How Urinary Stents Are Inserted for Hydronephrosis: Procedures and Alternatives
Hydronephrosis, a condition characterized by kidney swelling due to urine buildup, often requires medical intervention to restore proper urinary flow. One of the most effective treatments involves the placement of a urinary stent—a small, flexible tube that helps drain urine from the kidney to the bladder. Depending on the patient's anatomy and underlying conditions, doctors may use different approaches to insert the stent. Below are the two primary methods used in clinical practice today.
Method 1: Retrograde Stent Placement via Cystoscopy
The most common and minimally invasive approach is retrograde stent insertion, performed under cystoscopic guidance. During this procedure, a urologist inserts a thin, lighted scope called a cystoscope through the urethra and into the bladder. This allows clear visualization of the ureteral openings—where the ureters connect to the bladder.
Once the affected side is identified, an extremely smooth guidewire is carefully threaded up the ureter toward the kidney. Under real-time visual assistance, the physician then advances a slender stent (typically 1–2 mm in diameter) over the wire and positions it so one end sits in the renal pelvis and the other in the bladder. These stents are made of biocompatible, flexible materials designed to remain in place without causing significant discomfort.
Benefits and Common Side Effects
This method effectively relieves hydronephrosis, prevents further kidney damage, and supports long-term renal function. Most patients tolerate the stent well, although some may experience mild side effects such as:
- Flank or lower abdominal discomfort
- Occasional blood in the urine (hematuria)
- Increased urge to urinate or mild burning during urination
These symptoms are usually temporary and resolve on their own. Patients are advised to drink plenty of fluids, avoid strenuous activity, and follow post-procedure care instructions. In many cases, no additional medication is required unless discomfort becomes persistent.
Method 2: Antegrade Stent Placement Using Percutaneous Nephrostomy
In certain complex cases, retrograde insertion fails—especially when there are anatomical obstructions, bladder pathologies, or narrowed ureteral openings that prevent access through the urethra. When standard cystoscopy isn't feasible, physicians turn to an alternative technique known as antegrade stenting.
This approach begins with a percutaneous nephrostomy: under ultrasound or fluoroscopic guidance, a needle is inserted through the skin of the lower back directly into the swollen kidney. A drainage catheter may first be placed to relieve pressure, followed by the introduction of a nephroscope—a tiny camera used to navigate the kidney's internal structures.
Transitioning to Long-Term Stenting
With direct visualization inside the kidney, the doctor guides a guidewire down the ureter and across the blockage. The stent is then deployed along this wire, bridging the kidney and bladder. This method is particularly beneficial for patients with:
- Previous pelvic surgeries
- Ureteral strictures or tumors
- Neurogenic bladder dysfunction
- Failed prior stent placements
Antegrade stenting offers a reliable solution when traditional routes are obstructed, allowing for both immediate relief and long-term management of urinary obstruction.
Recovery and Follow-Up Care
Regardless of the insertion method, follow-up imaging (such as ultrasound or CT scans) is typically scheduled to confirm correct stent positioning and monitor kidney recovery. Most stents remain in place temporarily—ranging from a few weeks to several months—depending on the underlying cause of hydronephrosis.
Patients should maintain open communication with their healthcare provider, report any signs of infection (like fever or chills), and adhere to recommended removal or replacement schedules to avoid complications such as encrustation or stone formation.
Advancements in urological techniques continue to improve patient outcomes, making stent placement safer, more precise, and increasingly comfortable. Whether approached from below or above, modern interventions offer effective solutions for managing hydronephrosis and preserving kidney health.