Consent: Retrograde Ureteric Stent Insertion - Podcast Version TeachMeSurgery 0:00 / 0:00 1x 0.25x 0.5x 0.75x 1x 1.25x 1.5x 1.75x 2x This article is for educational purposes only. It should not be used as a template for consenting patients. The person obtaining consent should have clear knowledge of the procedure and the potential risks and complications. Always refer to your local or national guidelines, and the applicable and appropriate law in your jurisdiction governing patient consent. Overview of Procedure Retrograde ureteric stent insertion is the passage of a stent to relieve a ureteric obstruction, most commonly from from stones or urethral strictures. Via rigid cystoscopy, the stent is passed into the ureter (via the urethra and bladder, i.e. retrograde) under X-ray or ultrasound guidance using a guidewire. Both ends of the stent are subsequently coiled to prevent displacement. The stent may be removed after several days, weeks, or months after insertion depending on the clinical indication. CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0)], from Wikimedia Commons Figure 1A plain film abdominal radiograph showing a JJ ureteric stent in-situ, with associated renal (red arrow) and ureteric (yellow arrow) stones Complications Intraoperative Complication Description of Complication Potential Ways to Reduce Risk Haemorrhage Damage to surrounding blood vessels or intraluminal damage to the urinary tract Careful and meticulous handling of the instruments to avoid damage Damage to surrounding structures Damage can occur to the urethra, bladder, or ureters during the procedure Allergic reaction Local anaesthetic toxicity or reaction to instruments used Anaesthetic Risk Includes damage to the teeth, throat and larynx, reaction to medications, nausea and vomiting, cardiovascular and respiratory complications Forms a part of the anaesthetist assessment before the operation Early Complication Description of Complication Potential Ways to Reduce Risk Pain Suprapubic or flank pain due to bladder irritation from stent placement Infection Infection can be introduced by the instrumentation Maintain an aseptic technique throughout the procedure Bleeding Damage to intraluminal surfaces of the urinary tract, resulting in haematuria Stent displacement Migration of the stent from its original position Technical failure Difficult anatomy leading to abandoning of procedure and may result in further operation Blood clots DVTs and PEs are a possibility in any operation, yet often the procedure is often short so the risk is low The patient will be given anti-embolism stocking and low molecular weight heparin peri-operatively to minimise this risk as deemed appropriate Late Complication Description of Complication Potential Ways to Reduce Risk Stent blockage or encrustation Results from bacterial colonisation of the stent and subsequent crystal deposition Regular stent changes Reintervention Blocking of the stent may require reintervention Frequent questions What is retrograde ureteric stent insertion? Retrograde ureteric stent insertion is a medical procedure used to alleviate ureteric obstructions, typically caused by stones or strictures. The stent is introduced into the ureter through the urethra and bladder under imaging guidance. What are the potential complications of retrograde ureteric stent insertion? Potential complications include intraoperative haemorrhage, damage to surrounding structures, allergic reactions, and early complications such as pain, infection, and stent displacement. Careful technique and aseptic measures can help reduce these risks. How is a retrograde ureteric stent inserted? The procedure involves passing a stent into the ureter using rigid cystoscopy, guided by X-ray or ultrasound, and a guidewire. Both ends of the stent are coiled to secure its position and prevent displacement. What are the late complications associated with ureteric stents? Late complications can include stent blockage or encrustation due to bacterial colonisation and crystal deposition, which may necessitate regular stent changes or reintervention. Monitoring and timely intervention can help manage these issues. What measures can be taken to minimise the risks during the procedure? To minimise risks, practitioners should handle instruments meticulously to avoid damage, maintain an aseptic technique to prevent infection, and assess patients for anaesthetic risks. Additionally, appropriate peri-operative measures, such as administering anti-embolism stockings, can further reduce complications. Rate This Article