PROCEDURE: Percutaneous double J ureteral stent placement
DATE:Â Â Â Â
CLINICAL INDICATION:Â Â Â Â
OPERATING PHYSICIANS:Â John Doe, MD (Attending)/Jane Doe, MD (Fellow) Â Â
MEDICATIONS:Â Â , Levaquin 500 mg IVÂ
ACCESS:Â Â Â Â
CONTRAST: Approximately   mL of nonionic contrast
FLUOROSCOPY TIME: Â Â minutes
COMPLICATIONS: None
IMPLANTABLE DEVICE: 8 French x ___ cm double J ureteral stentÂ
PROCEDURE:
After written and informed consent was obtained, the patient was placed prone on the procedure table. Constant physiologic monitoring and conscious sedation were provided by radiology nursing. The   flank and existing catheter were prepped and draped in standard sterile fashion. A scout image was obtained. A small amount of contrast was injected through the tube to confirm positioning within the renal collecting system. The skin surrounding the catheter was infiltrated with local. The catheter was cut to release the Cope loop. A 0.035 inch Bentson guidewire was advanced to the catheter and coiled in the renal pelvis. The catheter was removed over the guidewire. A 40 cm 5 French Kumpe catheter was advanced over the guidewire into the renal pelvis. The Bentson guidewire was exchanged for a 0.035 inch Glidewire. The Glidewire and Kumpe catheter were used to access the ureter and bladder. The Glidewire was exchanged for the Bentson guidewire, which was used to measure the ureteral length. The Bentson guidewire was exchanged for a 0.035 inch extra stiff Amplatz guidewire. The Kumpe catheter was removed. Over the Amplatz guidewire, an 8 French x__ cm double J ureteral stent was advanced into position under fluoroscopic guidance. The proximal pigtail was formed and positioned in the renal pelvis. The pusher and guidewire were removed. A sterile bandage was applied. The patient tolerated the procedure well without immediate complications.
FINDINGS: Â Â The new double J ureteral stent is appropriately positioned with the distal pigtail in the bladder and the proximal pigtail in the renal pelvis.
IMPRESSION:Â Successful placement of a____double J ureteral stent and removal of the percutaneous nephrostomy tube.
Frequently Asked Questions
What is a double J ureteral stent and why is it used?
A double J ureteral stent is a tube placed in the ureter to help urine flow from the kidney to the bladder. It is called 'double J' because both ends are coiled, resembling the letter J, which helps keep the stent in place. This stent is typically used to relieve obstructions in the ureter, such as those caused by kidney stones or tumors, or to prevent such obstructions after surgery.
How is a double J ureteral stent placed percutaneously?
Percutaneous placement of a double J ureteral stent involves inserting the stent through the skin under imaging guidance. The procedure starts with making a small incision in the flank area. A guidewire is then used to navigate through the renal system, allowing the stent to be positioned correctly from the kidney to the bladder. This minimally invasive method is guided by fluoroscopy to ensure accurate placement.
What should I expect after a double J ureteral stent placement?
After a double J ureteral stent placement, patients may experience some discomfort, urinary frequency, or a sensation of urgency. These symptoms are usually mild and temporary. It is important to stay hydrated and follow any specific instructions given by your healthcare provider. Any severe pain, fever, or significant urinary changes should be reported to a doctor immediately.
Are there any risks or complications associated with ureteral stent placement?
While ureteral stent placement is generally safe, potential risks include infection, bleeding, stent migration, or discomfort. Rarely, the stent might cause injury to the ureter or bladder. Most complications can be managed effectively if they occur. The procedure is done under imaging guidance to minimize these risks.
How long does a ureteral stent stay in place?
The duration for which a ureteral stent remains in place varies depending on the reason for its placement. It can range from a few weeks to several months. Your healthcare provider will decide on the appropriate duration based on your specific condition and response to the treatment. Regular follow-ups will help determine the best time for removal.
What is the difference between percutaneous and traditional stent placement?
Percutaneous stent placement involves inserting a stent through the skin with the aid of imaging techniques, offering a minimally invasive approach. In contrast, traditional stent placement might require cystoscopy, where the stent is inserted through the urethra using a specialized scope. Percutaneous methods are often used when direct access to the ureter is needed.
What imaging techniques are used during ureteral stent placement?
Fluoroscopy is the primary imaging technique used during percutaneous ureteral stent placement. It provides real-time X-ray images, allowing the physician to accurately position the stent within the urinary system. This imaging helps ensure that the stent is correctly placed from the kidney to the bladder, reducing the risk of complications.