Ureteric Stent Insertion Flashcards
Ureteric Stent Insertion
Indications
Equipment
Consent
Perform
Can’t get wire past stone?
Op Note
Indications
Ureteric Calculi - Unremitting pain, Infection, AKI/Renal Failure, Solitary Kidney, Bilateral Stones
Long Term Obstruction - Strictures/PUJO/Retroperitoneal Fibrosis
Malignant Obstruction
Post-Operative - Ureteric Protection / Injury / Ureteric Repair
Pre-Operative - Protection of ureters/ Radiation
Ureteric Stent Insertion
Indications
Equipment
Consent
Perform
Can’t get wire past stone?
Op Note
Equipment
Requisite cleaning, gowning, draping (including an x ray cover), irrigation fluid + equipment
Suction for irrigation fluid
Cystoscope + Set (usually 22Ch30Degree)
Stack
Lubricant
Ureteric Catheter
Omnipaque contrast (diluted to 1:1 with saline)
C Arm
Radiographer
Lead Aprons
Hydrophilic Tip Wire
Stent
*May also need on standby- cluttons, Semi-Rigid Ureteroscope, S-Dilators *
Ureteric Stent Insertion
Indications
Equipment
Alternatives + Consent
Perform
Can’t get wire past stone?
Op Note
Alternatives
Primary Ureteroscopy (if for non-septic stone)
Nephrostomy
Observation
Consent
Clarify patient details, ensure patient comfortable. Use simple language / pictures and BAUS information leaflet to describe procedure. **Confirm Negative Pregnancy Test **
Name, indication and SIDE procedure on consent form
Risks:
Bleeding, Infection, Pain/Stent Symptoms (Dysuria/Flank Pain/Frequency/Urgency/Incontinence), Stent Migration, Stent Encrustation
Urinary Retention, Catheter
Damage- Bladder (including perforation), Urethra, Ureter, Kidney
Laparotomy
Failure, Further Procedure, Anaesthetic Risk
Other procedures that may become necessary - ureteroscopy, percutaneous nephrostomy, urethral dilation, stent insertion
MARK PATIENT!
Sign Print and Date - Ask patient to do the same
Ureteric Stent Insertion
Indications
Equipment
Consent
Perform
Can’t get wire past stone?
Op Note
Perform
Ensure patient has been consented, theatre brief has been undertaken, checklist has been performed, patient is appropriately positioned (lithotomy) and prepared.
Ensure Radiographer is in theatre and C Arm is prepared and in position with x ray cover.
Ensure everyone is wearing lead in theatre
Scrub
Antibiotics on induction (Gentamicin or as per urine culture sensitivities)
Consider pelvic examination (PV/DRE if required)
Ensure cystoscope is assembled correctly, camera head is attached, light lead is attached, irrigation is connected and scope if flushed.
Ensure camera light is on + White balance performed.
Lubricate scope.
Men - Ensure penis is stretched and foreskin retracted
Turn irrigation on
Gently insert scope into urethral meatus
Advance scope gently through urethra
Men - Examine prostatic urethra. ?Occlusive prostate. ?any evidence of urothelial malignancy
Perform a systematic Cystoscopy
- Look posteriorly at trigone/examine both ureteric orifices
- Systematically examine all of bladder - posterior, both lateral walls, anterior wall and dome.
Ask for hydrophilic wire and pass in through bridge attachment.
Guide into respective ureteric orifice
Use fluoroscopy to check advancement / position of wire
Advance ureteric catheter over wire and use fluoroscopy to assess position to proximal to point of obstruction
Aspirate urine (Send for MC&S)
Perform retrograde studies using contrast solution to confirm pelvicalyceal system opacification / evaluate stricture / evaluate extravasation (use minimum amount of contrast)
Once happy re-insert wire through ureteric catheter and confirm position in pelvicalyceal system on fluoroscopy
Remove Ureteric Catheter
Advance Ureteric Stent over wire into ureteric orifice under direct vision
Advance stent pusher over wire and use this to advance stent to renal pelvis (under direct vision)
Use fluoroscopy to confirm position of upper end of stent in renal pelvis. Remove wire - Ensure stent curls adequately in renal pelvis
Retract Scope to bladder neck - remove wire completely and ensure stent is coiled in bladder
Ensure bladder is emptied/catheter is inserted
Ensure images are saved and uploaded
Sign Out
Construct Operative note
Ensure specimen samples are labelled
Ureteric Stent Insertion
Indications
Equipment
Consent
Perform
Can’t get wire past stone?
Op Note
Can’t get wire past stone?
Use Terumo/Zip Wire
Advance catheter to stone and attempt to advance wire past it again
Call Consultant -> Rigid Ureteroscopy
Percutaneous Nephrostomy
Ureteric Stent Insertion
Indications
Equipment
Consent
Perform
Can’t get wire past stone?
Op Note
Op Note
Patient details, date, time
Surgeon name (s), anaesthetist name, type of anaesthetic, assistant, Position, Antibiotic use, DVT Prophylaxis,
Describe Cystoscopy findings
Describe steps of procedure
Follow Up:
?Further procedure - ureteroscopy, PCNL
?Antibiotics
?Further imaging
?Stent removal
Analgaesia for stent symptom prophylaxis
?Add to MDT
?Repeat Bloods
?HDU Involvement
?Chase urine cultures
