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Placement and management of indwelling ureteral stents

INTRODUCTION

Ureteral stents are one of the most common devices used by urologists. They are placed with cystoscopic guidance in an operating room setting. Ureteral stents are used to relieve ureteral obstruction, promote ureteral healing following surgery, and to assist with ureteral identification during pelvic surgery. Ureteral stent placement is associated with some degree of morbidity in the majority of patients that ranges from generalized urinary discomfort to urinary tract infection or obstruction. Much of the morbidity is related to the biocompatibility of the materials used to fashion the stent and, to some extent, their design; unfortunately, the ideal stent has yet to be discovered.

This topic will discuss the indications for ureteral stenting, technique of ureteral stent placement, management of stents, and stent complications. The management of urinary obstruction and urinary tract infection are discussed in detail elsewhere. (See "Clinical manifestations and diagnosis of urinary tract obstruction and hydronephrosis" and "Sampling and evaluation of voided urine in the diagnosis of urinary tract infection in adults".)

INDICATIONS FOR STENT PLACEMENT

Ureteral stents are functionally used to re-establish or maintain the patency of the ureter. Ureteral stents passively dilate the ureter; urine flows through the center of the hollow stent as well as around the stent, facilitating the passage of debris [1,2]. Stent insertion initially increases ureteral peristaltic activity, but with time, the frequency and amplitude of ureteral peristalsis decreases [3-5]. Indications for ureteral stent placement include the following:

Ureteral obstruction — Ureteral obstruction due to nephrolithiasis, tumor, or retroperitoneal fibrosis can be uncomplicated, or complicated by urinary tract infection, renal insufficiency, or renal failure. Patients with complicated obstruction need prompt decompression of the urinary tract with either placement of an indwelling ureteral stent or a percutaneous nephrostomy tube [6-8]. Retrograde ureteral stent placement and percutaneous nephrostomy both effectively relieve obstruction and infection due to ureteral calculi. In two randomized trials comparing both treatment modalities, neither modality demonstrated superiority in promoting a more rapid recovery after drainage [9,10]. The management of urinary tract obstruction is discussed in detail elsewhere. (See "Clinical manifestations and diagnosis of urinary tract obstruction and hydronephrosis" and "Management of ureteral calculi".)

A ureteral stent is generally chosen first to help relieve urinary tract obstruction because it is less invasive and has a lower risk of bleeding compared with placement of a percutaneous nephrostomy tube. However, in cases where a stent cannot be placed endoscopically or if the patient will require future percutaneous treatment of their stone burden, a percutaneous nephrostomy tube is placed primarily.

                              

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Literature review current through: Oct 2014. | This topic last updated: May 28, 2014.
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