Urological Procedures

Ureteral stenting and nephrostomy help restore urine flow through blocked ureters and return the kidney to normal function. Ureters are long, narrow tubes that carry urine from the kidneys to the bladder. They can become obstructed – and urine flow blocked – as a result of various conditions.

Your doctor may refer you to SDMI for the use of image guidance to place a thin, flexible tube called a stent into the ureter to restore urine flow. If a stent cannot be placed, you may require a nephrostomy, during which a tube is placed through the skin into the kidney and connected to either an external drainage bag or the bladder.

Image-guided, minimally invasive procedures such as ureteral stenting and nephrostomy are performed by a specially trained interventional radiologist in an interventional radiology suite at either our Northwest or Maryland Parkway location.

Prior to your procedure, ultrasound, computed tomography (CT) or magnetic resonance imaging (MRI) may be performed.

How do I prepare for my procedure?

You may have blood drawn prior to your procedure.

Prior to your procedure, your blood may be tested to determine how well your kidneys are functioning and whether your blood clots normally.

In general, you should not eat or drink anything after midnight the day of your procedure. However, you may take your routine medications with sips of water. If you are diabetic and take insulin, you should talk to your doctor as your usual insulin dose may need to be adjusted.

You will be given a gown to wear during the procedure.

Should I have a driver bring me and take me home?

Yes.

How is the procedure performed?

The area of your body where the catheter is to be inserted will be shaved, sterilized and covered with a surgical drape.  Then the interventional radiologist will numb the area with a local anesthetic.

The radiologist will use x-rays and/or ultrasound to locate your kidney and a needle will be inserted through your skin into the kidneys. Contrast dye will be injected through the needle.

During ureteral stenting, you are positioned on your stomach. Using a fluoroscope to see the ureter, a guide wire is inserted into the ureter. The stent is run over the guide wire and placed in its permanent position within the ureter. Once the stent has been placed, the guide wire may be removed, or a nephrostomy catheter may be left in place for a day or two and then removed.

At the end of the procedure, the catheter will be removed and pressure will be applied to stop any bleeding. The opening in the skin is then covered with a dressing. No sutures are needed.

During nephrostomy, you are positioned on your stomach. Using a fluoroscope to see the kidney, a guide wire is inserted into the kidney, followed by a catheter. This will be left in place until a ureteral stent can be placed or the ureteral blockage is resolved. Most commonly, the nephrostomy catheter is connected to an external bag that collects urine. You will be instructed on how to empty and care for the drainage bag prior to leaving the hospital.

Your intravenous line will be removed.

Both procedures are usually completed within one hour.

What will I experience during the procedure?

Devices to monitor your heart rate and blood pressure will be attached to your body.

You will feel a slight pin prick when the needle is inserted into your vein for the intravenous line (IV) and when the local anesthetic is injected. The arteries have no sensation. Most of the sensation is at the skin incision site which is numbed using local anesthetic.

You may be given a sedative through intravenous (IV) or conscious sedation which will make you feel relaxed and sleepy.

You may feel slight pressure as the catheter is inserted into the kidney and down the ureter. During placement of a ureteral stent, until the stent is positioned, you may feel pressure as the guide wire is inserted into the bladder.

You will remain in the recovery room until you are completely awake and ready to return home.

You will not feel when the contrast is excreted into the urine.  You should be able to resume your normal activities within a few days.