Ureteric Stenting in Cyprus
Ureteric stent insertion is a procedure in which Dr Zertalis uses ultrasound (US) and X-Rays (fluoroscopy) to insert a long plastic tube (stent) through the skin into your kidney and bladder to drain your urine.
Benefits
The urine from a normal kidney drains through a narrow tube (the ureter) into the bladder. The most common reason for having a stent inserted is blockage of the ureter. When the ureter becomes blocked the normal flow of urine from kidney to bladder is disrupted and urine accumulates in the kidney. If left untreated this can lead to urosepsis (infection) and renal failure (kidney impairment).
The benefits of ureteric stent insertion and drainage of urine include:
- Prevention and/or treatment of urosepsis (infection)
- Prevention and/or treatment of renal failure (kidney impairment)
You may already have had a percutaneous nephrostomy placed to relieve the blockage. While a nephrostomy can be a permanent solution, a ureteric stent allows an internal solution without the need for a tube or drainage bag on the outside.
Risks
Ureteric stent insertion is a safe, effective and accurate procedure, but as with any medical procedure there are some risks and complications that you may uncommonly experience.
Bleeding: Significant bleeding requiring treatment is rare (0.1%) and on very rare occasions, this may require another interventional radiological procedure or surgery to stop it.
Infection: This is an uncommon complication. You will be given antibiotics before the procedure and you will be monitored during and after the procedure to check for signs of infection.
Urinoma: Uncommonly there may be a leak of urine from the kidney, resulting in a small collection of fluid inside the abdomen (urinoma). If this becomes a large collection, it may require draining under local anaesthetic.
Allergy to contrast (X-ray dye): Most adverse events are mild and can be managed safely in our department. A major life-threatening contrast reaction is rare (<0.005%).
Kidney Impairment: Impairment of kidney function can occur following the treatment due to the contrast agent or dehydration. You will have a drip placed before the procedure. This is to give you sufficient fluids to minimise the risk of problems with kidney function.
Radiation Risk: Immediate harmful effects such as skin burns, or radiation sickness are extremely rare. The radiation dose you receive during the procedure is monitored to prevent this. On rare occasions the procedure will have to be stopped if the threshold for immediate harmful effects is reached. Increase in lifetime risk of cancer due to radiation per examination is also rare (< 0.001%).
Failure: Very rarely, Dr Zertalis will be unable to place the stent. This is more common if the ureter is completely blocked. If this happens, a nephrostomy catheter will be reinserted, and Dr Zertalis will arrange a second visit. Stenting may be successful on a second visit but occasionally surgery is necessary for a combined approach to place the stent.
Dr Zertalis will explain the procedure and ask you to sign a consent form. Please feel free to ask any questions that you may have and remember that even at this stage, you can decide against going ahead with the procedure if you so wish.
Before the procedure
The procedure is performed with local anaesthetic and sedation. You will be asked not to eat or drink for 6 hours before the procedure. Relevant bloods test will be undertaken before the procedure. A short and thin plastic tube (cannula) will be placed into a vein in your arm.
Please let Dr Zertalis know about any medications you take, any allergies you may have and if you previously have had a reaction to the x-ray dye (contrast).
The procedure
You will be asked to change into a hospital gown and lie on your front or side in the position that Dr Zertalis has decided is most suitable. You will have devices attached to your chest, arm and finger to monitor you pulse, blood pressure and oxygen levels. You will be given a sedative to relieve anxiety and painkillers where necessary. This is standard for all minimally invasive interventional radiology procedures performed in Cyprus.
The procedure is performed under sterile conditions and Dr Zertalis will wear sterile gowns and gloves to carry out the procedure. The skin near the point of insertion will be swabbed with antiseptic and you will be covered with sterile drapes.
Your skin near the point of insertion will be numbed using local anaesthetic. When the local anaesthetic is injected you will likely experience a burning sensation for 30 to 60 seconds.
Dr Zertalis will use ultrasound (US) and X-Rays (fluoroscopy), to place a fine needle accurately into the kidney. The blockage will be identified, and a guidewire will be used to cross the blockage into the bladder. Once the wire has been placed through the blockage and into the bladder, a long plastic stent can be placed over the guide wire. Sometimes a new nephrostomy drainage tube will be left in the kidney and clamped. This will be removed the next day if everything is working normally.
Every patient is different, however, expect to be in the radiology department for up to 1 hour.
After the procedure
You will be transferred to your ward where your pulse, blood pressure, oxygen levels and the entry site in the skin will be checked by our team at regular intervals. You should expect to be in bed for 6 hours and to stay in hospital for up to 24 hours.
With regards to how long the stent will stay in, Dr Zertalis will discuss this with you in detail.
