Cyst = pertaining to the urinary bladder
Oscopy = procedure done through a scope as opposed to an incision
Stent = thin plastic tube that can be placed in the ureter
Retrograde = backward to the normal direction of flow
Pyelogram = injection of dye into the kidney and taking an x-ray
The ureter is a tube that connects each kidney with your urinary bladder. It is the most common site in which a kidney stone gets caught and consequently causes pain. There are other reasons that a ureter may become blocked. There could be narrowing scar tissue inside the ureter (termed a stricture). There could be compression from outside the ureter due to a tumor or inflammatory response somewhere in the abdominal cavity or pelvis. There can be congenital (something you are born with) defects in the ureter.
When there is an obstruction in the ureter, it is sometimes necessary to place a tube (stent) inside. Sometimes, a special scope procedure (ureteroscopy) may be performed to diagnose or treat the problem right away. Sometimes, just a stent is placed to unblock the kidney. When this is done, a more definitive procedure may be done in the future. Sometimes, a stent can be removed at a later date without any further treatments. This stent is not visible on the outside of the body as one end is in the kidney, and the other in the bladder. Sometimes, a thin string is attached to the end of the stent in the bladder, and this string is left hanging out of the urethra. The stent can then be removed by pulling on the string. In the absence of the string, the stent can be removed with a scope procedure in the office.
The ureter or the inside of the kidney can sometimes be a source of hematuria (blood in the urine). There are different ways to evaluate a patient for hematuria. Sometimes, special x-rays (using injection of dye into a vein) can be used to examine the inner kidney and ureters.
Sometimes, a retrograde pyelogram is performed. This is when the dye is injected directly into the ureter (instead of into a vein) during a cystoscopy procedure. Your surgeon will explain why this procedure is being done instead of an x-ray with intravenous injection. Sometimes, a retrograde pyelogram is done prior to placing a stent to help demonstrate the anatomy of the ureter or even help diagnose the cause of an obstruction.
There is no particular preparation for stent placement or for retrograde pyelogram. It is necessary, as with any procedure or operation requiring anesthesia, that you have not eaten for at least eight hours prior to the scheduled time.
Sometimes, a stent placement or retrograde pyelogram can be done in the office without any sedation or with minor sedation. If this is the case, we recommend that you have not eaten for 2-3 hours prior to the procedure.
With regard to your medications, your anesthesiologist will have discussed (in a prior consultation if your procedure is being done in the hospital) which ones you should take the morning of your surgery. Any pill taken will be done so with only a small sip of water. If you have not been informed or have forgotten, please let us know.
To review the basics of what we discussed in the office: The actual procedure can take anywhere from 15 minutes to an hour depending on the particulars of the case and the individual’s anatomy. You will be placed in lithotomy position (lying down on your back with your legs gently elevated in holsters called stirrups). The scope is inserted into the urethra and into the bladder. The bladder is examined for any abnormalities.
Stent Placement: The ureteral orifice (hole where the ureter enters the bladder) on the side of concern is identified. A wire is placed into the hole and guided up the ureter to the inside of the kidney. A stent is then placed over the wire and advanced into the kidney. Once satisfied with the position, we remove the wire and the stent stays in the ureter. Each side of the stent forms a curl that helps it to remain in position. We may use x-ray guidance or ultrasound to help guide the placement. Sometimes, neither x-ray nor ultrasound are necessary.
Retrograde Pyelogram: The ureteral orifice (hole where the ureter enters the bladder) on the side of concern is identified. A small catheter is placed in the hole. X-ray dye is then injected into the catheter so that it flows up the ureter and into the inner aspect of the kidney. During and after the injection, we look at x-rays so that we can evaluate the anatomy of the ureter and inner kidney.
After the procedure, you will be in the recovery room until you are ready to be discharged. If done in the office, you may be observed for a short time before being allowed to leave. You may have some discomfort while urinating. This is from the cystoscopy. Although the stent is soft plastic, any degree of sensation from its presence is possible. Some patients have no feeling, while on the other extreme, some have very bothersome symptoms. The symptoms can be any one or a combination of back or groin discomfort (like still having a stone), urinary frequency, urgency or burning.
The symptoms may last only one day, or persist for the duration of the presence of the stent. Most patients, however, have very mild symptoms that are tolerable.
After the procedure, it is rare to have blood in the urine. A small amount of blood staining is possible for a few days, however. When there is a sharp stone in the ureter or in men with large prostates, blood in the urine is seen more often.
It is not always possible to advance the wire or the stent into the kidney. The blockage in the ureter (stone or stricture) may not be passable. Sometimes the entrance to the ureter in the bladder (ureteral orifice) cannot be catheterized. This would prevent either procedure.
Sometimes in a male, a very large prostate can obscure the passage of a wire or a catheter into the ureter.
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:
*If you have symptoms suggesting any of the above after your discharge from the hospital, you must contact us immediately or go to the nearest emergency room.
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.
UUANJ, P.C.
