Antegrade ureteric stenting

Transcription

1 Imaging department Antegrade ureteric stenting Information for patients What is antegrade ureteric stenting? The ureter is a muscular tube in the body that allows urine to flow from the kidney to the bladder. Most people have two ureters, one from each of their kidneys. If one of the tubes becomes blocked, for example by an infection, stone or tumour, it can cause a build-up of urine, which can damage your kidney. Antegrade ureteric stenting is a method of releasing urine from the kidney to the bladder. It is done by inserting a stent (plastic tube) into the affected kidney, through the blocked ureter, and into the bladder, allowing urine to drain normally. This procedure is usually performed under local anaesthetic (you will be awake and may feel some discomfort, but not pain). Why do I need antegrade ureteric stenting? Your doctor has recommended this procedure because other tests have shown that the tube leading from your kidney to your bladder has become blocked. If left untreated, your kidney will become damaged. What are the risks? Antegrade ureteric stenting is a very safe and quick procedure. However, some risks and complications may arise: there is a five to seven per cent risk that the stent will not be satisfactorily placed in the ureter. should this happen, we may try again or arrange another method of overcoming the blockage, such as surgery there is a one to two per cent risk of leakage of urine from the kidney into the abdomen (tummy), during or after the procedure, which may require draining there is a one to five per cent risk of slight bleeding from the kidney, during and after the procedure. In very rare cases (about one per cent), this may become severe and need an operation or another procedure to stop it there is also a risk of infection in the kidney, which can usually be treated with antibiotics. Imaging guidance such as x-rays or ultrasound is used to help to minimise the risk of complications. The radiologist (specialist x-ray doctor) will discuss the risks involved with you before starting the procedure and will be happy to answer any questions you may have. p1

2 Are there any alternatives to this procedure? Your doctor will only have requested antegrade ureteric stenting if they feel it is the best way to treat your condition without having an operation. This technique is less invasive than surgery and your recovery time is much quicker. Do I need to prepare for antegrade ureteric stenting? We will probably ask you not to eat anything for four hours before your appointment time, although you may be allowed to drink water. This is important because it will allow us to give you sedation and pain relief, should you require any. You can take all your medications as usual, except blood-thinning tablets. If you take blood-thinning medications, such as warfarin or aspirin, you must tell your doctor, as you may be advised to stop taking them for some time before your appointment. Please also let us know if you have asthma or are allergic to any medications or to the contrast medium (special dye used for antegrade ureteric stenting) before your appointment. It is very important that you have had your blood taken recently, as the results of these tests will tell us how well your blood clots. Please note that we will not do your antegrade ureteric stent without having normal results from your blood tests. What if I cannot keep my appointment? Please contact admissions or the ward at Hammersmith, Charing Cross or St Mary s hospitals, depending on where you are due to have your appointment. You will find the appropriate telephone numbers on your appointment letter. What happens on the day of my appointment? You will be admitted to hospital and will be seen by the ward doctor and/or nurses before you come to the imaging (x-ray) department for your ureteric stenting. We will ask you to change into a hospital gown. A cannula (a small plastic tube) will be inserted into a vein in your arm. It will be used to give you antibiotics before and painkillers during the procedure. After arriving in the imaging department, we will discuss the procedure with you in detail and ask you to sign a consent form. This is to make sure that you understand the risks and benefits of an antegrade ureteric stent. Staff in the imaging department will then check your details before taking you into the x-ray room. If you have not had a cannula inserted, the imaging nurse or radiologist will insert it now. They will then ask you to lie on your stomach on the x-ray table. A nurse will connect you to patient monitoring equipment, which will record your blood pressure and pulse throughout the procedure. The skin on your back will be cleaned with antiseptic fluid and then most of the rest of your body will be covered with sterile drapes (sheets). If you have not already had a percutaneous nephrostomy (a fine plastic tube put into the kidney through the skin), we will do this first. Please ask for the: Having a percutaneous nephrostomy leaflet for further details.

3 If you have already had a percutaneous nephrostomy, the radiologist will give you an injection of local anaesthetic to numb the area. This may sting but it will only last for a short time. When the area is completely numb, they will insert a fine wire through the nephrostomy tube into the kidney, and then down the ureter. Once the wire has been passed through the blockage and into the bladder, a long plastic stent can be placed over it, and the wire withdrawn. Urine should then be able to pass down the stent and into the bladder. It will be necessary to temporarily leave a nephrostomy catheter (fine plastic drainage tube) in the kidney. It will enable us to check that the stent has not been blocked by tiny blood clots about 24 to 48 hours after the operation. If there are no problems with your stent, we will remove the nephrostomy catheter. Antegrade ureteric stenting takes approximately 30 minutes for patients who already have a nephrostomy tube. It may take longer for patients without the tube. As a general guide, please expect to be in the x-ray room for about one hour. Will it hurt? Please note that you may be aware of the urine passing into the bladder, and sometimes this is painful. Please tell us if you have any discomfort and we will give you more painkillers. Placing the stent in the ureter only takes a short time, and once in place, this should not hurt at all. What happens afterwards? We will take you to the angio recovery room for a short period or until your condition is stable and you are ready to be collected by your ward nurse and taken back to your ward. You will need to rest in bed for a few hours until you have recovered. The nursing staff will continue to record your pulse and blood pressure during this time. They will also check your puncture site and assess your urine output to make sure that there are no problems. The nephrostomy catheter (drainage tube) will stay in place for the time being and will be attached to a collection bag. It is important that you try not to make any sudden movements (such as getting up out of a chair) without remembering about the bag and making sure that it can move freely with you. The bag will need to be emptied fairly regularly, so that it does not become too heavy. The nurses will measure how much urine has collected in the bag each time they empty it. How long will the drainage catheter and/or ureteric stent need to stay in place? The doctors will discuss this with you, as it will depend on your individual situation. The nephrostomy catheter (drainage tube) may only need to stay in a short time (around 48 hours), until we are sure the stent is working fine. It will not hurt when we remove it. The stent may stay in place for a longer period of time, depending on the nature of the blockage and whether surgery is being considered. Please be assured that you will still be able to carry on with life as normal with the stent in place. When can I go home? Your doctor will advise you as this will depend on your general condition. 3

4 Is there anything I need to watch out for at home? You may have some bruising where the stent was inserted this is normal and is part of the healing process. However, if you notice any swelling, redness or urine leaking around the insertion site, have a high temperature, or your urine changes colour, please either contact your GP or go to your nearest A&E department. These signs may indicate an infection that requires antibiotics. Contact details Please do not hesitate to contact our imaging departments if you have any queries or concerns: Hammersmith Hospital: Du Cane Road, London W12 0HS Telephone: Charing Cross Hospital: Fulham Palace Road, London W6 8RF Telephone: St Mary s Hospital: Praed Street, London W2 1NY Telephone: How do I get to the hospital? You are advised to travel, if possible, by public transport when visiting our hospitals. Car parking is severely limited and you may find it very difficult to find a place to park near the hospital. The nearest tube stations for Hammersmith Hospital are East Acton and White City (both on the Central Line) and Wood Lane (Hammersmith & City Line). Buses that stop outside the hospital are numbers 7, 70, 72, 272 and 283. The nearest tube stations for Charing Cross Hospital are Hammersmith (District, Piccadilly and Hammersmith & City lines) and Barons Court (District and Piccadilly lines). Buses that stop outside the hospital are numbers 190, 211, 220 and 295. The nearest tube stations for St Mary s Hospital are Paddington Mainline Station, while Paddington and Edgware Road tube stations are about five minutes walk away. St Mary s Hospital is served by bus routes 7, 23, 27, 36, 205, 332 and 436. How do I make a comment about my visit? We aim to provide the best possible service and staff will be happy to answer any of the questions you may have. If you have any suggestions or comments about your visit, please either speak to a member of staff or contact the patient advice and liaison service (PALS) on (Charing Cross, Hammersmith and Queen Charlotte s & Chelsea hospitals), or (St Mary s and Western Eye hospitals). You can also PALS at pals@imperial.nhs.uk. The PALS team will listen to your concerns, suggestions or queries and is often able to help solve problems on your behalf. Alternatively, you may wish to express your concerns in writing to: Complaints department Fourth floor Salton House St Mary s Hospital Praed Street London W2 1NY 4

5 Alternative formats This leaflet can be provided on request in large print, as a sound recording, in Braille, or in alternative languages. Please contact the communications team on Wi-fi We have a free and premium wi-fi service at each of our five hospitals. For further information please visit our website: Imaging department Published: November 2016 Review date: November 2018 Reference no: 1141 (refreshed) Imperial College Healthcare NHS Trust 5