How is a ureteral stent placed?

Photograph of a ureteral stentIf you ever wondered how ureteral stents are placed, we’ll explain the process to you here step by step. Ureteral stents are typically used in two situations: 1) When a stone is causing blockage of the ureter and drainage needs to be established.  2) After a surgery to improve healing of the ureter or kidney.

Diagram of a ureteral stent in position.

 

How to place a ureteral stent in 8 steps (with video below):

1. Use a cystoscope to locate the ureteral orifice where urine drains into the bladder. (A cystoscope is a camera that can be placed into the bladder).
2. Pass a soft flexible wire called a “guidewire” into the ureteral orifice.
3. Use x-ray imaging to monitor the guidewire as it is advanced up the ureter.
4. If there is a blocking stone, contrast fluid can be injected using a soft hollow temporary stent. The contrast fluid will outline the ureter to improve guidance. The fluid can also push the stone back up the ureter in some cases.
5. Advance the guidewire all the way into the kidney
6. Thread a ureteral stent over the guidewire and push it up into the kidney using a “pusher”.
7. Remove the guidewire once the ureteral stent is in the correct position. The stent has a natural curl at both ends which will keep it in place. Once the guidewire is removed, the curls can develop.
8. Confirm correct placement of the stent using x-rays and by visualizing the stent in the bladder.

(Occasionally, stents are also placed in the opposite direction, from the kidney down to the bladder. This is done when access is obtained into the kidney during a percutaneous nephrolithotripsy (PCNL) procedure or when it is not possible to place a stent from below.)

Video of ureteral stent placement in a patient with an obstructing left kidney stone in the ureter.

About Dr. Mike Nguyen

Mike M Nguyen, MD, MPH, is a urologist and an Associate Professor of Clinical Urology at the Keck School of Medicine of USC in Los Angeles, CA. He specializes in the treatment of kidney stones with both surgery and dietary prevention and the in the treatment of kidney and prostate cancer using the latest robotic and laparoscopic surgical approaches. He sees patients patients at USC-Keck urology clinics located in Los Angeles, Pasadena, and La Canada, CA. He is the founder of the www.KidneyStoners.org website.
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16 Responses to How is a ureteral stent placed?

  1. Sharon Williams says:

    I have a family member that had kidney stones removed. The doctor put stints in the opening of both kidneys because he said there were stones to far up for him to remove, and the stints would allow the stones to flush out of the body. This took place about one and a half years ago, the stints have never been removed, the family member has bloody urine and can’t do physical movement because of the pain. The doctor has told him he would remove them for 13,000.00 dollars, which he doesn’t have. My question is are the stints causing serious damage to his body?

  2. ANNA says:

    Always pain at lower right site and feel pain at my lower abdomen when pee sometime and very hard to stop pee because feeling pee continue but just a bit come out.

  3. nadeem says:

    My father age 77 diabetic MRI says cancer spread bit in bladder and bone doctor advised stenting pl advice at this age what to do
    If at this age stenting n removing of stent can damage his health further
    Please urgent suggestions
    Thanks

  4. Pingback: Understanding Ureteral Stents | Urology Care of Central New Jersey

  5. kate says:

    Hi
    my dad has history of kidney stone. Last Thursday he had bad pain, went to urgent care, urine and blood were collected both show clear of bacteria, CT next day review 6mm stone in one of his kidney fever and 101 appeared on the same day. Went to ER, they decided that he needed an stent to relief pus that was build up from infection. And i was told he has sepsis, because of hi fever from kidney infection. Post stent surgery, his temp shoot up to 106, was admitted to ICU, its been 2 days post procedure, he still have fever of 39.9C and despite vanco and myromycin?antibiotic, fever won’t go down, unless we give tyleno, but fever shoots back up after 4 hrs or so, it is never gone totally. culture from urine sample collected after the stent, show that enteroccocus was found, however, i was told preliminary result did not show bacteria in blood, but they say long time is needed to have the final blood result. Now i wanted to know is it normal to have hi fever like this after placement of stent? and will it be possible that the stent procedure is actually the one causing such high fever? i am very worried because, my dad is over 65 and i am worry prolong hi fever will effect other organs in his body?

  6. Sharon Lightfoot says:

    I went to ER on November 1 with excruciating pain in left abdomen. Scan revealed large kidney stone blocking ureter. A stent was recommended. I was taken up to Urology area. They told me it would only take about 5 minutes. They only gave me the “Laughing Gas” that I’ve had in dental office. The 5 minute procedure turned into 45-50 minutes. It was torture and horrible!! I didn’t realize that a resident doc was doing this. After I screamed and yelled at them several times the regular dr came in and finished the procedure in 2 minutes. I have been reading lots of articles online. Every article states that the procedure is done under anesthesia. Is it common to not to do this without going under? I am supposed to have the kidney stone removed in 2 days. I was told that I would be under general anesthesia for this. I’m very nervous.

    • Dr. Mike Nguyen says:

      Ureteral stent placement is usually done under general anesthesia. However, it can also be performed under local anesthesia (just numbing jelly) or sedation (like what you received). I don’t think there is good data on what the actual breakdown is in term of percentages but it’s not extremely unusual.

      Actual treatment of stones is usually done under general anesthesia. The exception is in some cases of shockwave lithotripsy (ESWL) at the discretion of the urologist and anesthesiologist. If you have concerns, talk to your physician to make sure that you will be under general anesthesia.

  7. Anubhav Saxena says:

    Dear sir,

    stent is placed in right side kidney due to lower structure in ureter on dated 27/10/13
    but due to last 10-12 days very discomfort in the lower part of bladder every time with blood and some pieces clots
    Sir, may be possible stent is move from actual position

    anubhav Saxena
    13/11/13

    • Dr. Mike Nguyen says:

      Stents can “migrate” and slip down or up. This can result in increased pain. The best way to check for this is with a simple plain x-ray (a “KUB”).

      However, stents can cause discomfort and blood even if they are in the correct position. Talk to your doctor to see what he or she would advise.

  8. jenny says:

    I had a stent put in my right kidney 2 days ago,I am in excruciating pain all over my abdominal area.almost like a gastro cramp is this right,

  9. I have passed 4 stones on my own 4 years ago 2 stones on each side at the same time it was painfull but they were small enough to pass now i have a bigger one on my left side kidney their going to put a ureter stent in this information and videos really make me more relaxed thank you so much for this info.

  10. sagar ingale says:

    wanted to thank you for the information of placement of stent. I will be having this procedure for the second time, and your information was very comforting to read what will actually be happening.

  11. donald nerf says:

    Hi everyone

    I have bladder cancer. the doc went in and removed the cancer. I have a blockage in my right kidney. They put a stent in and it’s been very painful the whole time. and every time i try to work. I start bleeding and it burns when i pee. is this normal

    thank you
    don

  12. Hari Kumar says:

    Hi All,
    My father aged 57 (diabetic) recently had stent removal from both sides. Post procedure he started having fever reaching upto 102 degree celisias with chills. Is this normal ? Is it common to get fever after stent removal ? We met the doc and he just says it is normal.. Please suggest.

  13. Lynne Hoppel says:

    I wanted to thank you for the video of placement of stent. I will be having this procedure for the second time, and your video was very comforting to watch what will actually be happening. I appreciate your efforts Dr. Nguyen in the research you are performing.

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