A ureteral stent is a slender, flexible tube that is inserted into the ureter, which is the duct that carries urine from the kidney to the bladder. This medical device is designed to facilitate the flow of urine from the kidney to the bladder, particularly in situations where there may be an obstruction or narrowing in the ureter that impedes normal urine passage.
The stent is carefully threaded through the ureter and positioned in such a way that it helps to maintain an open pathway for urine drainage. This is crucial for preventing potential complications that can arise from urinary blockages, such as kidney damage or infections. Ureteral stents are commonly used in various clinical scenarios, including after surgeries to ensure proper urine flow, during the treatment of kidney stones, or in cases of ureteral strictures or tumors
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Urine is normally carried from the kidneys to the bladder via a pair of long, narrow tubes called ureters (each kidney is connected to one ureter). A ureter may become obstructed as a result of a number of conditions including kidney stones, tumors, blood clots, postsurgical swelling, or infection. A ureteral stent is placed in the ureter to restore the flow of urine to the bladder. Ureteral stents may be used in patients with active kidney infection or with diseased bladders (e.g., as a result of cancer or radiation therapy). Alternatively, ureteral stents may be used during or after urinary tract surgical procedures to provide a mold around which healing can occur, to divert the urinary flow away from areas of leakage, to manipulate kidney stones or prevent stone migration prior to treatment, or to make the ureters more easily identifiable during difficult surgical procedures. The stent may remain in place on a short-term (days to weeks) or long-term (weeks to months) basis.
Chronic blockage of a ureter affects approximately five individuals out of every 1,000; acute blockage affects one out of every 1,000. Bilateral obstruction (blockage to both ureters) is more rare; chronic blockage affects one individual per 1,000 people, and acute blockage affects five per 10,000.
The size, shape, and material of the ureteral stent to be used depends on the patient’s anatomy and the reason why the stent is required. Most stents are 5-12 inches (12-30 cm) in length, and have a diameter of 0.06-0.2 inches (1.5-6 mm). One or both ends of the stent may be coiled (called a pigtail stent) to prevent it from moving out of place; an open-ended stent is better suited for patients who require temporary drainage. In some instances, one end of the stent has a thread attached to it that extends through the bladder and urethra to the outside of the body; this aids in stent removal. The stent material must be flexible, durable, non-reactive, and radiopaque (visible on an x ray).
The patient is typically placed under general anesthesia for stent insertion, ensuring that the patient remains completely relaxed and immobile during the procedure. A cystoscope, which is a thin, telescope-like instrument, is inserted through the urethra and advanced into the bladder to locate the opening of the ureter that requires stenting. In certain cases, a guide wire may be introduced into the ureter with the assistance of a fluoroscope, an imaging device that uses X-rays to visualize internal structures on a fluorescent screen. The guide wire helps create a pathway for the stent, which is then threaded over the wire and positioned appropriately. Once the stent is correctly placed, both the guide wire and cystoscope are removed. If this method is unsuccessful or not feasible, the stent may be placed percutaneously—through a small incision in the skin—directly into the kidney and then into the ureter. In India, this procedure is commonly performed in advanced urological centers equipped with modern technology to ensure effective patient care and outcomes.
A stent that has an attached thread may be pulled out by a physician in an office setting. Cystoscopy may also be used to remove a stent.
Stents must be periodically replaced to prevent fractures within the catheter wall or build-up of encrustation. Stent replacement is recommended approximately every six months; more often in patients who form stones.
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