Can I drive after kidney stent removal?

Cystoscopy, Cystoscopy with Biopsy, and Cystoscopy with Removal of Stent

Cystoscopy, except in special circumstances, is an office-based procedure. Simply put, it is the placement of a small telescope into the bladder by way of the urethra (the tube through which you urinate). Because the urethra is fully visualized as well, it is sometimes referred to as cystourethroscopy. The scope provides lighting and magnification so that we may carefully examine the anatomy inside. With this minor procedure we are able to see tumors, areas of inflammation, abnormal variations in anatomy, stones, drainage of urine from the kidneys into the bladder, etc. The procedure takes just a few minutes and can be done using only numbing jelly to minimize discomfort.

Through the cystoscope, we can pass instruments to take biopsies (tissue samples) of areas that we believe are abnormal. Small biopsies can sometimes be done in the office. An area that we biopsy can also be cauterized (burned) if there is any bleeding. Cauterization can also be used to kill cells that we perceive to be abnormal. Patients who undergo hospital procedures for kidney stones often have a stent placed during the procedure. This is a plastic tube that goes from the kidney down to the bladder. Except for unusual circumstances, we can remove a stent in the office while doing a cystoscopy.

Occasionally, patients request sedation (relaxing medication) for biopsy procedures or stent removals. If you are anxious, please let us know during the consultation so that we may consider sedation if we feel it is appropriate.

Preparation

There is no particular preparation for a cystoscopy. While it is not absolutely necessary, we would prefer that you have someone to drive you home. Some patients unexpectedly feel light-headed or uncomfortable after any procedure. If you do not have anyone available, we may ask that you relax for a while in our waiting room after the procedure before going home.

*If you had any sedation given, you must have somebody drive you home. For your own
safety, we will make few exceptions.

*For women of child-bearing age, it is important that you are not pregnant. Please let us know if there is any suspicion that you may be. While cystoscopy itself is not contraindicated in pregnancy, we would prefer to know prior to the procedure. We may decide to give you a dose of an antibiotic tablet. We may check a urine pregnancy test prior to the procedure.

Procedure

To review the basics of what we discussed in the office: The actual procedure typically takes a few minutes for a plain cystoscopy. Removal of a stent may add a bit more time. Biopsy(s) and possible cauterization can add more time.

We may decide to give you an antibiotic tablet just before or after the procedure. We will have you lie on your back with your legs in stirrups (holsters). Your urethra will be cleaned with an antiseptic to create a sterile field. Numbing jelly may be placed in your urethra and allowed to remain for a short time. Next, the scope is guided through the urethra (under direct vision) and into the bladder. Some urologists will look directly into the end of the scope. In other cases, a camera will project the image onto a small television screen. In a simple cystoscopy, we would remove the scope once we visualized all of the important areas. If a biopsy is to be taken, you might feel a little pinch when the tissue is grabbed. After the tissue is removed, we may cauterize (burn) the area with a special instrument. Again, you may feel a little sting. When a stent is removed, you may feel a twinge of discomfort in the area of the kidney. The stent typically comes out in just seconds.

Post Procedure

After the procedure, you might have a little stinging in the urethra until the next time you urinate. In some patients, it may last a bit longer. While it is quite unusual to see any blood in a female patient (except in some cases of stent removal), we occasionally see blood after cystoscopy in men. This is more common in men with large and obstructing prostates, in situations where the urethra contains a stricture (narrowing due to scar tissue), or again in cases of stent removal.

You have no restrictions after a cystoscopy and may even return to work if you choose. Ideally, we would prefer that you take it easy at home for the remainder of the day or evening.

If you received sedation, we insist that you return home with your family member or friend and relax for the remainder of the day or evening.

Expectations of Outcome

If a biopsy is performed, the specimens are sent to a pathology laboratory for evaluation by a trained pathologist. We understand that you are anxious to have the results and ask for your patience. We will call you as soon as they are available to us.

Possible Complications of the Procedure

ALL procedures, regardless of complexity or time, can be associated with unforeseen problems. They may be immediate or even quite delayed in presentation. While we have discussed these and possibly others in your consultation, we would like you to have a list so that you may ask questions if you are still concerned. It is important that every patient be made aware of all possible outcomes which may include, but are not limited to: l Urinary Tract Infection or Urosepsis (Bloodstream Infection): Even from a minor and sterile procedure, it is possible for you to get an infection with bacteria that typically cause urinary tract infections (UTIs). It may be a simple bladder infection that presents with symptoms of burning urination, urinary frequency and a strong urge to urinate.

This will usually resolve with a few days of antibiotics. If the infection enters the bloodstream, you may feel very ill.

This type of infection often presents with the urinary symptoms and any combination of the following: fevers, shaking chills, weakness or dizziness, nausea and vomiting. You may need a short hospitalization for intravenous antibiotics, fluids, and observation.

This scenario is more common in diabetics, patients on long-term steroids, or patients with any disorder of the immune system.

If you have symptoms of any of the above, you must contact us immediately or go to the nearest emergency room.

• Blood Clots in the Urine: Rarely, the scope can traumatize a blood vessel on the surface of the prostate or less commonly in the bladder. In this instance, you may develop hematuria (blood in the urine). In patients having a biopsy, we rarely have any significant bleeding because we only take small samples. There are instances where a scab (from the cauterization) can fall off and a patient subsequently develops hematuria one or a few days later. In almost all instances, the urine clears on its own over the next few days. Ongoing bleeding with the development o clots is uncommon. If the clots block the bladder, a catheter may need to be inserted to flush out the clots. If bleeding persists, we may have to look back in the bladder to control or cauterize the bleeding.
• Urinary Retention: In men, pressure from the scope can occasionally cause swelling of the prostate. It may block the flow of urine and cause “retention”. This is more common in men with a prior history of an enlarged prostate (BPH) or difficulty urinating. In most circumstances, it resolves with a catheter over the next few days. Less commonly aremedications or a prostate procedure required.
• Perforation: The wall of the bladder can be perforated from a biopsy. In most cases, all we need to do is leave the catheter in for an extra few days to allow self-healing. If the perforation occurs in a specific area of the bladder, we may need to perform a formal bladder repair through an incision in the abdomen, or place a drainage tube in the lower abdomen to evacuate this fluid.
• Inability to Pass the Scope: Occasionally, a severe stricture (scar in the urethra) or bladder neck contracture (full circumference scar at the neck of the bladder) may prevent safe passage of a scope into the bladder. In these instances, we would remove the scope and perhaps suggest a cystoscopy procedure in the hospital using anesthesia.
• Inability to Remove a Stent: It is quite unusual that we cannot easily remove a stent. In patients that have had a stent in place for a long time, or in patients that have made stones that stick to the stent, it can quickly become difficult to remove in the office. If we notice resistance to removal of the stent, we will remove the scope and recommend that the procedure be done under anesthesia in the hospital. Sometimes, other procedures are necessary. In rare instances, the ureter (tube that transports urine from the kidney to the bladder) can be injured during a difficult stent removal. Treatments may include replacement of a new stent, placement of a tube or stent through the back and into the kidney, or even open surgery to repair the injury if it is severe.

We provide this literature for patients and family members. It is intended to be an educational supplement that highlights some of the important points of what we have previously discussed in the office. Alternative treatments, the purpose of the procedure/surgery, and the points in this handout have been covered in our face-to-face consultation(s).

The information contained in this document is intended solely to inform and educate and should not be used as a substitute for medical evaluation, advice, diagnosis or treatment by a physician or other healthcare professional. While UUANJ endeavors to ensure the reliability of information, such information is subject to change as new health information becomes available. UUANJ cannot and does not guaranty the accuracy or completeness of the information contained in this document, and assumes no liability for its content or for any errors or omissions. Please call your doctor if you have any questions.

One of our representatives is eager to help you. For more details or to book an appointment. Contact us today at
609-581-5900

What to Expect from a Ureteral Stent

Ureteral stents are an implant used to correct a blockage in one of the ureters in your body. The ureters are tubes that allow urine to drain from the kidneys and enter the bladder. When blockages occur, urine backs up in the kidneys, which causes swelling that can lead to permanent kidney damage if left unaddressed.

Blockages can be caused by kidney stones, a tumor or other object pressing on the ureters, or scar tissue that develops in the ureters. A ureteral stent is a thin tube inserted into the ureters to open the passage and allow urine to properly drain from the kidneys.

If your doctor decides this implant is necessary to preserve your kidney’s health, you’ll want to be prepared for what to expect once the stent is implanted and after the stent is removed.

Side Effects and Symptoms After Stent Placement

Once a kidney stone stent is implanted, you can expect to notice some changes in your body, including some symptoms of discomfort as your body recovers after the stent’s placement.

Symptoms may include a frequent urge to urinate, which will likely decrease over time. The urge to urinate may come on suddenly, so patients receiving a ureteral stent should be mindful of their proximity to a bathroom in the days following the procedure. You may experience pelvic pain as your body recovers, and you may also notice blood in your urine at times while the stent is in place. This is usually not cause for alarm, although you can mention it to your doctor if you’re concerned.

How to Sleep with a Kidney Stent

When a ureteral stent has been placed, discomfort from the implant can make sleep difficult for patients. Sleep is crucial to recovery, so patients should consult with their doctor if they’re experiencing sleep issues because of discomfort or pain.

Different treatments may be recommended based on the severity of discomfort and the patient’s medical history. Over-the-counter medications to relieve pain may be recommended. Your doctor may also suggest alpha blockers to alleviate spasms and cramping that can occur when a stent has been implanted.

Anticholinergic medications may be recommended to alleviate frequent urination, which can disrupt sleep and impede recovery. Patients may also want to be mindful about their fluid intake during the day, increasing fluid consumption during daytime hours to maintain a steady supply of urine, while tapering off this consumption closer to bedtime.

What to Expect After Ureteral Stent Removal

If your stent is only required for a short period of time, your doctor will then remove the stent from your ureters. This process, like the implanting of the stent, will require a recovery time that may be marked with symptoms and side effects that patients should be aware of.

The removal of a stent can, again, be followed by a period of frequent urination. When urinating, patients can expect to feel some burning or discomfort for a couple of days after the procedure. Despite this discomfort, patients are encouraged to drink a lot of water and other fluids to prompt the production of urine that will aid in flushing out the ureters and encourage a full recovery. You may also notice some blood in your urine. This is normal, although you should notify your doctor if it doesn’t go away or gets worse after several days of recovery.

Some patients may instantly sleep better after a stent removal, while others may still be kept awake by discomfort or pain. Your doctor may encourage you to continue taking medications as you recover from the stent removal—especially if you suffered from sleep issues while the stent was in place.

Your doctor may have other recommendations or guidance to recover after a stent removal. Always follow your doctor’s instructions to support a smooth recovery and avoid the risk of post-stent complications, such as a urinary tract infection.

When to Call Your Doctor Regarding Your Ureteral Stent

While ureteral stents may be uncomfortable and unpleasant, they are typically a safe and routine intervention. However, patients should be aware of possible signs of an infection or other complications that may require emergency medical attention. Call your doctor if you experience any of the following symptoms while your stent is in place:

• Fever
• A burning sensation while urination
• Changes in the characteristics of your urine, including color or smell
• Kidney pain or other abdomen pain
• Chills
• Chest pain
• Other unexpected symptoms or side effects

A ureteral stent may not always be comfortable but, when compared to the pain and possible kidney damage caused by a ureteral blockage, the procedure offers a welcome alternative that preserves the health and function of your kidneys. If you’re experiencing pain due to a potential ureteral blockage, talk to your doctor today.

Ureteral Stents

Ureteral stents hold open the ureters, tubes that allow urine to flow from the kidneys into the bladder. People may need them due to ureteral obstructions from kidney stones, ureteral stones, narrowed ureters or tumors. Most stents are temporary, but some people with chronic problems need ureteral stents for a longer time.

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Overview

What are ureteral stents?

Ureteral stents are thin, flexible tubes that hold ureters open. The ureters are part of the urinary system. Typically, these long, thin tubes carry urine from the kidneys to the bladder. Healthcare providers place ureteral stents to prevent or treat ureteral obstructions.

Silicone or polyurethane (plastic) ureteral stents are about 10 to 15 inches long and about ¼ inch in diameter. They line the entire length of the ureter, keeping it open. The top part of the stent has a coil that sits inside a kidney. The loop at the lower end sits inside the bladder.

Who needs ureteral stents?

Sometimes ureters can become blocked so that urine can’t drain as usual. A ureteral stent can clear the ureter so your kidneys can work as they should.

The most common use of ureteral stents is to allow urine to flow through the ureter around a kidney stone that’s blocking urine flow. Also, your provider may use a stent after breaking up kidney stones to prevent blockage from the passing fragments. Stents can also be used after kidney stone removal to prevent the ureter from getting blocked by postoperative swelling.

Healthcare providers also use ureteral stents to treat ureteral obstructions due to:

• Blood clots.
• Inflammatory bowel disease (IBD).
• Scar tissue buildup from endometriosis or other conditions.
• Tumors.
• Ureteral stones.
• Ureteropelvic junction obstruction (an inherited condition that causes the ureters to narrow).

Procedure Details

What happens before ureteral stenting?

Before a ureteral stent procedure, your provider may ask you to:

• Get blood tests to check kidney function.
• Give your healthcare team a list of the medications and supplements you take.
• Stop taking medications like aspirin that thin the blood.
• Fast (not eat or drink) for a specified amount of time before the procedure.

What happens during ureteral stenting?

Stenting is typically an outpatient procedure. You go home the same day. A urologist, a doctor who specializes in conditions that affect the urinary system, performs the procedure.

Before the procedure, you receive anesthesia. Most often, you have general anesthesia, so you’re asleep. You lie on your back for the procedure. Your provider:

• Uses X-ray imaging (fluoroscopy) or a kidney ultrasound to locate the obstruction and guide the procedure.
• Inserts a small scope device with a lens (cystoscope) through the urethra and into the bladder. The urethra is the tube where urine leaves your body when you pee.
• Threads a thin, flexible wire (guidewire) through the cystoscope into the blocked ureter.
• Uses the guidewire to place the ureteral stent. A curled part of the stent sits in the kidney, while another curled part rests in the bladder. These coils hold the stent in place.
• Gently removes the guidewire and cystoscope, leaving the stent in place.

What happens after ureteral stenting?

Someone should drive you home when your provider says it’s safe to go. Your provider may recommend drinking lots of water after the procedure to help with kidney and bladder function.

You may notice some blood in the urine and have some discomfort. These symptoms are normal after the stent placement and should gradually improve in a couple of days. However, you may see traces of blood and have discomfort until your provider removes the stent. You may also experience frequent urination and pain in the kidney that gets worse when you urinate as long as the stent is in place. The blood in your urine may come and go randomly.

How long will I have a ureteral stent?

Most ureteral stents are temporary. Your healthcare provider will perform another procedure to remove the stent after the kidney stone passes, infection clears up or other problems resolve. You’ll probably have the stent for a few days or weeks.

Some people need stents for months or years. People who have tumors that press on the ureters or narrowed ureters may need ureteral stents for an extended time. Your provider will replace the stent with a new one every three to six months. Replacing the stent reduces the likelihood of complications.

How are ureteral stents removed?

Some short-term ureteral stents have strings that hang outside the urethra, where pee comes out. Your healthcare provider gently pulls on the string to remove the ureteral stent.

If you need a ureteral stent for a few weeks or longer, the stent won’t have a string. Your provider removes the stent during a minor office procedure. You may get X-rays or an ultrasound before removal. This imaging assures the provider that your kidney stone or other issue has resolved.

To remove the stent during a procedure, your provider:

• Inserts a cystoscope through the urethra and into the bladder.
• Uses tiny clamps attached to the cystoscope to grab onto the stent.
• Gently removes the stent.

Risks / Benefits

What are the potential risks or complications of ureteral stenting?

As many as eight out of 10 people with ureteral stents experience:

• Bladder irritation, bladder spasms (painful cramps) and frequent urination.
• Blocked, broken or dislodged stents.
• Blood in urine (hematuria) or painful urination.
• Infections, including urinary tract infections (UTI).

Your healthcare provider will talk about your likelihood of risk. They will also tell you how to handle any worrying signs while the stent is in place.

Recovery and Outlook

How can I relieve ureteral stent pain?

Ureteral stents can be uncomfortable. You may have pelvic pain or a pulling sensation when you pee. Over-the-counter pain relievers such as nonsteroidal anti-inflammatory drugs (NSAIDs) can help.

Do I need to restrict activities while I have a ureteral stent?

You may need to restrict physical activities for the first week after the procedure. If your job doesn’t require lifting heavy objects, you should be able to return to work as usual within 24 hours after the procedure.

Your provider may recommend not having sex for the first week after stent placement to reduce the risk of a UTI.

What’s the prognosis for someone who has ureteral stents?

Ureteral stents are generally safe. They don’t typically cause any long-term problems.

Despite the risk of annoying side effects, ureteral stents are helpful. Ureteral stents often allow kidney stones to pass. They also work well to resolve ureteral obstructions. Left untreated, a ureteral obstruction can lead to life-threatening kidney failure and sepsis.

When to Call the Doctor

When should I call the doctor?

You should call your healthcare provider if you experience:

• Clots of tissue in urine.
• Dark, cloudy or foul-smelling urine.
• Difficulty urinating or extreme pain or burning sensation when peeing.
• Kidney pain (dull ache deep on the left or right side of the spine).
• Nausea and vomiting.
• Signs of infection, such as fever or chills.

Additional Details

What is a kidney stent?

Rarely, a healthcare provider can’t place a ureteral stent due to scarring or other problems. You may need a nephrostomy (kidney stent) instead. To perform nephrostomy, a radiologist inserts a stent (tube) directly into a kidney. The kidney stent drains urine from the kidney into a bag outside of the body, bypassing the ureters and bladder.

A note from Cleveland Clinic

Ureteral stenting is an effective way to allow painful kidney stones to pass through the ureters and out of the body. Ureteral stents for kidney stones and ureteral stones are temporary. Some people need ureteral stents longer to keep narrowed ureters open. A ureteral stent can be uncomfortable and even slightly painful. Your healthcare provider can suggest ways to ease discomfort until it’s time to remove the stent.

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Last reviewed by a Cleveland Clinic medical professional on 08/25/2021.

References

• British Society of Interventional Radiology. Ureteric Stenting. (https://www.bsir.org/patients/ureteric-stenting/) Accessed 10/6/2021.
• European Association of Urology. Double-J stent placement. (https://patients.uroweb.org/treatments/double-j-stent-placement/) Accessed 10/6/2021.
• Gadzhiev N, Gorelov D, Malkhasyan V et al. Comparison of silicone versus polyurethane ureteral stents: A prospective controlled study. (https://pubmed.ncbi.nlm.nih.gov/32013936/) BMC Urology. 2020;20(1):10. Accessed 10/6/2021.
• Merck Manual (Consumer Version). Urinary Tract Obstruction. (https://www.merckmanuals.com/home/kidney-and-urinary-tract-disorders/obstruction-of-the-urinary-tract/urinary-tract-obstruction) Accessed 10/6/2021.
• Radiological Society of North America. Ureteral Stenting and Nephrostomy. (https://www.radiologyinfo.org/en/info/ureteralnephro) Accessed 10/6/2021.
• Urology Care Foundation. Insights: Why Urologists Use Ureteral Stents. (https://www.urologyhealth.org/healthy-living/urologyhealth-extra/magazine-archives/fall-2018/insights-why-urologists-use-ureteral-stents) Accessed 10/6/2021.

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