This leaflet tells you about having antegrade on the outside. Ureteric stents can be placed Are you required to make any special ureteric stenting. It explains what is involved either by an antegrade or retrograde preparations? and what the possible risks are. It is not technique, but in your case the decision has Antegrade ureteric stenting is usually carried meant to replace informed discussion been made to place it in an antegrade out as a day case procedure under local between you and your doctor, but can act as fashion. anaesthetic. You may be asked not to eat for a starting point for such discussions. If you Are there any risks? four hours before the procedure, although have any questions about the procedure you may still drink clear fluids such as water. please ask the doctor who has referred you Antegrade ureteric stenting is a very safe for the test or the department which is going procedure, but as with any medical If you have any allergies or have previously to perform it. procedure there are some risks and had a reaction to the dye (contrast agent), complications that can arise. you must tell the radiology staff before you What is antegrade ureteric stenting? The main risk is probably the failure to place have the test. Urine from a normal kidney drains through a the stent. This is more common if the ureter Who will you see? narrow muscular tube (the ureter) into the is completely blocked. If this happens, a bladder. When, for example, a stone blocks A specially trained team led by an nephrostomy will be reinserted and the interventional radiologist within the radiology the ureter, the kidney can rapidly become interventional radiologist will arrange a affected, especially if there is infection department. Interventional radiologists have second visit. Antegrade stenting may be special expertise in reading the images and present as well. While an operation may successful on a second visit but occasionally become necessary, it is also possible to using imaging to guide catheters and wires surgery is necessary for a combined to aid diagnosis and treatment. relieve the blockage initially by placing a approach to place the stent. nephrostomy tube and then by inserting a Where will the procedure take place? long plastic tube, called a stent, through the There may also be bleeding from the kidney and, on very rare occasions, this may In the angiography suite or theatre; this is skin, into the bladder through the ureter. As usually located within the radiology the stent is put in through the kidney and require another radiological procedure or surgery to stop it. department. This is similar to an operating down the ureter, this is called an antegrade theatre into which specialised X-ray procedure (as opposed to placing a stent Despite these possible complications, the equipment has been installed. through the bladder and up the ureter, which procedure is normally very safe and will is a retrograde procedure). This stent allows almost certainly result in a great What happens during the procedure? urine to drain in the normal fashion, from the improvement in your medical condition. You will be asked to get undressed and put kidney into the bladder. Who has made the decision? on a hospital gown. A small cannula (thin tube) will be placed into a vein in your arm. Why do you need antegrade ureteric The consultant in charge of your care and stenting? the interventional radiologist performing the You will have already had a nephrostomy Other imaging tests have shown that the procedure have discussed your case and performed. You will lie on the X-ray table, ureter has become blocked. You will have feel that this is the best option. However, you generally flat or nearly flat, on your stomach. already had a percutaneous nephrostomy will also have the opportunity for your You need to have a needle put into a vein in placed to relieve the blockage. While a opinion to be considered and if, after your arm, so that the interventional nurse nephrostomy can be permanent solution, a discussion with your doctors, you no longer can give you a strong sedative and ureteric stent allows an internal solution want the procedure, you can decide against painkillers. You may have monitoring without the need for a tube or drainage bag it. devices attached to your chest and finger How long will it take? and may be given oxygen. Every patient is different, and it is not always Antegrade ureteric stenting is performed easy to predict; however, expect to be in the under sterile conditions and the radiology department for about an hour. interventional radiologist and radiology nurse What happens afterwards? will wear sterile gowns and gloves to carry out the procedure. You will be taken back to your ward. Nursing staff will carry out routine observations Your skin near the point of insertion will be including pulse and blood pressure and will swabbed with antiseptic and you will be also check the treatment site. You will covered with sterile drapes. Your skin near generally stay in bed for a few hours, until the nephrostomy tube will be numbed with you have recovered and are ready to go local anaesthetic. The nephrostomy tube will home. British Society of Interventional be removed over a guidewire to allow the Radiology introduction of a special plastic tube Finally (catheter). The blockage will be identified Some of your questions should have been and a new guidewire will be used to cross answered by this leaflet, but remember that the blockage into the bladder. Once the wire this is only a starting point for discussion has been placed through the blockage and about your treatment with the doctors Antegrade ureteric stent into the bladder, the long plastic stent can be looking after you. Make sure you are insertion placed over the guide wire. Urine should satisfied that you have received enough now be able to pass down the stent and into information about the procedure. the bladder. As a safety measure, a new nephrostomy drainage tube will be left in the Contact: British Society of Interventional Radiology kidney and clamped. This will be removed www.bsir.org the next day if everything is working normally. This leaflet has been prepared by the British Society of Interventional Radiology Patient information Will it hurt? (BSIR) and the Clinical Radiology Patients’ Liaison Group (CRPLG) of The Royal College of Radiologists. Approved by the Board of the Faculty of Clinical When the local anaesthetic is injected, it will Radiology: 25 February 2011 sting for a short while, but this soon wears © The British Society of Interventional Radiology (BSIR) 2011 Permission is off. granted to modify and/or re-produce these leaflets for purposes relating to the improvement of health care provided that the source is acknowledged and that During the procedure, you may be aware of none of the material is used for commercial gain. If modified, the BSIR and RCR Endorsed by logos should not be reproduced. The material may not be used for any other some pushing as the ureteric stent is purpose without prior consent from the Society. delivered to the correct position. Legal notice Please remember that this leaflet is intended as general information only. It is not Occasionally you may feel some discomfort definitive, and the RCR and the BSIR cannot accept any legal liability arising from its use. We aim to make the information as up to date and accurate as possible, when the wire enters the bladder. Although but please be warned that it is always subject to change. Please therefore always this is uncomfortable for a short while, it check specific advice on the procedure or any concerns you may have with your doctor. means that the procedure has been successful.