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Tuesday, September 2, 2014
Stent removal cystoscopy
I am due to have a ureteroscopy to remove a 5mm stone in the bottom end of the right ureter. It is only one stone. Is it essential to stent in the first place, after removal? All this will be performed under general anaesthetic. However, if I require a stent removing in 2 weeks have been told, this is done by local anaestheic and cystoscopy. I assume they are using stents without the thread attached. Can I ask them to use the thread one? Is it painful having a cystoscopy without general? I am anxious about all this?
The need for a stent after ureteroscopy would really depend on the amount of obstruction and swelling to the ureter that is being caused by the 5 mm stone. This would be known only during the surgery. If the stone is possible to be removed easily and does not appear to be causing swelling at the site of ureteral obstruction (as noted by ur urologist during the surgery), then it is often possible to do the surgery without the need for a stent. The stent basically helps with the healing of the area where the stone is lodged and also prevents any further ureteral obstruction that might occur due to the swelling of the inner wall of the ureter. The stent also helps with the passage of small stone fragments that might result from fragmentation of the original stone during the ureteroscopy.
The additional point to know is that sometimes it might not be possible to insert an instrument (ureteroscope) easily into the ureter if the ureteral lumen is narrow. In this case the stent might need to be inserted during the first procedure (without treating the stone at that time). This stent would then cause the ureter to dilate which would make subsequent ureteroscopy (after a few weeks) easier and more likely to be successful.
The procedure to remove the stent can be performed under local anesthesia with a flexible instrument (cystoscope). The procedure is usually associated with minimal discomfort which most patients are able to tolerate without much problem. It is possible to leave a string attached to the lower end of the stent with the stent coming out through the penis. The urologist can then remove the stent by pulling on the string. It is possible that your urologist might not be leaving the string since they are planning to keep the stent in for about 2 weeks. This is often a surgeon preference and is variable between different urologists but you could discuss this option with him/her further.
Krishnanath Gaitonde, MD
Assistant Professor of Clinical Urology
College of Medicine
University of Cincinnati