Things to Remember About Indwelling Ureteral Stents!
What is a ureteral stent?
A ureteral stent is widely used in clinical practice. It is a hollow tube made of polymer materials. Because both ends are curled and resemble the letter “J,” it is also called a “D-J” stent. As both ends look like a pig’s tail, it is also referred to as a “pigtail” stent.
The upper end is placed in the renal pelvis, the lower end in the bladder, and the middle portion passes through the ureter.
What is the function of a ureteral stent?
Ureteral stents are commonly used in procedures for urinary stones, urological tumors, ureteral strictures, and other conditions. They help drain urine from the kidney, relieve ureteral obstruction, and promote postoperative ureteral healing.
Considerations when selecting a ureteral stent
Material:
Stents made of relatively rigid materials may aggravate symptoms such as dysuria and lower back or abdominal discomfort. Hydrophilic-coated silicone ureteral stents are recommended, as they are softer and offer good tissue compatibility.
Length:
The length should be selected according to the ureteral length. Friction and irritation of the bladder wall caused by the distal end of the stent are the main reasons for stent-related symptoms (such as pain and urinary irritation). The longer the portion of the stent within the bladder, the larger the area of bladder mucosa being stimulated, and the more pronounced the irritation symptoms.
Diameter:
A smaller diameter stent is preferred. Thinner stents are more flexible, easier to bend, and exert less pressure on the ureteral lumen.
Type:
The type should be selected individually according to the clinical situation, mainly including “Single-J” stents and “Double-J” stents.
Precautions During Indwelling Ureteral Stent Placement
Drink more than 2000 ml of water per day. Avoid holding urine; urinate promptly when you feel the urge to prevent urine reflux.
Avoid strenuous exercise such as running, skipping rope, or playing basketball to prevent stent displacement or bleeding. Light activities such as walking are acceptable, but avoid excessive fatigue.
Increase fluid intake to at least 2000–3000 ml per day to increase urine output and reduce the risk of infection and stone formation. Reduce the intake of foods high in calcium, oxalate, and purines, such as milk, spinach, and animal organs, to help prevent stone formation.
Observe the color and characteristics of urine. If hematuria, cloudy urine, or foul odor occurs, seek medical attention promptly. Pay attention to urinary irritation symptoms such as frequent urination, urgency, or pain, and inform your doctor if abnormalities occur. If lower back pain or fever develops, this may indicate stent-related complications and medical consultation should be sought as soon as possible.
Possible complications may occur during indwelling ureteral stent placement. How can they be prevented?
Pain
Causes:
The distal curled end of the ureteral stent is the main cause of suprapubic pain, especially during movement or changes in body position.
During urination, vesicoureteral reflux may increase renal pelvic pressure, which can lead to flank pain while voiding after stent placement.
Management:
Drink plenty of water (more than 2000 ml per day) and urinate frequently to help relieve pain. Avoid holding urine, straining during urination, and maintain regular bowel movements.
Medication: Anticholinergic drugs or α1-receptor antagonists, such as solifenacin or tamsulosin, can significantly improve symptoms. Usually, symptoms improve within 1–2 days.
Hematuria
After surgery, varying degrees of visible hematuria may occur, which generally clears gradually within 12–24 hours. Avoid strenuous activity and drink plenty of water. In most cases, it resolves spontaneously.
If a sudden large amount of hematuria occurs after activity, lie down immediately and increase fluid intake. If the urine color becomes lighter, continue bed rest and hydration for observation. If there is no improvement in urine color, seek medical attention nearby.
Urinary Tract Infection
Causes:
- Persistent ureteral obstruction after stent placement
- Vesicoureteral reflux caused by the indwelling stent
- Reduced ureteral peristalsis due to the stent
- Bacterial colonization on the stent
Management:
When infection occurs, especially with persistent flank pain on the affected side accompanied by fever, obstruction or reflux should first be ruled out.
If examination shows hydronephrosis on the affected side (especially worsening compared with preoperative status), or stent migration, infection is usually caused by obstruction. Replacement of the stent or removal of the obstructive factor is recommended.
If flank pain on the affected side with fever occurs during urination, vesicoureteral reflux should be considered. Indwelling urinary catheterization may be attempted to reduce reflux.
These two factors may coexist.
In addition, active anti-infective treatment should be administered.
What are the risks of forgetting to remove a ureteral stent?
Encrustation (“stone formation on the stent”):
After placement of a Double-J stent, stones may pass along the stent. If the stent is left in place for a long time, significant stone deposition can occur on the stent surface.
Hydronephrosis:
Long-term indwelling of a Double-J stent also carries the risk of complete blockage, which may lead to hydronephrosis.
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