If 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.
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.