Name of the Procedure:

Placement of Ureteral Stent, Percutaneous, including Diagnostic Nephrostogram and/or Ureterogram When Performed, Imaging Guidance (eg, Ultrasound and/or Fluoroscopy), and All Associated Radiological Supervision and Interpretation; New Access

Summary

During this procedure, a thin tube (stent) is placed in the ureter (the duct between the kidney and bladder) through the skin to help urine flow. Imaging techniques like ultrasound or fluoroscopy guide the placement. Diagnostic imaging of the kidneys and ureters (nephrostogram or ureterogram) may also be conducted. This procedure involves creating a new access point and includes interpretation of related radiological images.

Purpose

This procedure addresses blockages or narrowing in the ureter that prevent urine from flowing correctly from the kidney to the bladder. The goals are to relieve urinary obstruction, prevent kidney damage, and allow proper urine drainage.

Indications

• Obstructive uropathy (blockage in the urinary tract)
• Kidney stones
• Ureteral strictures (narrowing)
• Tumors affecting the ureter or nearby organs
• Post-surgical complications

Preparation

• Fasting for at least 6-8 hours before the procedure
• Adjusting or stopping certain medications (as advised by your doctor)
• Blood tests and imaging studies like CT scans or X-rays may be required to plan the procedure

Procedure Description

1. The patient lies on their stomach or back.
2. Local anesthesia or conscious sedation is administered.
3. Imaging guidance (ultrasound or fluoroscopy) is used to locate the ureter and kidney.
4. A small incision is made in the skin to create a new access point.
5. A guide wire is inserted through the incision and advanced to the ureter.
6. A catheter is passed over the guide wire to place the stent in the ureter.
7. Diagnostic imaging (nephrostogram or ureterogram) may be performed to check the placement and function of the stent.
8. The guide wire and catheter are removed, and the site is bandaged.

Duration

The procedure typically takes 1 to 2 hours.

Setting

• Hospital
• Outpatient surgical center

Personnel

• Interventional radiologist or urologist
• Radiology technicians
• Nurses
• Anesthesiologist (if deeper sedation is required)

Risks and Complications

• Infection at the insertion site
• Bleeding or hematoma
• Displacement or blockage of the stent
• Injury to surrounding organs or tissues
• Allergic reaction to contrast material used in imaging

Benefits

• Immediate relief from urinary obstruction
• Prevention of kidney damage
• Improved kidney function
• Can be performed minimally invasively with a quick recovery time

Recovery

• Patients are usually monitored for a few hours post-procedure.
• Pain management with medications as needed.
• Instructions to drink plenty of fluids to flush the urinary system.
• Avoid heavy lifting or strenuous activities for a few days.
• Follow-up appointments to monitor stent placement and function.

Alternatives

• Ureteroscopy (endoscopic removal of obstructions)
• Open or laparoscopic surgery to address the underlying cause of obstruction
• Observation and medication management for less severe cases

Patient Experience

• Mild discomfort or soreness at the incision site is common.
• You may feel a sensation of urgency to urinate.
• Pain management with prescribed medications.
• Patients can usually resume normal activities within a few days but should avoid heavy lifting and strenuous activities for a short period.