, and this problem isn't detected early, severe damage to the kidneys can occur. If the stent has to be put in after radiation treatment for cancer of the kidney or other abdominal organs.
What can you ask for to minimize these complications?
- A single dose of non-steroidal antiinflammatory medication (usually you would get Celebrex rather than Aspirin, to minimize bleeding risk) may eliminate the risk of severe pain after removal of the stent. In a Canadian study, 55 percent of people having a stent removed experienced severe pain without pre-treatment, but none did with it.
- An imaging method called flexible cytoscopy is less painful than a method called ureteroscopy, especially for women.
- Endometriosis and recent hysterectomy increase the likelihood of pain in women who get ureteric stents. Ask about other methods of managing the symptoms.
- Slipped disks in the lower back can lead to complications with a ureteric stent. If you have lower back pain due to straining or lifting while you have a stent in place, call your doctors so they can examine you and make sure the stent is not also affected.
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