Antegrade Ureteric Stent Insertion
Date issued: November 2024
For review: November 2026
Ref: B-250/Imaging/RA/Antegrade ureteric stent insertion v2
PDF: Antegrade ureteric stent Insertion.pdf [pdf] 236KB
This leaflet tells you about having an antegrade ureteric stent insertion. It explains what is involved and what the possible risks are. It is not meant to replace informed discussion between you and your doctor but can act as a starting point for such discussions. If you have any questions about the procedure, please ask the doctor who has referred you or the department which is going to perform it.
Referral and consent
The referring clinician should have discussed the reasons for this examination with you in the clinic and you should make sure that you understand these before attending. You will be referred to a radiologist for this procedure. Radiologists are doctors who have trained and specialised in imaging and X-ray treatments.
Before the procedure you will need to sign a consent form, if one hasn’t previously been completed. This is a legal requirement and ensures that you are fully informed about your procedure.
If after discussion with your hospital doctor or Radiologist, you do not want this examination then you can decide against it. If the radiologist feels that your condition has changed or that your symptoms do not indicate such a procedure is necessary, then they will explain this to you and communicate with the referring clinician. You will then return to your referring clinician for review.
At all times the radiologist and referring clinician will be acting in your best interests.
What is antegrade ureteric stenting?
Urine from a normal kidney drains through a narrow muscular tube (the ureter) into the bladder. When, for example, a stone blocks the ureter, the kidney can rapidly become affected, especially if there is infection present as well.
While an operation may become necessary, it is also possible to relieve the blockage initially by placing a nephrostomy tube and then by inserting a long plastic tube, called a stent, through the skin, into the bladder through the ureter. Because the stent is put in through the kidney and down the ureter, it is called an antegrade procedure (as opposed to placing a stent through the bladder and up the ureter, a retrograde procedure). This stent allows urine to drain in the normal fashion, from the kidney into the bladder.
Why do you need antegrade ureteric stenting?
Other imaging tests have shown that the ureter has become blocked. You may have already had a percutaneous nephrostomy placed to relieve the blockage. A ureteric stent allows an internal solution without the need for a tube or drainage bag
on the outside. Ureteric stents can be placed either by an antegrade (kidney down) or retrograde (bladder up) technique, but in your case the decision has been made to place it in an antegrade fashion.
Are there any risks?
Antegrade ureteric stenting is a very safe procedure, but as with any medical procedure there are some risks and complications that can arise.
The main risk is probably the failure to place the stent. This is more common if the ureter is completely blocked. If this happens, a nephrostomy will be reinserted, and the interventional radiologist will arrange a second visit. Antegrade stenting may be successful on a second visit but occasionally surgery is necessary for a combined approach to place the stent.
There may be bleeding from the kidney, and, on very rare occasions, this may require another radiological procedure or surgery to stop it. Rare complications such as bladder irritation, ureteric perforation, urine leak, infection (kidney or urine) and stent blockage are also possible.
Despite these possible complications, the procedure is normally very safe and will almost certainly result in a great improvement in your medical condition.
Are you required to make any special preparations?
Antegrade ureteric stenting is usually carried out as a day case procedure under local anaesthetic.
If you have a morning appointment, you will be asked to have nothing to eat from midnight although you may still drink water up to 6am then sips of water for the 2 hours before your examination.
If you have an afternoon appointment you may eat normally up to 6am and then water only up to 10am with sips of water for the 2 hours before your examination.
This is because the procedure may be painful, and you may need sedation.
If it is decided that the procedure will be performed with just local anaesthetic, then you may eat and drink normally.
If you are taking warfarin, rivaroxaban, apixaban, ticagrelor (anticoagulants) this will be stopped before the procedure and you may require admission to hospital to give you an alternative.
If you have any allergies or have previously had a reaction to the dye (contrast agent), you must tell the radiology staff before you have the test.
If you are pregnant or suspect that you may be pregnant you should notify the department. A baby in the womb may be more sensitive to radiation than an adult. There is no problem with something like an x-ray of the hand or chest because the radiation field is at a safe distance from the foetus. However, special precautions are required for examinations where the womb is in, or near, the beam of radiation. If you are a female of childbearing age the radiographer will ask you if there is any chance of you being pregnant before the examination begins and you will be asked to sign a form. If there is a possibility of pregnancy, then your case will be discussed with the team looking after you to decide whether or not to recommend postponing the investigation.
There will be occasions when diagnosing and treating your illness is essential for your health and where the benefit clearly outweighs the small radiation risks. The procedure may go ahead after discussing all the options with you.
Who will you see?
A specially trained team led by an Interventional radiologist within the radiology department. Interventional radiologists have special expertise in reading the images and using imaging to guide catheters and wires to aid diagnosis and treatment.
Where will the procedure take place?
If you are having the procedure as a day case, then you will attend PIU/Postbridge/Urology ward prior. You will be asked to get undressed and put on a hospital gown. A small cannula (thin tube) may be placed into a vein in your arm.
Our porters will collect you and bring you to the interventional radiology suite which is located within
X-ray East. This is similar to an operating theatre into which specialised X-ray equipment has been installed.
What happens during the procedure?
You may have already had a nephrostomy performed. You will lie on the X-ray table, nearly flat, on your stomach. You need to have a needle put into a vein in your arm, so that the interventional nurse can give you a strong sedative, painkillers and antibiotics. You may have monitoring devices attached to your chest and finger and may be given oxygen.
Antegrade ureteric stenting is performed under sterile conditions and the Interventional Radiologist and radiology nurse will wear sterile gowns and gloves to carry out the procedure.
Your skin near the point of insertion will be swabbed with antiseptic and you will be covered with sterile drapes. Your skin near the nephrostomy tube will be numbed with local anaesthetic. The nephrostomy tube, if in situ, will be removed over a guidewire to allow the introduction of a special plastic tube (catheter).
The blockage will be identified, and a new guidewire will be used to cross the blockage into the bladder. Once the wire has been placed through the blockage and into the bladder, the long plastic stent can be placed over the guide wire. Urine should now be able to pass down the stent and into the bladder. As a safety measure, a new nephrostomy drainage tube may be left in the kidney. This will be removed once your doctors are satisfied that the procedure has been successful.
Will it hurt?
When the local anaesthetic is injected, it will sting for a short while, but this soon wears off. During the procedure, you may be aware of some pushing as the ureteric stent is delivered to the correct position.
Occasionally you may feel some discomfort when the wire enters the bladder. Although this is uncomfortable for a short while, it means that the procedure has been successful. Sedation will be available if needed.
How long will it take?
Every patient's situation is different, and it is not always easy to predict. However, expect to be in the radiology department for about an hour.
What happens afterwards?
You will be taken back to your ward. Nursing staff will carry out routine observations including pulse and blood pressure and will also check the treatment site. You will generally stay in bed for a few hours, until you have recovered and are ready to go home.
A ureteric stent must be changed approximately every 6 months. If you do not hear from the hospital within 6 months, then please telephone the hospital and speak to a member of staff from the team looking after you and an appointment can then be arranged. ng your wound site
Other Risks
Antegrade ureteric stent insertion is a very safe procedure but as with any procedure or operation complications are possible. We have included the most common risks and complications in this leaflet.
We are all exposed to natural background radiation every day of our lives. This comes from the sun, food we eat, and the ground. Each examination gives a dose on top of this natural background radiation.
Any exposure to ionising radiation (e.g. X-rays) has the potential to cause cancer later in life. This is much lower than the risk we all have of developing cancer in our life of ~1 in 3 and will be considered by the doctor before your procedure.
For information about the effects of X-rays read the publication: “X-rays how safe are they” on the Health Protection Agency
Finally
Some of your questions should have been answered by this leaflet but remember that this is only a starting point for discussion about your treatment with the doctors looking after you. Make sure you are satisfied that you have received enough information about the procedure.
Contact
Interventional Radiology Department
01752 430838 - IR Co-ordinator
01752 432063 – Bookings Clerk
Additional Information
Bus services:
There are regular bus services to Derriford Hospital. Please contact:
Car parking:
Hospital car parking is available to all patients and visitors. Spaces are limited so please allow plenty of time to locate a car parking space. A charge is payable.
Park and Ride:
Buses (1/1A/42C/34) run from the George Junction Park and Ride Mon-Sat (except Bank Holidays) every 15/20 mins from 6am. The last bus leaves the hospital at 11:30pm.
Plympton Park and Ride (52) runs from Coypool Park and Ride.
Parking is free although you will need to purchase a ticket to travel on the bus.
Patient Transport:
For patients unable to use private or public transport please contact The Patient Transport Service:
Devon GP: 0345 155 1009
Cornwall GP: 01872 252211
Comments and Suggestions
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