PROCEDURE:Â
- Right antegrade nephrostogram
- Right percutaneous nephroureteral stent exchange
INDICATION: __ year-old male with invasive bladder cancer needing nephroureteral stent exchange with plant to convert to internal double J stent. Patient continues to have tube connected to gravity drainage.
DATE:Â
OPERATORS:Â
MEDICATIONS: Levaquin 500 mg IV, Versed 2 mg IV, fentanyl 200 mcg IV
FLUOROSCOPY TIME: 3 minutes
CONTRAST: 15 ml of nonionic contrast
CATHETER: 8 F nephroureteral stent
COMPLICATIONS: None immediate
TECHNIQUE:
The risks, benefits, and alternatives to the procedure and sedation were explained. Written informed consent was obtained. A surgical timeout was performed.
The existing catheter and surrounding soft tissues were prepped and draped in sterile fashion. Local anesthetic was injected at the catheter entry site. A scout radiograph was obtained.
Non-ionic contrast was injected through the existing nephroureteral stent and images of the collecting system obtained.
A 0.035-inch Amplatz wire was advanced through the nephroureteral stent and coiled within the urinary bladder. The tube was removed over the wire under direct fluoroscopic visualization. A new 8 F nephroureteral stent was advanced over the wire and the Cope loop formed and locked in the renal pelvis and urinary bladder. Contrast injection confirmed location. The catheter was sutured to the flank with 0-0 Prolene and capped. A sterile dressing was applied.
The procedure was well tolerated, and the patient was discharged from the angiography suite in satisfactory condition.
FINDINGS: Comparison is made to a previous exam dated ______.
- Antegrade flow of contrast from renal pelvis to urinary bladder was seen prior to NUS exchange.
- Uneventful exchange of 8 Fr x 24 cm nephroureteral stent.
IMPRESSION:Â
Uneventful image-guided replacement of a right nephroureteral stent as described above.
PLAN: Patient instructed to keep tube capped and return in 1 week for internalization to a double J stent. He was also advised to reconnect to gravity drain if nausea/vomiting/fever/chills/abdominal pain and to call on-call interventional radiologist for any concerns. A gravity drain was sent home with the patient.
Frequently Asked Questions
What is a percutaneous nephroureteral stent exchange?
A percutaneous nephroureteral stent exchange is a procedure used to replace an existing stent in the urinary system that helps drain urine from the kidneys to the bladder. It's typically used in patients with urinary obstructions or conditions like bladder cancer. The procedure involves removing the old stent and placing a new one using a wire guide and imaging techniques like fluoroscopy to ensure proper placement.
Why is a nephroureteral stent exchange necessary?
Nephroureteral stent exchange is necessary to maintain proper drainage of urine from the kidneys to the bladder, especially in patients with obstructions due to tumors, stones, or strictures. Regular exchange is crucial to prevent infection, encrustation, or blockage of the stent, ensuring it functions correctly and reduces the risk of complications.
What medications are used during a nephroureteral stent exchange?
During a nephroureteral stent exchange, medications such as antibiotics like Levaquin are administered to prevent infection. Sedatives like Versed and pain relievers such as fentanyl are also given to ensure patient comfort and manage pain during the procedure.
The procedure involves prepping the area around the catheter in a sterile manner, administering local anesthesia, and using imaging techniques to guide the exchange. A wire is inserted through the existing stent, which is then removed and replaced with a new one. The new stent is positioned accurately using fluoroscopic guidance, and the patient is monitored for complications.
What should patients expect after a nephroureteral stent exchange?
After the procedure, patients are typically monitored for immediate complications and then discharged with instructions. They are advised to keep the tube capped and return for follow-up appointments. If symptoms like nausea, vomiting, fever, chills, or abdominal pain occur, they should reconnect to a gravity drain and contact their healthcare provider.
Are there any risks associated with nephroureteral stent exchange?
While the procedure is generally safe, potential risks include infection, bleeding, and injury to the urinary tract. However, these complications are rare, and the procedure is usually well-tolerated. Proper care and monitoring by healthcare professionals minimize these risks.
How long does a nephroureteral stent stay in place before needing replacement?
The duration a nephroureteral stent remains in place varies based on the patient's condition and the type of stent used. Typically, stents are exchanged every few months to prevent complications like encrustation or blockage. The specific timeline should be determined by a healthcare provider.
What is the role of fluoroscopy in a nephroureteral stent exchange?
Fluoroscopy is an imaging technique used during a nephroureteral stent exchange to provide real-time X-ray images. It allows the physician to visualize the urinary tract and ensure precise placement of the new stent, reducing the risk of misplacement and enhancing the procedure's safety and effectiveness.