Ureteral Stent

Aka: Ureteral Stent, Neglected Ureteral Stent, Retained Ureteral Stent

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II. Indications

  1. Ureteral obstruction (e.g. Nephrolithiasis, tumor, fibrosis)
    1. Percutaneous Nephrostomy may also be used for this purpose
  2. Ureteral anastomosis (e.g. ureteral repair)
  3. Prophylactic stenting prior to Extracorporeal Shock Wave Lithotripsy of large stones (>1.5 cm)

III. Protocol: Ureteral Stents

  1. Ureteral Stents are 22 to 30 cm in length and extend from Kidney to Bladder
  2. Placed temporarily (for 3-12 weeks) at the time of lithotripsy or other procedure
  3. Stents maintain ureteral patency (e.g. while stone fragments are passing)

IV. Symptoms: Occur in 80% of stented patients

  1. Dysuria
  2. Dull Flank Pain, sharp with voiding (due to the bypassing of the UVJ)
  3. Urinary urgency
  4. Urinary Frequency

V. Labs

  1. Urinalysis
    1. Unreliable while Ureteral Stents are in place
    2. Will normally demonstrate positive Leukocyte esterase, Urine WBCs and Urine RBCs
  2. Urine Culture
    1. Required to diagnose Urinary Tract Infection while Ureteral Stents are present

VI. Imaging

  1. Abdominal PA Xray (KUB Xray)
    1. Indicated to identify a Retained Ureteral Stent (Neglected Ureteral Stent)

VII. Precautions: Neglected Ureteral Stents (retained stents)

  1. Neglected Ureteral Stents (retained stents) are high risk for complication
  2. Increased risk of complicated and serious Urinary Tract Infection as well as encrusting and obstruction
  3. See KUB XRay imaging above to identify a retained stone
  4. Urgent referral to urology for removal is indicated for a neglected stent present >3 months (unless otherwise directed by urology)

VIII. References

  1. Nakada in Richie (2014) Placement and Management of Indwelling Ureteral Stents, UpToDate, accessed 10/15/2014
  2. Sharp (2014) Am Fam Physician 90(8): 542-7 [PubMed]

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