Preparing for your retrograde ureteric stent

Transcription

1 Preparing for your retrograde ureteric stent Welcome We look forward to welcoming you to The Royal London Hospital. You have been referred to us to have a stent (plastic tube) put in to support your ureter (the tube that leads from your kidney to the bladder). This leaflet will tell you more about the procedure. What is a ureteric stent? A ureteric stent is a hollow tube made of flexible plastic that is placed inside the ureter (the tube that leads from your kidney to the bladder). It is held in place by coils at both ends. The top end coils in the kidney and the lower end coils inside the bladder to prevent it from slipping up or down. The stents are flexible enough to adapt as you move your body. What s a retrograde ureteric stent procedure? Retrograde means moving backwards and refers to the way that the stent is inserted (from the bladder and up to the kidney). This is opposite to the way that urine flows. When the stent is put in the other way (through the kidney, and down the ureter) it s called an antegrade procedure.

2 Why do I need a ureteric stent? This procedure can help if you have an obstruction, or potential obstruction of the kidney or ureter. If the blockage isn t removed, it may cause the kidney to work less efficiently and in some cases, stop the kidney from working altogether. Common causes of obstruction include: A kidney stone or stone fragment(s) moving into the ureter either spontaneously or following lithotripsy treatment (where shockwaves or lasers are used to break up stones) A narrowing of the ureter which may be due to scarring Complications after surgery on the ureter or kidney Compression of the ureter (eg from a tumour or during pregnancy). What happens if I don t have the operation? If nothing is done, a blocked kidney will stop working. If the kidney is infected it can lead to lifethreatening complications (eg septicaemia, also known as blood poisoning). The procedure is normally very safe and will almost certainly result in a great improvement in your medical condition. It can help with symptoms such as pain and changes in your urinary habits. Page 2

3 What happens on the day of my appointment? Please do not eat anything for six hours before your appointment. You may continue to drink WATER ONLY up until two hours before your appointment We will welcome you to the short stay surgical unit. You may need to have a blood test to check that your blood will clot properly. You may also be given some strong pain relief and some antibiotics through a needle in your arm. We will discuss all of the risks and benefits with you in detail, before we ask you to sign a consent form giving your permission to go ahead with the procedure. You will need to change into a gown and you will be taken to the interventional suite. What happens during the procedure? A special telescope (cystoscope) is passed through your water passage (urethra) into your bladder where the openings of your ureters can be identified. With the help of x-rays the stent is then passed up over a guide wire through your ureter until it lodges in your kidney. Urine should then be able to pass down the stent into the bladder. Special contrast dye is used during the procedure to check on the position of the stent. What happens after the procedure? After the procedure you will go back to the ward where your nurse will record your pulse and blood pressure, check your wound site and measure your urine. You will stay in bed for a couple of hours until you have recovered and you will usually be discharged the same day. If you feel unwell at any time please tell your nurse. If you have had sedation or an anaesthetic you will need someone to escort you home and who will stay with you for 24 hours following your procedure. Page 3

4 How long will the stent stay in place? The stent has to be kept in place as long as necessary, that is, until the obstruction has gone. How long this takes will depend on the cause of blockage and how it is being treated please talk to your doctor about this. Stents are usually removed after a few weeks or months. However, a stent in the right position can stay in for up to six months without the need to replace it. Your urologist will tell you how long they expect your stent to remain in place. How long will it be before I m back to normal? You will feel quite tired when you go home. It is important to rest and at first you may feel like having a sleep during the day. It is also important to take exercise regularly. This should be gentle at first but gradually built up as you start to have more energy. You should avoid heavy lifting or driving for about two to three weeks after your operation. What are the side effects with a ureteric stent? Some patients with a stent carry on with their lives, without any problems. However, some people will experience some side effects whilst the stent is in place. These are usually minor, but in rare cases they can be severe. The main side effects include: Going to the toilet more often An urgent need to urinate Blood in the urine Feeling that the bladder isn t empty after going to the toilet Discomfort in the bladder and kidney area (and occasionally in other areas such as the groin, urethra and the genitals) Discomfort after physical activity Discomfort after passing urine. Page 4

5 Will I be able to work after the procedure? Yes, you should be able to return to work after a few days rest, but if your job involves heavy manual labour or physical activities then you may experience some discomfort. Any side effects such as urinary symptoms and pain may make you feel tired. You may wish to talk to your employer about temporarily adjusting your workload. Can I do sports and other physical activities while my stent is in place? Yes, provided that you are fit and well enough to do so (ask your doctor for advice). However, you may experience some discomfort in the kidney area and passing of blood in your urine. You may also feel more tired than normal. Is it OK to take painkillers? Seek medical advice within the hospital or from your GP before taking any new medication. What happens if I get a urine infection? Following your operation, you are at risk of getting a urine infection. If you find that your urine becomes cloudy or smelly, and you have a burning sensation on passing urine, then you should contact your GP straight away, as you may need a course of antibiotics. How can I reduce my risk of getting an infection? Every day, you should drink at least 2 to 2½ litres of fluids (that s approximately five pints). Drink mostly water. This will help to minimise your risk of infection and will reduce the amount of blood in your urine. It will also help in the treatment of stones. Page 5

6 Are there any other risks or complications associated with having a stent put in? Ureteric stenting is a very safe procedure, but there are some risks and complications that can arise. Occasionally we are unable to place the stent in exactly the right place. If this happens, the doctor will have to overcome the blockage in another way, which may involve surgery at the same time as the procedure. Sometimes there is a leak of urine from the kidney, resulting in a collection of fluid inside the abdomen. If this becomes a large collection, it may require draining. There may be slight bleeding from the kidney. On very rare occasions, this may become severe, and need surgery or another radiological procedure to stop it. Occasionally there may be infection in the kidney, or in the space around it. This can generally be treated with antibiotics. What happens when the stent is removed? Once your obstruction has been treated, the stent can be removed under local anaesthetic (which only takes five to10 minutes). You will then be followed up in the urology outpatient clinic. What are the alternative treatments? One possibility is antegrade stent insertion. This is performed by making a small cut in your back and then a needle is inserted into the kidney so a guide wire can be passed through the needle into the kidney and down the ureter. Once the wire has been placed through the blockage and into the bladder, the ureteric stent can be placed over the guide wire and the wire withdrawn. Who can I contact for further information about my procedure? Please contact the Urology Nurse Specialist: Department of Urology, 9th Floor, The Royal London Hospital, Whitechapel, London, E1 1BB Fax: Patient Advice and Liaison Service (PALS) If you need general advice or support with our services, including help with any concerns you may have, please contact the Patient Advice and Liaison Service (PALS) for The Royal London Hospital: Tel: or Fax: Page 6

7 Large print and translations To receive this leaflet in large print, please call the Patient Advice and Liaison Service (PALS) on or If you would like help interpreting this leaflet, please call the Health Advocacy Administrator on Data Protection Act 1998 The Trust uses your personal information to help us provide you with high quality healthcare. Your health records could also be used for teaching, training, audit and research. This is so that we can deliver the best possible care across the Trust. Further information can be found on our website at Reference: BH/PIN/59 Publication date: July 2012 All our patient information leaflets are reviewed every three years. Barts Health NHS Trust Switchboard: Page 7