Name of the Procedure:

Placement of ureteral stent, percutaneous, including diagnostic nephrostogram and/or ureterogram when performed, with imaging guidance (e.g., ultrasound and/or fluoroscopy), and all associated radiological supervision and interpretation; pre-existing nephrostomy

Summary

This procedure involves inserting a stent into the ureter through the skin using imaging techniques such as ultrasound or fluoroscopy. It often includes diagnostic imaging tests of the kidney and ureter, and is performed in patients who already have a nephrostomy (a tube inserted into the kidney).

Purpose

The procedure addresses medical conditions causing blockage or narrowing of the ureter, such as kidney stones or cancer. The stent helps keep the ureter open and ensures proper urine flow from the kidney to the bladder.

Indications

• Ureteral obstruction due to kidney stones or tumors
• Need for drainage of urine when the ureter is blocked
• Post-surgical complications causing ureteral blockage
• Patients with pre-existing nephrostomy requiring additional ureteral support

Preparation

• Patients may need to fast for a few hours before the procedure.
• Blood tests are usually done to check kidney function and blood clotting.
• Instructions on medication adjustments, particularly blood thinners, will be given.

Procedure Description

1. The patient is positioned, and the skin around the nephrostomy site is sterilized.
2. Local anesthesia or sedation is administered to minimize discomfort.
3. A guidewire is inserted through the nephrostomy tube into the ureter under imaging guidance.
4. A stent is then threaded over the guidewire and positioned within the ureter to ensure patency.
5. Imaging tests like a nephrostogram or ureterogram are performed to confirm proper placement of the stent.
6. Radiological supervision and interpretation ensure accuracy throughout the procedure.

Duration

The procedure typically takes 30 minutes to 1 hour.

Setting

This procedure is performed in a hospital or an outpatient clinic equipped with imaging facilities.

Personnel

• Radiologist or interventional urologist
• Radiologic technologist
• Nurses
• Possibly an anesthesiologist or sedation nurse

Risks and Complications

• Infection at the insertion site
• Bleeding
• Discomfort or pain
• Dislocation or migration of the stent
• Rarely, damage to the ureter or kidney

Benefits

• Relief from symptoms caused by ureteral obstruction
• Improved kidney function and urine flow
• Generally quick recovery and minimally invasive

Recovery

• Patients may need to stay for a short period for observation.
• Instructions will include caring for the nephrostomy site and managing discomfort.
• Avoid heavy lifting and strenuous activities for a few days.
• Follow-up appointments to monitor stent position and function.

Alternatives

• Ureteroscopy with laser lithotripsy for stone removal
• External drainage via nephrostomy without stent placement
• Open surgical procedures for complex cases
• Each option has benefits and drawbacks regarding invasiveness, recovery time, and suitability for specific conditions.

Patient Experience

• Patients might feel pressure or mild discomfort during the procedure.
• Post-procedure discomfort is generally managed with pain relief medications.
• Ensuring hydration and following post-procedure care instructions will aid recovery.