Ureteral stent

Urine travels from each kidney to the bladder through a narrow tube called the ureter. A stone, tumor, scar or swollen lymph nodes can squeeze or block it. A ureteral stent is a thin, soft plastic tube that runs inside the ureter and keeps it open so urine can reach the bladder.

Each end of the stent curls into a small loop, like the letter J. One loop sits in the kidney and the other in the bladder, which keeps the stent from moving. That is why it is often called a double-J stent. Unlike a nephrostomy tube, nothing comes out of your skin.

On the X-ray, the stent is a thin white line running down the side of the spine, with one curl in the kidney and another curl low in the pelvis inside the bladder.

Urologists (surgeons of the urinary tract) place most ureteral stents from below, through the bladder, using a small camera. We place them from above, through the kidney, when the route from below does not work or is not safe. Often you already have a nephrostomy tube, and we use its track, so no new needle stick is needed.

If you are not sure a fully internal stent will work, we may first place a nephroureteral stent. It gives the same internal drainage, but keeps an outside tube as a safety valve until we know urine flows well. The interventional urology page explains how these options fit together.

1. 1
   Getting comfortable

   You lie on your stomach on the X-ray table. You receive moderate sedation through your IV, and monitors track your heart, blood pressure and oxygen.

2. 2
   Mapping the ureter

   We numb the skin and go in through your existing nephrostomy track, or through a new small needle stick into the kidney. Contrast dye shows the ureter and the blockage on X-ray.

3. 3
   Crossing the blockage

   A thin guidewire is gently steered down the ureter, through the narrow spot and into the bladder. The stent then slides over the wire until one curl sits in the bladder and the other in the kidney.

4. 4
   Checking and finishing

   We confirm the position on X-ray. Sometimes we leave a small capped tube in your back for a few days as a safety valve, and remove it once we know the stent drains well.

You rest for about an hour afterward. Most people go home the same day. You can eat and drink once you are fully awake.

Many people barely notice their stent. Others have bothersome symptoms, especially in the first few weeks. These are caused by the curl of the stent rubbing the bladder wall and by urine flowing back up the stent when you pee. They are not dangerous, and they usually settle as your body gets used to it.

Drinking plenty of water helps. Medicines can also help: tamsulosin (Flomax) relaxes the ureter, and bladder medicines such as oxybutynin or mirabegron calm spasms. Ask us or your urologist whether these are right for you.

1. First day
   Rest. No driving, alcohol or important decisions after sedation.
2. First 2–3 days
   Mild pelvic or back discomfort. Acetaminophen (Tylenol) usually helps.
3. First week
   Urine may look like rosé wine or cranberry juice. It should stay see-through.
4. After 24 hours
   Most normal activity, driving and work are fine. Avoid heavy lifting for a day or two.
5. Every 3–6 months
   The stent is changed or removed. Never let a stent stay in longer than planned.

Minerals from urine slowly coat the stent. Left too long, it can clog, break or become stuck. That is why a stent is changed on a schedule, usually every 3 to 6 months, or removed once the cause is fixed. A urologist often does this through the bladder with a small camera. We can also change it under X-ray. Keep a note of your due date and make sure a visit is booked.

I tell patients a stent is a bit like a houseguest: most are easy, some are annoying, and none should stay forever. If your symptoms are wearing you down, tell me, because medicines or a change of stent size often help. And please keep your change date on your calendar, because a forgotten stent is the one real problem I work hard to prevent.

Fabio Komlos, MD, interventional radiologist · About Dr. Fabio Komlos