Name of the Procedure:

Ureterotomy for Insertion of Indwelling Stent
Common name(s): Ureteral Stent Placement, Ureterotomy with Stent
Technical/Medical term: Ureterotomy for Insertion of Indwelling Stent

Summary

A ureterotomy for the insertion of an indwelling stent involves making an incision in the ureter (the duct that carries urine from the kidney to the bladder) to place a stent. The stent helps to keep the ureter open and ensures proper urine flow from the kidney to the bladder.

Purpose

This procedure addresses urinary obstructions or strictures in the ureter. It aims to restore normal urine flow, relieve pain, prevent urinary infections, and protect kidney function.

Indications

• Ureteral obstruction due to kidney stones, tumors, or scarring
• Strictures or narrowing of the ureter
• Post-surgical or traumatic ureteral injuries
• Chronic urinary tract infections related to ureteral blockages
• Conditions causing impaired urine flow

Preparation

• Patients may need to fast for 6-8 hours before the procedure.
• Important to adjust or stop certain medications (as advised by the doctor) including blood thinners.
• Pre-procedure diagnostic tests might include imaging studies like ultrasound, CT scan, or intravenous pyelogram (IVP).

Procedure Description

1. The patient receives anesthesia: general or regional, depending on the specific case.
2. The surgeon makes a precise incision in the ureter.
3. Using specialized tools like a ureteroscope, the surgeon navigates to the obstruction site.
4. A stent is carefully inserted into the ureter to keep it open.
5. The stent remains in place, and the surgical site is closed.
6. X-rays or other imaging techniques are used to confirm correct stent placement.

Duration

The procedure typically takes about 1-2 hours.

Setting

The procedure is performed in a hospital operating room or a dedicated surgical center.

Personnel

The healthcare team typically includes:

• Urologist (surgeon)
• Anesthesiologist
• Surgical nurses
• Radiology technician (if imaging assistance is needed)

Risks and Complications

• Infection at the surgical site
• Bleeding
• Injury to the ureter or surrounding organs
• Discomfort or pain from the stent
• Migration or displacement of the stent
• Rare: stent-related complications like encrustation or blockage

Benefits

• Restores normal urine flow and relieves symptoms of obstruction.
• Prevents kidney damage and reduces the risk of infections.
• Immediate relief from associated pain and discomfort.

Recovery

• Patients may go home the same day or stay overnight, depending on the specific circumstances.
• Pain management will be provided, usually with oral pain medications.
• Instructions for hydration and any activity restrictions will be given.
• Follow-up appointments to monitor the stent and plan for its removal, usually in 6 weeks to 6 months.

Alternatives

• Observation with periodic monitoring (for mild cases)
• Medications to relieve symptoms
• Minimally invasive procedures like balloon dilation
• Surgery to remove or bypass the blockage

Patient Experience

• During the procedure, the patient will be under anesthesia and feel no pain.
• Post-procedure discomfort can be managed with pain medications.
• Some patients might feel the stent, especially at first, causing mild discomfort.
• Bladder discomfort and frequent urination may occur but typically improve in a few days.