Antegrade ureteric stent Information for you Follow us on Twitter @NHSaaa Find us on Facebook at www.facebook.com/nhsaaa Visit our website: www.nhsaaa.net All our publications are available in other formats
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This leaflet gives you information about the procedure known as antegrade ureteric stenting. It explains what is involved and what the possible risks are. It is not meant to replace discussion between you and your doctor, but can act as a starting point for such a discussion. The consent form This form gives the hospital a formal indication that you agree to the treatment as stated on the form. It is valuable to you as it offers a written check on what you are consenting to. You should be fully informed of the proposed procedure and any associated risks before signing the consent form. You will have the opportunity to speak with the doctor before the procedure. The doctor will be able to answer any questions you may have. What is antegrade ureteric stenting? The urine from the kidney drains through the ureter (a narrow, muscular tube) into the bladder. When the ureter becomes blocked - for example, by a stone, the kidney is affected and it may stop working. If there is an infection, the kidneys will be more affected. While an operation may be necessary, it is also possible to relieve the blockage by inserting a long plastic tube (a stent) through the skin, into 3
the kidney and then down the ureter. Because the stent is put through the kidney, and down the ureter, this is called an antegrade procedure. Placing a stent through the bladder and up the ureter is called a retrograde procedure. This stent then allows urine to drain normally, from the kidney into the bladder. Why do I need antegrade ureteric stenting? Other tests will have shown that the tube leading from your kidney to your bladder has become blocked. However, it may not be obvious what the cause of the blockage is. If left untreated, your kidneys will become damaged. An operation may be necessary to provide a permanent solution to the blockage, but in the meantime, the stent will allow the kidney to drain in the normal way. The doctors in charge of your case and the radiologist doing the antegrade ureteric stenting will have discussed the situation, and feel that this is the best treatment option for you. However, you will also have the opportunity to discuss this. If after discussion with your doctors, you do not want the procedure carried out, then you can decide against it. 4
Who will carry out the procedure? A specially trained doctor called a radiologist will carry out the procedure. Radiologists have expertise in using x-ray and scanning equipment and also in interpreting the images produced. They need to look at these images while carrying out the procedure. As a result, radiologists are the best trained people to insert needles and fine tubes into the body, through the skin and place them correctly. Where will the procedure take place? The procedure will take place in the interventional theatre, which is a specially designed theatre with specialised x-ray equipment. How do I prepare for antegrade ureteric stenting? You will need to be an inpatient in the hospital. We will ask you not to eat for four hours beforehand, though you may be allowed to drink small amounts of water. We will give you a theatre gown to wear. We will then insert a small plastic needle (venflon) into a vein in your hand and carry out blood tests. If you have any allergies, you must tell your doctor. If you have previously reacted to intravenous 5
contrast medium (the dye used for kidney x-rays and CT scan), you must tell your doctor about this. What actually happens during antegrade ureteric stenting? It is quite likely that you have already had a percutaneous nephrostomy (a fine plastic tube put into the kidney through the skin). In this case the first part of the procedure has already been done and you should be familiar with what will happen. If you have not, you might like to read the leaflet, Information for patients undergoing percutaeous nephrostomy. You will lie on the x-ray table, generally flat on your stomach, or nearly flat. We will attach a monitoring device to you which will monitor your blood pressure and pulse. You will probably receive oxygen through a small tube in your nose. If needed, we will give you some light sedation and / or painkillers through the venflon in your hand. The nurse assisting the radiologist will clean the skin around the nephrostomy catheter and cover most of your body with a sterile drape. The radiologist will insert some local anaesthetic around the nephrostomy catheter and then pass a guide wire along the catheter through your kidney into your 6
ureter. Once the wire has been placed through the blockage and into the bladder, the long plastic stent can be placed over the guide wire, and the wire withdrawn. Urine should then be able to pass down the stent and into the bladder. As a temporary measure, it may be necessary to leave a fine drainage tube, called a catheter, in the kidney to let urine drain externally. This catheter will be placed into a drainage bag, which will be attached to the surface of your skin. Will it hurt? You may feel some discomfort during the injection of the local anaesthetic. The radiologist and nursing staff looking after you can give you additional painkillers through the needle in your arm, if necessary. You may be aware of the needle, then the stent passing into the kidney and sometimes this is painful, especially if the kidney was sore to start with. You may be aware of the guide wire causing some irritation in the bladder but this only lasts for a short time. Generally, placing the stent in the ureter only takes a short time, and once in place it should not hurt at all. 7
How long will it take? Every patient s situation is different and it is not always easy to predict how complex or how straightforward the procedure will be. It may be over in 20 minutes, if you already have a nephrostomy tube in place, or very occasionally it may take longer. As a guide, expect to be in the interventional theatre for around an hour altogether. What happens afterwards? We will take you back to the ward on a bed. Nurses in the ward will carry out routine observations, such as taking your pulse and blood pressure, to make sure that there are no problems. You will generally stay in bed for a few hours, until you have recovered. The nursing staff will let you know when you can eat and drink. If you have an external nephrostomy catheter, this will stay in place for the time being and will be attached to a collection bag. It is important that you try not to make any sudden movements. For example, take care when getting up from a chair. Always remember about the bag, and make sure that it can move freely with you. The bag needs to be emptied fairly frequently, so that it does not become too heavy, but the nurses will want to measure the amount in it each time. 8
How long will the drainage catheter and the ureteric stent stay in, and what happens next? These are questions only the doctors looking after you can answer. The nephrostomy catheter may only need to stay in for a short time. Taking this out will not hurt. You will be able to carry on as normal with the catheter and the stent in place. The stent may stay in position for a much longer period of time, depending on the nature of the blockage and whether any operation is being considered. Are there any risks or complications? Antegrade ureteric stenting is a very safe procedure, but there are some risks and complications can happen. Perhaps the biggest problem is being unable to place the stent suitably in the ureter. If this happens, a surgeon will arrange another method of overcoming the blockage, which may involve surgery. Sometimes there is a leak of urine from the kidney, resulting in a small collection of fluid inside the abdomen. If this becomes a large collection, it may need to be drained. There will usually be slight bleeding from the kidney into the urine which should settle in 24 to 48 hours. On very rare occasions, this may become severe and require a surgical operation or another radiological procedure 9
to stop it. The risk of bleeding needing further treatment is less than one per cent. Occasionally there may be an infection in the kidney, or in the space around it. This can generally be treated with antibiotics. Despite these possible complications, the procedure is normally very safe and should result in an improvement in your medical condition. Remember This leaflet should have answered some of your questions, but remember that this is only the starting point for discussion about your treatment with the doctors looking after you. Make sure you are satisfied that you have received enough information about the procedure, before you sign the consent form. 10
Your notes 11
All of our publications are available in different languages, larger print, braille (English only), audio tape or another format of your choice. Tha gach sgrìobhainn againn rim faotainn ann an diofar chànanan, clò nas motha, Braille (Beurla a-mhàin), teip claistinn no riochd eile a tha sibh airson a thaghadh. 0800 169 1441 Tell us what you think... If you would like to comment on any issues raised by this document, please complete this form and return it to: Communications Department, 28 Lister Street, University Hospital Crosshouse, Crosshouse KA2 0BB. You can also email us at: comms@aaaht.scot.nhs.uk. If you provide your contact details, we will acknowledge your comments and pass them to the appropriate departments for a response. Name Address Comment Compiled by: X-ray department, Ayr Hospital Last reviewed: July 2015 Leaflet reference: AXR07-001-GD