Ureteric stents

Why stents are used

• Emergency drainage of an obstructed or infected kidney, before the stone itself is treated.
• After ureteroscopy, to reduce post-operative pain from ureteric swelling and prevent obstruction.
• After PCNL in some cases, particularly if a ureteric perforation has occurred or if there is residual stone to pass.
• Pre-stenting, occasionally done a few weeks before a planned ureteroscopy to passively dilate a narrow ureter.
• Protecting the ureter during or after procedures for very large stones.

How a stent is placed

Stent insertion is usually done under general anaesthetic. A cystoscope is passed into the bladder, a guidewire is fed up into the kidney, and the soft plastic stent - typically 22-28 cm long with curled ends - is advanced over the wire. One curl sits in the renal pelvis, the other in the bladder. An x-ray confirms position.

In some emergencies a stent cannot be placed from below (for example, because an infected stone is impacted in the ureter); in that case a percutaneous nephrostomy is placed from above through the flank instead.

What living with a stent feels like

Most patients notice stent symptoms to some degree:

• Frequency and urgency - needing to pass urine often, with a sudden sense of fullness.
• Mild burning or stinging on passing urine.
• Flank discomfort radiating up to the kidney when voiding (urine is briefly pushed back up the stent).
• A pink tinge to the urine.
• Occasional dull ache in the lower abdomen or groin.

These symptoms are temporary and almost always settle rapidly after the stent is removed. Good oral fluid intake helps; bladder-relaxing medication (such as solifenacin or mirabegron) is useful for some patients. Most people continue working with a stent in place.

Stent removal

Stents are usually removed 7-14 days after a stone procedure. Removal is normally done in the rooms under local anaesthetic gel, using a flexible cystoscope - a quick office procedure lasting a few minutes. General anaesthetic removal is used in selected cases (children, patients with difficult anatomy, or patients who had difficulty with stent placement).

A stent left in for more than the recommended time can encrust and become much harder to remove. It is important not to miss the removal appointment, and to inform the rooms if travel or illness makes it difficult to attend.

Longer-term stents

Some patients need a stent for longer - for example, awaiting definitive stone surgery after emergency drainage, or where stone treatment must be staged. In that case:

• Stents are typically changed every 3-6 months.
• Specialised coated stents can sometimes be left longer.
• Regular urine cultures and hydration advice are important.

Patient information brochures

Ureteric stent insertion PDF - BAUS patient brochure Advice to patients with a ureteric stent PDF - BAUS patient brochure Percutaneous nephrostomy PDF - BAUS patient brochure

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