Background Information:

What are the other Names for the Procedure?

• Stent Placement in Ureter
• Ureteral Stenting

What is Ureteral Stenting and Nephrostomy radiology procedure? (General Explanation)

• A variety of medical conditions, such as kidney stones, infections, blood clots, or tumors, can cause an obstruction of the ureter. The ureter is a tube in the human body that carries urine from the kidneys to the urinary bladder where it is stored
• Ureteral stenting consist of placing a flexible tube in the ureter to keep it open. A nephrostomy is usually performed when it is not possible to place ureteral stents. Nephrostomy involves placing the tube through patient’s skin on their back into the kidney. The tube coming out of the kidney is connected to the drainage bag outside of the body or from the kidney to the bladder

What part of the Body does the Procedure involve?

Kidney, bladder, ureter is involved in Ureteral Stenting and Nephrostomy procedure.

Why is the Ureteral Stenting and Nephrostomy radiology procedure Performed?

Ureteral Stenting and Nephrostomy procedures are performed to relieve ureter obstructions that are usually caused by kidney stones, infections, blood clots, or tumors.

What is the Equipment used? (Description of Equipment)

The following equipment is used for Ureteral Stenting and Nephrostomy:

• Ultrasound - the equipment for ultrasound imaging consists of:
  • An ultrasound transducer
  • A computer monitor
  • A central processing unit
  • A printer        

A transducer is used to send high-frequency sound waves in the body and the computer creates the image based on the echoes of that sound returning from the patient’s body.

• X-ray machine 
  • X-ray machine consist of an examination table, an x-ray tube, and a television monitor
  • Fluoroscopy uses x-rays and converts them into real-time images        
• Guide wire: A guide wire is used to put the stent in ureter. It looks like a long, thin wire
• Ureteral stent: It is about 10-12 inches long and keeps the ureter open

What are the Recent Advances in the Procedure?

There have been no recent advances with respect to Ureteral Stenting and Nephrostomy procedures.

What is the Cost of performing the Ureteral Stenting and Nephrostomy radiology procedure?

The cost of Ureteral Stenting and Nephrostomy procedures depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary. 

When do you need a Second Opinion, prior to the Procedure?

• It is normal for a patient to feel uncomfortable and confused with a sudden inflow of information regarding Ureteral Stenting and Nephrostomy procedure and what needs to be done
• If the patient needs further reassurance or a second opinion, a physician will almost always assist in recommending another physician
• Also, if the procedure involves multiple steps or has many alternatives, the patient may take a second opinion to understand and choose the best one. They can also choose to approach another physician independently

What are some Helpful Resources?

http://www.ncbi.nlm.nih.gov/pubmed/25707456 (assessed on 3/8/2015)

http://www.ncbi.nlm.nih.gov/pubmed/25695024 (assessed on 3/8/2015)

http://www.ncbi.nlm.nih.gov/pubmed/25709140 (assessed on 3/8/2015)

Prior to Ureteral Stenting and Nephrostomy radiology procedure:

How does the Ureteral Stenting and Nephrostomy radiology procedure work?

The Ureteral Stenting and Nephrostomy procedure is performed in the following manner:

• Ureteral stenting consist of placing a flexible tube into the ureter to keep the ureter open
• Nephrostomy is usually done when it is not possible to use ureteral stents. Nephrostomy involves placing the tube into the kidney, through the patient’s back. The tube coming out of kidney is connected to the drainage bag placed outside of the body, or from kidney to the bladder
• Thus, through this procedure it is possible to eliminate urine from the kidneys, in cases of ureteral obstruction

How is the Ureteral Stenting and Nephrostomy radiology procedure Performed?

• Ultrasound, CT, or MRI scans are usually performed prior to Ureteral Stenting and Nephrostomy to check for ureter obstruction and its severity
• The vital signs, such as blood pressure, heart rate, and pulse, are monitored using various monitors. An IV line is inserted into the patient’s arm vein to administer IV fluid and sedation, if necessary
• Patients may be moderately sedated during the procedure. In certain cases, a general anesthetic may be used and the patients are completely unconscious during the procedure
• The area of catheter insertion is shaved, cleaned, sterilized, and numbed using local anesthesia
• Fluoroscopy or ultrasound is used to locate the kidney and a needle is inserted through the skin into the kidney. A contrast is injected through the needle to check its location
• Ureteral stent placement:
  • The patient is positioned in a prone position on their stomach
  • Fluoroscopy is used to locate kidneys and ureter
  • A guide wire is inserted into the ureter using fluoroscopy
  • The stent is placed over the guide wire and inserted into the ureter
  • Once the placement of stent is confirmed, the guide wire is removed      
• Nephrostomy:
  • The patient is placed in a prone position on their stomach
  • Fluoroscopy is used to locate the kidneys and a guide wire is inserted into the kidney
  • A catheter is inserted over the guide wire in the kidneys
  • The catheter is left in that position, until ureteral blockage is dissolved
  • The catheter coming out of kidney is connected to an external bag           
• After the procedure is complete, the catheter is removed and pressure is applied to stop the bleeding. The IV line is removed

Where is the Procedure Performed?

Ureteral Stenting and Nephrostomy is performed as an outpatient procedure, at a hospital.

Who Performs the Procedure?

An interventional radiologist performs the Ureteral Stenting and Nephrostomy procedure.

How long will the Procedure take?

• The Ureteral Stenting and Nephrostomy procedures take about an hour to complete
• The time for the procedure may take longer depending upon the complexity of anatomy and health of the patient

Who interprets the Result?

An interventional radiologist or an urologist interprets the results of Ureteral Stenting and Nephrostomy.

What Preparations are needed, prior to the Procedure?

Following preparations are needed prior to the Ureteral Stenting and Nephrostomy procedure:

• The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient, including information related to the medications that are currently being taken
• Do inform the medical professional if you have a history of any medical conditions such as a heart disease, asthma, diabetes, or kidney disease
• Patients may be asked to stop taking blood thinning medications such as aspirin, warfarin, heparin, or NSAIDs
• Do inform the medical professional about any allergies, especially related to barium or iodinated contrast material, which may be used in the procedure
• It is advisable to wear comfortable and loose clothes. Avoid wearing any metal objects or jewelry, as it may interfere with the x-ray
• Women should notify the physician if they are pregnant or breastfeeding their child, as many such procedures may not be performed on pregnant women
• Depending on the procedure adopted, the patient may be asked for certain bowel or bladder preparations before the preparation sessions
• The patient may be asked to avoid eating or drinking several hours before the procedure
• Patient may also be given medications to prevent nausea or vomiting. Antibiotics may also be prescribed to avoid any infection

What is the Consent Process before the Procedure?

A physician will request your consent for the Ureteral Stenting and Nephrostomy procedure using an Informed Consent Form.

Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent. 

You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What are the Benefits versus Risks, for this Procedure?

Following are the benefits of Ureteral Stenting and Nephrostomy:

• It is very effective in relieving the ureteral obstruction and allowing flow of urine
• It is a minimally invasive procedure that has much less complications when compared to other surgical procedures
• The recovery time is very short for these procedures

Following are the risks of Ureteral Stenting and Nephrostomy:

• There is a minimal risk of bleeding from the kidneys, if they are injured during the procedure
• Organs adjacent to the kidneys may be damaged during the procedure; although, it is a very rare possibility
• Contrast material used during the procedure may cause severe allergy reactions in some patients
• Rarely, some patients may experience bladder spasms due to ureteral stent placement
• Since skin is penetrated for catheter insertion, there is a slight risk of infection

What are the Limitations of the Ureteral Stenting and Nephrostomy radiology procedure?

In certain cases, Ureteral Stenting and Nephrostomy may not be able to relieve ureter obstruction and surgical procedure may be necessary.

What are some Questions for your Physician?

Some of the basic questions that you might ask your healthcare provider or physician are as follows:

• What is a Ureteral Stenting and Nephrostomy procedure?
• Why is this procedure necessary? How will it help?
• How soon should I get it done? Is it an emergency?
• Who are the medical personnel involved in this procedure?
• Where is the procedure performed?
• What are the risks while performing the procedure?
• What are the complications that might take place during recovery?
• What are the possible side effects from the procedure? How can I minimize these side effects?
• How long will it take to recover? When can I resume normal work?
• How many such procedures have you (the physician) performed?
• Are there any lifestyle restrictions or modifications required after the procedure is performed?
• Are there any follow-up tests, periodic visits to the healthcare facility required after the procedure?
• Is there any medication that needs to be taken for life after the procedure?
• What are the costs involved?

During the Ureteral Stenting and Nephrostomy radiology procedure:

What is to be expected during the Ureteral Stenting and Nephrostomy radiology procedure?

The following may be expected during the Ureteral Stenting and Nephrostomy procedure:

• When the IV line is inserted, the patient may feel a slight pinprick
• The area of catheter insertion is numbed using local anesthetic, so the catheter insertion does not cause any pain; but, patients may feel a little pressure from the procedure
• Patient will feel sleepy and relaxed, if the sedation is used during the procedure
• Patient will feel some pressure when the ureteral stent is placed
• Patient may feel a warm sensation when the contrast material is injected
• After the procedure is complete, the patient is taken to the recovery room

What kind of Anesthesia is given, during the Procedure?

Moderate sedation or general anesthetic could be used during the Ureteral Stenting and Nephrostomy procedure.

How much Blood will you lose, during the Procedure?

Since it is a minimally invasive procedure, the blood loss involved during the procedure is minimal.

What are the possible Risks and Complications during the Ureteral Stenting and Nephrostomy radiology procedure?

• There is a minimal risk of bleeding from the kidneys if they are injured during the Ureteral Stenting and Nephrostomy procedure
• Rarely, the organs surrounding the kidneys may be injured during the procedure
• Sometimes, the contrast material used during the procedure may cause severe allergic reactions
• The placement of ureteral stent may lead to bladder spasms in some rare cases

What Post-Operative Care is needed at the Healthcare Facility after the Ureteral Stenting and Nephrostomy radiology procedure?

No specific post-operative care is needed at the healthcare facility after the Ureteral Stenting and Nephrostomy procedure.

After the Ureteral Stenting and Nephrostomy radiology procedure:

What is to be expected after the Ureteral Stenting and Nephrostomy radiology procedure?

• Patient is taken to the recovery room after Ureteral Stenting and Nephrostomy and kept under observation, until they are completely awake and are ready to be discharged
• Patients may resume their normal activities a few days after the procedure

When do you need to call your Physician?

Patients may need to call their physician in the following situations after Ureteral Stenting and Nephrostomy:

• If there any signs of infection at the catheter insertion site, such as redness, warmth, pain, or swelling accompanied by fever or chills
• If patient has problems urinating, pain with urination, or severe bleeding while urinating

What Post-Operative Care is needed at Home after the Ureteral Stenting and Nephrostomy radiology procedure?

• No specific postoperative care is needed at home after Ureteral Stenting and Nephrostomy procedure
• If nephrostomy is performed, the patient may need to empty their urine bag regularly
• Patients should avoid any heavy lifting for a few days after the procedure

How long does it normally take to fully recover, from the Procedure?

It may take 2-3 days to completely recover from the Ureteral Stenting and Nephrostomy procedure.

Additional information:

What happens to tissue (if any), taken out during the Procedure?

Ureteral Stenting and Nephrostomy procedure does not involve the removal of any body tissue.

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

Since no tissue is removed during the procedure, a pathologist does not get involved in the care of the patient.

Who will you receive a Bill from, after the Ureteral Stenting and Nephrostomy radiology procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers.

Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

• The hospital, where the procedure is performed
• Healthcare providers, physicians, and radiologists, who are involved in the process

The patient is advised to inquire and confirm the type of billing, before the procedure is performed.