Ureteral stenting is a procedure that ensures the outflow of urine and normal functioning of the kidneys. Installation and removal of a stent in the ureter: indications for surgery, complications

A stent in the ureter helps restore the passage of urine when stones form or tumor processes. It is made from special plastics or alloys. Installation is performed by a qualified surgeon different ways(retrograde and anterograde)

Kidney problems are accompanied by different symptoms: from involuntary urination to anuria due to complete failure kidney function. In some situations, a stent in the ureter helps to improve the functions of the excretory system.

Characteristics of the procedure

The stent was first used at the end of the twentieth century. It was inserted into coronary artery person. Now there are several types of stents: vascular, esophageal, biliary and urinary tract. Staging requires various auxiliary structures. They are installed to prevent narrowing of the canal or eliminate it.

Not all urological diseases can only be cured with medication. Conservative therapy do not eliminate mechanical obstacles that interfere with the outflow of urine: tumors, stones, ureteral strictures and other pathologies.

There are 2 methods for stenting the kidney: retrograde and antegrade. With the retrograde method, intervention is carried out through bladder. For anterograde - through a small incision in abdominal cavity make (a hole) and then insert the tube.

For pathology renal arteries stent the vessels. And when the outflow of urine completely stops, stenting of the ureter is performed.

Types of stents

A stent is a flexible plastic tube that is placed at the site of suspected obstruction. The main task of the device is to expand the desired area and restore normal urine flow. Stents are distinguished by material, length, location of holes, and functionality. They are used only on a pathologically narrowed fragment or along the entire length of the urinary duct, from the kidney to the bladder.

Vessel stenting is performed using a mesh made of cobalt-chromium alloys or nitinol self-expanding devices.

Ureteral stents are made of silicone, polyurethane, and polyvinyl chloride. The base is treated with a hydrophilic composition, which improves compatibility with human tissues. Ureteral stents are selected based on the pathology and age of the patient.

The device has a length from 120 to 300 mm, an extended version up to 600 mm, a cross-section of 1.5–6 mm. For reliable fixation, there is a loop (pigtail) in the form of a small spiral at both ends of the stent. It is more practical to use a silicone stent - it is resistant to salts in the urine, but due to its softness it is more difficult to install and fix.

Often used for sentencing metal constructions. The stent is installed in the ureter in a compressed form, and then the device itself acquires the required diameter. The growing epithelium fixes the tube and prevents it from moving.

There are stents that are made of X-ray contrast material. This makes it possible to verify whether the tube is positioned correctly. The cost of the procedure depends on the complexity of the disease and the type of stent.

When is stenting necessary?

Indications for stenting are complications caused by surgery, illness, or injury. Pathology can occur in one ureter or on both sides. Purely urological causes include the following conditions:

• obstruction of the walls of the ureters;
• neoplasms, lymphoma;
• BPH;
• adhesions;
• blockage by blood clots;
• stones in the kidneys.

Some diagnostic procedures and healing procedures require preliminary stenting of the ureters. Kidney surgery using an endoscope or reconstructive surgery involves inserting a tube. During complex surgical interventions, the inserted stent helps to see the ureter.

Shock wave therapy is used to destroy stones in urolithiasis. The tube prevents complications during the advancement of crushed stones. Even a small stone can injure the ureter, and the released blood can block the outflow of urine.

Women often experience difficulty urinating during pregnancy. If this is an inflammatory process or urolithiasis, in order to prevent complications and complete the pregnancy, the woman is given a temporary stent. It is removed after delivery, and then the necessary drug treatment is carried out.

When manipulation is contraindicated

Stent placement is a surgical procedure. Before carrying out it, it is important to evaluate general state the patient's body. TO absolute contraindications include shock, stroke, myocardial infarction and other conditions that threaten the patient’s life. The operation is also canceled in the following situations:

• kidney injury with damage to the renal artery;
• anuria, renal failure;
• blood clotting disorder;
• pulmonary pathology;
• allergies to medications used during surgery;
• acute infectious and inflammatory processes of the urinary system.

Stenting is contraindicated in inflammatory process, as they happen restrictive changes fabrics. With intervention possible Negative consequences– trauma, ruptures, wounds inflamed area, as well as hemorrhages. There is a danger of infection spreading to healthy areas, so first treat the inflammation with antibiotics.

Before stenting, a preventive examination of the reproductive system is necessary.

Contraindication is inflammation prostate gland, seminal vesicles, epididymis and urethra in men. Before surgery, women need sanitation of the uterus, ovaries, and vagina.

Features of installing a stent in the ureter

The operation is performed using a cystoscope in a hospital setting. Before the procedure, diagnostics are carried out to reduce the risk of complications. Study anatomical features and the length of the affected area. Select the most appropriate tactics. The operation is performed on adults under local anesthesia, for children - under general anesthesia.

Using a guide, a special balloon is inserted into the urinary duct, onto which a mesh frame is previously placed. When the entire structure reaches the desired location, the balloon begins to inflate. As a result, the mesh straightens and acquires the desired shape and position, preventing narrowing of the ureter. After this, the balloon is removed.

The stent is removed when it is no longer needed. To prevent damage to the mucous membrane, the design must be changed after 3 months.

Removal of the stent from the ureter is performed on an outpatient basis. As anesthesia, a special gel is injected into the urethra, which softens the process. Using a cystoscope, the end of the tube is found and the instrument is pulled out. Removal of the stent causes discomfort, blood may appear in the urine. In the future, the patient should be examined regularly, as he may need to have a new stent installed.

Complications associated with the urinary system, caused by the development of infection or abnormal processes in the body, can cause disruptions in urine output. To prevent fluid retention with waste products in the kidneys or bladder, a stent is installed in the ureter. This method reduces the possibility of developing hydronephrosis, pyelonephritis and ensures the normal functioning of the excretory system.

Stent - what is it?

Normally, the fluid located in the renal pelvis passes through two ducts - the ureters to the bladder, and from there urine enters the urethra and is excreted from the body. Due to various abnormal processes, blockage of the ureters can occur, which leads to urine retention and various diseases.

In order to normalize the functioning of the excretory system, stenting of the ureter is performed. A stent is a tube whose length can reach 30 cm and diameter up to 6 mm. In this case, spiral-shaped fasteners are installed on the side or at its ends to prevent shifts during life.

The design features of the ureteral stent may differ depending on the purpose:

• during pregnancy, women are fitted with an extended stent to prevent compression of the ureter;
• urological operations involve the installation of a pyeloplastic tube;
• in the presence of stones, in the process of minimally invasive intervention, an individually selected stent with a specific design is placed.

If wearing a drainage means a long period, then in this case a tube with a hydrophilic coating is used to avoid the risk of developing infectious diseases.

Indications for use

The causes of obstruction of the outflow of urine are most often stones in the urinary tract, which prevent urine output, or the presence of tumor neoplasms. If present infectious process, this can cause fluid retention in the kidneys, ureter or bladder.

The inability to perform an excretory function is divided according to the mechanism of the disorder:

1. Obstructive – urolithiasis, tumors and all kinds of diseases of the urinary tract that interfere with the normal flow of urine.
2. Restrictive – adhesions or scarring after surgery.
3. Invasive – wounds (gunshot, stab wounds), varying degrees severity in which the functionality of urine excretion is damaged.

An additional reason for installing a stent may be visualization of the pelvic area and ureter during surgery.

Stent installation

Stent installation involves only local anesthesia. The only exception is children younger age or women with pathologies in the vaginal area, then general anesthesia is used.

There are two methods for introducing a stent, the choice depends on the patient’s condition:

1. Retrograde method is used most often. All manipulation actions are carried out through urethra under visual control of a cystoscope. The stent is installed with smooth spiral movements to a depth of up to 30 centimeters.

Additionally, a catheter is inserted to excrete urine and monitor its color, because cloudy fluid indicates purulent or bloody masses. Then the procedure is completed until the pathological disorders are eliminated.

2. Antegrade method Stent installation is used during surgery or in case of significant disturbances in the functioning of the ureter and bladder. The method involves inserting a tube percutaneously directly to the kidney.

Visualization occurs using an X-ray machine, it is possible to use contrast agent for clearer pictures. In the antegrade method, the catheter remains in the abdominal cavity for several more days to control urine drainage and monitor the stent. The duration of the procedure is no more than half an hour, most often all manipulations take about 20 minutes.

During pregnancy, stenting is also possible, but only according to doctor's indications. The procedure is used when the outflow of urine is difficult and threatens the life of not only the mother, but also the child. After a successful birth, after a month, the stent is removed.

Complications

Some complications may occur immediately after the stenting procedure:

• feeling of pain when urinating;
• frequent urge or difficulty passing urine;
• presence of blood in urine;
• painful sensations in the lumbar or groin area.

One of dangerous consequences is the addition of an infection, therefore, in order to exclude this possibility, the patient is prescribed a course of antibiotics. Prolonged use of the stent may cause it to become dislodged or migrate. To prevent this, radiography is periodically performed. If the tube is found outside its intended location, the stent is removed.

Urine is a liquid containing toxic substances, slags and decomposition products that naturally have Negative influence on the installed stent, accumulating salts on it. Therefore, you should promptly notice this process and carry out the procedure of removing the tube or replacing it with a new one.

It should be taken into account that the presence of drainage in genitourinary system imposes some restrictions on the patient’s daily activities. First of all, doctors insist on plenty of drinking regime and on the decline physical activity so that the stent does not move from its location.

Removal procedure

Removal of the stent occurs painlessly and fairly quickly, after 4-6 months, if there are no other indications. All manipulations are carried out in the same way as during installation using a cystoscope, for visual control. Younger children age category and older people undergo the procedure under general anesthesia. The removal process is associated with some pain in the abdomen and lower back.

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Over the course of 4-5 days, a urine test is taken to identify pathologies and to understand the functioning of the urinary system without a stent. To prevent infection after the tube is removed, the doctor prescribes antibiotics. wide range actions.

Complications that arise after removal (burning sensation, pain when urinating) can last up to 3-4 days. If the discomfort does not stop after of this period, this must be reported to your doctor.

Installation of a stent for urinary outflow disorders is a common procedure and has proven itself to be the most effective for urolithiasis or tumors. Stenting prevents the development of many diseases that are caused by urinary stagnation. Re-installation of the stent is possible only if there is no positive dynamics after the prescribed course of treatment for the disease that led to stagnation of urine.

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Sometimes by various reasons there may be a disturbance in the outflow of urine from the ureter. This can happen due to the displacement of kidney stones, blood thickening, etc.

Purpose

A ureteral stent is designed to restore urine flow. This is an easy to bend tube that will need to be placed in the ureter. It serves to drain urine into external environment By the way, a ureteral stent is installed for certain infectious diseases of the kidneys and during complex operations.

Device

The length of the stent reaches 30 cm with a tube diameter of up to 6 mm. To urinary catheter securely fixed, one of its ends is equipped with a spiral, which is otherwise called a “pig tail”. The device is installed using a cystoscope or ureteroscope. The ureteral stent is made of polyurethane or silicone. Its surface should be smooth, it should not be exposed to urine, and not be covered with salts. Silicone has proven to be the most resistant to degradation and salt encrustation, but due to its high flexibility, the tube is difficult to fix and hold in the required position. To reduce the reactivity of the stent, it is treated with a hydrogel coating. This increases the service life of the device.

Complications after the stent placement procedure

Patients complain of dysuria, involuntary urge to urinate, and nocturia. These phenomena are observed more often immediately after installation of the catheter, sometimes very pronounced. To avoid stent removal, antispasmodics are prescribed. A decrease in the intensity of symptoms is observed after a few days. Sometimes patients complain of pain in the side and abdomen. The cause of pain in the side is urine reflux during urination. An installed ureteral stent sometimes causes infectious inflammation urinary tract. To prevent complications, antibiotics are prescribed, although it is undesirable to use them for a long time, since resistant microorganisms may develop.

Proximal migration is a serious complication that occurs when a very short stent is installed with a suboptimal twist of the distal end or when the upper calyx is injured at the proximal end. If the stent remains in the ureter for a long time, its fragmentation may occur.

The fragmented ureteral stent is subject to removal, which is carried out by ureteroscopy, cystoscopy or through the skin.

Application

A ureteral stent is used for stenting the ureter in the presence of obstruction of the renal system, i.e. if there is a problem with the outflow of urine from the kidneys. The reasons may be different - urological, non-urological and iatrogenic. Urological diseases include urolithiasis, neoplasms in the ureter, prostate or bladder, prostate adenoma, retroperitoneal fibrosis. Obstruction that does not relate to the field of urology - compression and germination in another location, various lymphomas and lymphadenopathy. Iatrogenic causes are after operations performed on the pelvic organs, as well as after radiation therapy.

For some nephrological pathologies, the patient undergoes ureteral stenting. This procedure helps restore normal urine flow and prevent serious complications. In addition, a stent is installed during difficult abdominal operations to avoid injury to the urinary tract. Stenting is performed when alternative treatment not effective. Nevertheless, the procedure is painless and has quite few contraindications.

Ureteral stenting – medical procedure, which helps restore normal urine flow.

What does it represent?

During normal functioning, urine passes from the kidneys to the bladder through two channels - the ureters. They usually have a length of up to 350 mm and a width of 40 mm. Pathological processes can provoke a narrowing of the canal, thereby complicating the natural exit of urine from the body. In this case, a ureteral stent helps. It is a long narrow tube made of polyurethane or silicone, one part of which is fixed in the renal pelvis, and the opposite part is carried out into the genital organ.

Types of stent

There are the following types of tube in the ureter:

• stents of various diameters;
• standard, up to 32 cm long with spirals, on both sides;
• elongated (600 mm) with one spiral end;
• pyeloplastic (used in cosmetic surgery);
• with several extended elements;
• having a special shape to facilitate the removal of crushed stones.

In addition, there are stents with and without hydrophilic coating. The choice is determined by the characteristics of the application. If drainage is installed for a long period, special spraying prevents reproduction pathogenic flora in the urinary tract and the deposition of salts on the structure. Stents vary in configuration. Typically drainage includes the following elements:

• stent;
• pusher;
• conductor with a fixed or movable core.

Indications for installation of a stent in the ureter

A ureteral stent is placed in the following cases:

• obstructive processes;
• preoperative preparation.

Factors that provoke narrowing of the ducts:

• cancer of the lymphatic system;
• blockage of the duct with a stone;
• adhesive disease;
• swelling of the ureteral mucosa due to surgery;
• chronic inflammation of the fatty tissue of the ureter;
• any neoplasms of the genitourinary system;
• congenital anomalies;
• blockage of the duct with a blood clot;
• infectious diseases that led to infiltration of the walls of the ureter;
• compression of the duct by a tumor of a neighboring organ;
• the use of radiation therapy on the pelvic organs.

If the cause of the outflow disturbance is a stone blocking the duct, they can apply. This is a procedure that crushes stones in the genitourinary system. Drainage facilitates and speeds up the exit of small elements. Another case of the need for stenting is complex surgical interventions. The tube makes it easier to identify the ureter on x-ray because it is made of special polyurethane.

Procedure

Preparation

Installing a stent in the ureter requires the patient to undergo a series of tests.

Preparatory activities include general lab tests blood and urine, which help the doctor assess the state of health and biological indicators sick. In addition, the optimal method of anesthesia is selected. The doctor describes the stenting procedure and warns about possible consequences. To accurately calculate the size and diameter of the drainage, use instrumental methods diagnostics:

How to install?

The procedure for installing drainage is often performed under local anesthesia, since the operation lasts only 15 minutes. General anesthesia used when operating on children. There are retrograde and antegrade stenting. The first means installing drainage through urinary tract. The second option involves making an incision on the side to insert a stent; in this case, urine flows through a catheter into a special reservoir. The antegrade route is used when pathological changes genitourinary tract. The stent is placed using a cystoscope inserted into the bladder; thanks to the device, the doctor monitors the progress of the operation through a monitor.

Features of stenting during pregnancy

If the patient has problems with the kidneys or organs urinary system, then during the period of gestation they may worsen. For example, with urolithiasis, a stone can block the duct and cause serious consequences for the mother and child. Therefore, doctors often recommend that a woman install a stent in the ureter during pregnancy. For stenting, drainage with an antireflux valve is usually used. The procedure is performed lying on your back, so it cannot harm the child. The drainage is worn throughout pregnancy, and the stent is removed after childbirth.

What complications arise?

Sometimes the procedure provokes consequences such as:

• pain and discomfort when urinating;
• heat;
• the appearance of blood in urine;
• swelling of the mucous membrane of the ducts or bladder;
• frequent urination.

The stent from the ureter is removed when the following pathologies develop:

• incorrect installation of drainage;
• displacement of the structure;
• infectious inflammation;
• encrustation - deposition of salts on a structure that has blocked the duct;
• vesicoureteral reflux;
• swelling or spasms of the lumen;
• ureteral rupture.

Infectious infection

As a rule, if the indication for stenting is narrowing of the duct due to infectious disease, then before the procedure the patient undergoes therapy antibacterial drugs. If the disease manifests itself after installation of the drainage, the stent is removed and the patient is treated. Sometimes infection occurs due to unscrupulous sterilization of the structure before installation. The main symptom signaling a problem is when it is painful for the patient to urinate.