Ureteric stents

A ureteric stent is a thin flexible pipe that is placed in the ureter (the tube that transports urine from the kidney to the bladder). The insertion of a ureteric stent is typically done under general anaesthesia and is commonly used to unobstruct a kidney or relieve pain caused by kidney stones, ureteric strictures, inflammation or cancers.

Why Are Ureteric Stents Inserted?

Ureteric stents are usually inserted to:

• Relieve Obstruction: When a kidney stone or stricture blocks the ureter, a stent can bypass the blockage, allowing urine to flow freely again into the bladder.
  

• Reduce Pain: Stents can relieve pain associated with kidney stones, especially when they are lodged in the ureter.
  

• Prevent Kidney Damage: By relieving an obstruction, ureteric stents can help prevent kidney damage due to a build up of pressure in the affected kidney (hydronephrosis, a swelling of the kidney).

If this is done for stone disease and the stone is still present a definitive procedure such as shockwave treatment, ureteroscopy and LASER lithotripsy or a PCNL procedure needs to be performed prior to removal of the stent.

• Facilitate the healing process: After certain surgical procedures, such as kidney stone removal (ureteroscopy or PCNL) or ureteric repair, a stent can aid the healing process by keeping the ureter open. Ureteric stents are proven to reduce the number of unplanned hospitalisations (1)

Common Symptoms of Ureteric Stents

While ureteric stents are designed to relieve discomfort, they can sometimes cause side effects, including:

• Frequent urination: The stent can irritate the bladder, leading to frequent urination.

• Urgent need to urinate: This can be particularly bothersome, especially at night.

• Painful Urination: The stent can irritate the urethra, causing painful urination.

• Visible blood in urine (haematuria): This is often mild and temporary but can cause dark red blood in the urine.

• Flank Pain: This may indicate a more serious issue, such as infection or obstruction but is often commonly associated with ureteric stents.

• Difficulty working: Stent symptoms can significantly impact a person’s ability to work or carry out daily activities particularly if you are mobile at work.

Managing ureteric stent symptoms

Several strategies can help manage the discomfort associated with ureteric stents:

• Medication: Over-the-counter pain relievers like ibuprofen or paractemol can help reduce pain and reduce inflammation. Tamsulosin or alfuzosin (alpha-adrenoreceptor antagonists) reduce ureteric stent related pain. Solifenacin (an anticholinergic drug) has shown a benefit in stented patients for reducing pain, and lower urinary tract symptoms of urgency and blood in the urine2. The ideal agent or combination to use after ureteric stent insertion has not yet been determined.

• Increased Fluid Intake: Drinking plenty of water can help flush out the urinary tract and reduce irritation.

The Impact of Ureteric Stents on Work and Daily Life

Ureteric stents can significantly disrupt a person’s daily life, particularly their ability to work. The frequent and urgent need to urinate can make it challenging to concentrate, attend meetings, or travel. Communicating with your employer about your condition and any necessary accommodations is essential.

If you’re experiencing severe symptoms or difficulty managing your stent, it’s crucial to consult your healthcare provider. They may recommend additional treatments or adjust your medication.

Maximum Duration and Removal of Ureteric Stents

Ureteric stents are generally designed to be temporary. If inserted with strings out of the urethra, they are typically designed to be removed in 3-7 days following a procedure, either by patients themselves or in a clinic environment. They are typically designed to be removed or replaced within 3 to 6 months to prevent complications such as encrustation, infection, or stent migration.

In some cases, stents can be left in place for up to a year, but this requires regular monitoring and periodic replacement.

If your stent has been left in for over a year you should contact your urologist for an urgent appointment. Stents that are left in for a long time tend to encrust, potentially causing complications like infections and kidney failure, and necessitating multiple operations.

Common removal methods for ureteric stents:

• Flexible cystoscopy and stent removal: The most common method involves using a flexible cystoscope under a local anaesthetic. A thin, flexible tube with a camera, is inserted through the urethra to visualise and remove the stent using a tiny grasping device through the scope. The procedure typically takes 1-2 minutes.

• String Removal: Some stents have a string attached that extends outside the body, allowing for easier removal by gently pulling on the string.

Further information from the European Association of Urology

https://patients.uroweb.org/treatments/double-j-stent-placement/

Mr Ivo Dukic is an experienced consultant urologist and high-volume complex stone surgeon who offers personalised consultations and the latest technology for operations in Birmingham, United Kingdom.

You can schedule an appointment with him for expert, bespoke advice through his Top Doctors profile or book an appointment through the Harborne Hospital, HCA Healthcare or the Priory Hospital, Edgbaston, Circle Health Group.

References

1. Wang H, Man L, Li G, Huang G, Liu N, Wang J. Meta-analysis of stenting versus non-stenting for the treatment of ureteral stones. PLoS One 2017; 12: e0167670–e.

2. Sali GM, Joshi HB. Ureteric stents: overview of current clinical applications and economic implications. International Journal of Urology. 2020 Jan;27(1):7-15.

An overview of the use of ureteric stents for patients