Urology

Insertion of a catheter, stent into the kidney + X-ray examination

What does this procedure entail?

Examination of the calyx, renal pelvis and ureter using a contrast agent and X-rays (UPG) and/or ensuring urine outflow by inserting/replacing the stent (plastic tube).

What are the alternatives to this procedure?

• X-ray examination of the urinary tract after venous administration of a contrast agent (alternative of UPG)
• Puncture nephrostomy (tube inserted into the kidney through the skin – alternative of stent)
• Follow-up – monitoring, suitable if spontaneous improvement or, e.g., elimination of the stone can be expected
• Open or endoscopic surgery – removal of an obstruction in the ureter (access to the ureter via an incision through the abdominal wall or through the urethra and bladder, or through the kidney)
• In the case of stones, non-invasive therapy with extracorporeal shock wave

What should I expect before this procedure?

If you regularly use Anopyrin, Clopidogrel, Warfarin, etc., you must tell your doctor. These medications can be associated with increased risk of bleeding during and after the surgery if they are not stopped in time. In some cases, it is necessary to replace these drugs with injection preparations. It is necessary to consult your general practitioner or cardiologist about this approach.

At the request of the referring physician, you will have to schedule preoperative examinations to assess your overall condition, including laboratory and instrumental tests. If the report does not preclude the indicated procedure, you will be admitted to the hospital. If you don’t undergo a preoperative examination or it is incomplete, you will not be able to have the surgery as scheduled. You will be admitted by a nurse and a member of the medical team will complete your examination and assess your fitness for the surgery.

You will be asked not to eat or drink for at least 6 hours before the surgery!

In the evening before the surgery, you will receive medication from an anaesthesiologist to calm you down so that you sleep well.

Remember to inform your physician about the following possible facts before the surgery:

• artificial heart valve
• coronary artery stent
• pacemaker
• artificial joint
• artificial vascular graft
• neurosurgical bypass
• other implanted foreign body
• use of the following prescription drugs: Acylpyrin, Anopyrin, Aspirin, Godasal, Clopidogrel, Plavix, Kardegic, Aspegic, Micristin, Ibustrin,Ticlid, Tagren, Ipaton  Apo-Tic, Plavix, Persantin, Curantyl, Anturan, Aggrenox, Vessel due F.
• drug and other allergies
• any abnormalities or eventualities

It is NECESSARY to inform the physician about your use of drugs affecting blood clotting before your admission for the procedure.

What will happen during the surgery?

You will normally receive an injection or oral antibiotics before the procedure, but any allergies must be checked first.

The procedure is performed nearly exclusively under general anaesthesia.

The surgery is initiated with cystoscopy (examination of the bladder with an endoscopic instrument inserted through the urethra), followed by the examination of the ureter and renal excretory system using a thin tube (ureteral catheter = UC), which is used to administer a contrast agent. This will allow for visualisation using X-rays.

A stent is a thin tube made of a special material, which has both ends twisted in the shape of pig tails. These ends ensure the stability of the tube between the kidney and the bladder. The stent is inserted using a special guide under X-ray visualisation – it is used to bypass an obstacle between the kidney and the bladder. The stent can be used for temporary drainage – until the obstacle is removed, but also for permanent drainage (in this case, it must be replaced regularly at certain intervals).

The procedure uses an X-ray emitter.

This procedure takes between 30-45 minutes.

What will happen immediately after the procedure?

You will wake up at the intensive care unit equipped for the continued monitoring of patients immediately after the procedure. The surgeon will inform you about the course of the procedure. You will still have high levels of anaesthetics in your blood at that time, so you may not remember this conversation.

Kidney bleeding may occur after the surgery. Blood in the urine usually disappears within 24-48 hours. If blood loss is more significant, you will be given a blood transfusion. Revision (surgical control) may be considered in case of massive or persistent bleeding or in case of unexpected complications. In the evening after the surgery, you should be able to eat and drink, if the course of the treatment is usual.

Sometimes it is necessary to temporarily (usually for 24-48 hours) ensure the outflow of urine from the kidney with a ureteral catheter (a plastic tube inserted in the ureter). In such case, it is forbidden to get out of bed or sit on the bed until it has been removed. After the procedure, you will have a permanent catheter inserted into your bladder for 1-3 days.
The average hospitalisation is 2-4 days.

Once you are fully conscious, you should:

• ask if the planned outcome was achieved
• inform the medical staff about any problems
• ask what you can and cannot do
• ask all the questions you have for the healthcare professionals and members of the medical team.
• remember (and understand) why the surgery was performed, how it turned out, and what will follow

What are the postoperative risks or complications?

Common (10% of procedures of this type)

• Mild burning when urinating or the presence of blood in the urine shortly after the surgery (hours up to a day)
• Necessity of temporary urinary tract drainage using a permanent catheter (day to several days)
• Stent introduction is usually a temporary solution and another procedure will be necessary – resolution of the finding and removal of the stent (sometimes necessary or possible only during the next, third procedure).

 Occasional (2-10% of procedures of this type)

• Urinary tract infections
• Injuries to the examined organs – bladder, ureter, kidneys (insignificant, without the need for a surgical management)
• Anatomical conditions preventing the successful completion of the procedure at that moment
• Tender ureter
• The stone cannot be reached or removed or bypassed

Rare (may occur in 2% of procedures of this type)

• Significant injury to the ureter, kidney or other organs requiring temporary drainage of the kidney via a nephrostomy drain (plastic tube inserted into the kidney through the back muscles) or open surgery with possible need to remove the injured organ
• Scarring of the ureter with the formation of strictures (narrowed areas of the ureter preventing free outflow of urine from the kidney), requiring further intervention
• Kidney infection with subsequent deterioration of general health condition, rarely with the development of sepsis ("blood poisoning") and the need for intensive treatment with prolonged hospitalisation
• TUR syndrome caused by the absorption of a larger amount of lavage fluid into the bloodstream. It leads to increased blood pressure and heart rate, shortness of breath, headache with nausea or vomiting. Severe events can lead to unconsciousness or renal failure requiring dialysis

 Hospital infections

• MRSA colonisation (0.9% – 1 of 110)
• Intestinal infection by clostridium difficile (0.01% – 1 of 10,000)
• MRSA blood infection (0.02% – 1 of 5,000)

Hospital infection rates may be higher in high-risk patients, such as in cases requiring long-term drainage, after a previous infection, after prolonged hospitalisation or after multiple hospitalisations.

What should I expect when I return home?

When you are discharged from the hospital, you should:

• get recommendations on recovery at home
• ask when you can return to normal activities such as work, exercise, driving, cycling, housework
• get a contact number for further questions after returning home or in case of trouble
• ask about the date of the following check-ups and the place where you should come (hospital or your attending physician)
• make sure you are aware of the reason, course and outcome of the surgery, the results of examinations or the removal of tissues or organs.
• a stent sometimes leads to an irritated sensation when urinating, and sometimes, especially after physical activity, blood may appear in the urine – consult your doctor if these problems occur.

At your departure from the hospital (sometimes several days later), you will receive a hospitalisation report. The document contains important information about your hospital stay, your surgery and recommended follow-up. If you need to call your attending physician or visit the hospital for any reason, take this document with you so that the physician knows the details of your treatment. This is especially important if you need to consult another doctor or longer after discharge.

What else should I watch out for?

If you experience more frequent problems, burning or difficulty urinating or fever, or have unusual bleeding, consult your attending physician.

Any important information?

Most patients do not need more than a few days of rest at home before they are able to handle a full workload. Before returning to work, we recommend resting, especially if you have a physically strenuous occupation.

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