With an increase in usage of ureteral stents in the management of urinary tract diseases, familiarity of the devices is becoming wide-spread. With this, the consequences and complications have come to light.
What is Ureteral Stent Placement?
The urine formed in the kidney is carried to the bladder by a fine muscular tube called a ureter. The bladder then acts as a reservoir for the urine. However, sometimes the kidneys and ureter can become obstructed. This can be caused by a kidney stone, narrowing of the ureter or after an instrument has been inserted into the ureter or kidneys. This causes pressure to build up behind the kidney, causing the function of the kidneys to suffer. First designed in 1967, the ureteral stent, also known as a ureteric stent, is a thin, hollow tube. It is placed in the ureter to help urine pass from the kidneys to the bladder. This is often performed under a brief general anaesthetic via a telescope. A guidewire is inserted into the ureteric opening in the bladder and, using X-ray screening, is passed up into the kidney. They have both ends coiled to ensure they stay in place. Today, ureteral stents are inserted as an almost routine procedure in patients with ureteric obstruction. They can also be useful for many conditions such as hydronephrosis due to stone disease, pregnancy, UTIs and a malignant neoplasm. In general, they are considered safe and well-tolerated. However, there are different complications that may occur with short or long-term use of the stents.
For most, the stent only needs to stay in place from a few weeks for a few months. However, they can sometimes stay in for up to 3 months. There are also stents that can be left in for much longer. A large number of people have reported health complications after the surgery, and researchers have recently taken a key interest in this. Late complications of ureteral stents are frequent and can be prevented by regular health checks with a surgeon. One common complication is the stent falling out, which can cause urinary incontinence. Urge incontinence is the most common type of incontinence experienced after a ureteral stent insertion. If this does occur, Doctors advise you call them straight away for an evaluation. Other common complications associated with ureteral stent insertion include infection, ureteral tissue irritation and irregular peristalsis. Stent migration and failure can also occur. These complications are, however, most commonly found in those with forgotten ureteral stents or those with long-term stents.
One particular study from February 2012 to September 2015 explored the risk factors and complications of the popular procedure. Data was collected from 68 patients that had long-term ureteric stents placed for more than 6 months for various causes. Flank pain, irritative bladder symptoms and hematuria were the predominant problems. Other symptoms such as gross haematuria, lion pain, suprapubic pain were minimal as the patients handled these symptoms for more than 6 months. Recurrent fever was also reported in 2 patients that indicated ascending infection due to blocked stent. A similar study in 2009 aimed to review the common problems people experience post-surgery. Of the 110 stents, 11 percent fragmented and nine migrated. Stent migration occurred with pre- and intraoperative fragmentation of the stent in 9 cases and was associated with the lack of urine acidification. Thirty four patients had fever after stent insertion. Interestingly, it has been discovered that patients with stones and asymptomatic patients have been found to be more liable to complications. Experts believe that asymptomatic patients are more prone to neglect or to forget their stent, developing time-related complications.
There are potential risks to health due to a ureteral stent insertion, as with any procedure. An anaesthetist should discuss these with you, including how to look after yourself following surgery. These are the following:
–Urinary incontinence and increased frequency in passing urine
-Blood in the urine
-Discomfort and pain
-A small amount of blood in the urine
-Risk of a stone forming around the stent
-Pain and discomfort in the pelvis and kidney while passing urine
You can relieve these side effects by having an adequate fluid intake of around 1.5 to 2 litres per day.
Are We Moving Forward?
Progress has been made recently in the development of drug-eluting expandable metal stents and biodegradable stents. Currently, engineering technologies are being investigated to provide stents with better biocompatibility and drug-elution characteristics. This may help prevent common complications and will be an important step forward. To prevent complications after surgery, please ensure you are given a clear date as to when the stent needs to be removed. The indications for stent insertion should be considered carefully in each patient. If you feel any unbearable pain or discomfort after the procedure, ensure you contact a Doctor.
Tips for Caring for Yourself after Treatment
- Rest when you feel tired. You will recover much quicker if you get enough sleep
- Check with your Doctor when it is okay to have sex
- Avoid strenuous activities until your doctor says it is okay
- Maintain a good fluid intake
- Ask your doctor when you can drive again
- You may need to do less strenuous activities while the stent is in
Ureteral stent insertion can be life-changing and rapidly increase quality of life. Although there are potential complications, these are often not long-term and can be solved quickly. However, it is important to talk to the anaesthetist about the potential complications and when the ureteral stent needs to be removed. Adequate care and frequent checks can prevent any problems or complications!