ureteric stent and uti's

[fuentejps]

ok, I had posted about bladder uti issue long ago when it started. had urosepsis in January then began 1x daily gent instil, no uti for 5 mths. then got uti, ultrasound showed ureter blocked and hydroneprosis again. uro did scope with retro pylogram, die wouldn't drain so stent put in.

a lot of pain and ad with the styent, he warned me prior. yadda yadda I can deal with this no meds just motrin, HOWEVER I'm getting uti's since stent placed. from what I have read this can be a major problem for ppl with stents. good news is kidney is normal now, will likely have stent for 3mths.

nurses, any thoughts on how to avoid these uti's while stent is in? 30yrs post sci- I cath 1x at night and can reflex void without external and bag during day. I have sensation of when bladder contracts. external cath and night bag for bed. I drink a lot of water and pee a lot.

[gjnl]

ok, I had posted about bladder uti issue long ago when it started. had urosepsis in January then began 1x daily gent instil, no uti for 5 mths. then got uti, ultrasound showed ureter blocked and hydroneprosis again. uro did scope with retro pylogram, die wouldn't drain so stent put in.

a lot of pain and ad with the styent, he warned me prior. yadda yadda I can deal with this no meds just motrin, HOWEVER I'm getting uti's since stent placed. from what I have read this can be a major problem for ppl with stents. good news is kidney is normal now, will likely have stent for 3mths.

nurses, any thoughts on how to avoid these uti's while stent is in? 30yrs post sci- I cath 1x at night and can reflex void without external and bag during day. I have sensation of when bladder contracts. external cath and night bag for bed. I drink a lot of water and pee a lot.

You are most likely retaining urine after you think you may have emptied your bladder using reflex voiding. That retained urine in the bladder is brewing up bacteria, causing the urinary tract infections. The healthiest thing you can do for your bladder and kidneys is go to CIC, Clean Intermittent Catheterization, every 4-6 hours around the clock. But, I think that has been suggested before.

I had a Urolume mesh stent placed about 20 years ago. This is a non-magnetic wire stent that allows epithelialization that helps to keep the stent in place. This means that tissue grows over and between the mesh, embedding it in the urethra helping to prevent migration and encrustation. While it has been said that these stents can be removed, they rarely are because of the arduous task of releasing the stent from all the epithelial coverage using a resectoscope. I've had three urologist say they wouldn't even consider trying to remove this kind of stent. You, of course, may have something different, however, what does your urologist think will change for you in three months to warrant the removal of the stent?

[fuentejps]

GJ, ureter not urethera. temporary in ureter.

You are most likely retaining urine after you think you may have emptied your bladder using reflex voiding. That retained urine in the bladder is brewing up bacteria, causing the urinary tract infections. The healthiest thing you can do for your bladder and kidneys is go to CIC, Clean Intermittent Catheterization, every 4-6 hours around the clock. But, I think that has been suggested before.

I had a Urolume mesh stent placed about 20 years ago. This is a non-magnetic wire stent that allows epithelialization that helps to keep the stent in place. This means that tissue grows over and between the mesh, embedding it in the urethra helping to prevent migration and encrustation. While it has been said that these stents can be removed, they rarely are because of the arduous task of releasing the stent from all the epithelial coverage using a resectoscope. I've had three urologist say they wouldn't even consider trying to remove this kind of stent. You, of course, may have something different, however, what does your urologist think will change for you in three months to warrant the removal of the stent?

[fuentejps]

anyone? I'm sure there are others with experience with these kidney to bladder stents.

[SCIfor55+yrs.]

John, reflex voiding drives the pressure in the bladder up. When the pressure gets to a high enough level it drives the urine up the ureter. The only way I can think of to keep the pressure down is to cath more frequently. Keeping the pressure down to a level below the reflex threshold might help. You have the same problem that I had decades ago that resulted in my ileal conduit. That is why reflex voiding is losing support by urologists.

[fuentejps]

my uro and ID dr think the blocked ureter is the reason this started out of nowhere last year. the urine laying in my kidney and not draining. I do understand about the high pressure, mine is on the highside.

John, reflex voiding drives the pressure in the bladder up. When the pressure gets to a high enough level it drives the urine up the ureter. The only way I can think of to keep the pressure down is to cath more frequently. Keeping the pressure down to a level below the reflex threshold might help. You have the same problem that I had decades ago that resulted in my ileal conduit. That is why reflex voiding is losing support by urologists.

[SCI-Nurse]

I think SCIfor55 has a good point. If you are refluxing urine up your ureter due to high bladder pressures, especially when reflex voiding (which can be determined by doing a videourodynamics study), having the ureteral stent in place can actually now make it easier for colonized urine to go from your bladder to your kidney, causing a true UTI.

If your stent was placed because of a swollen or scarred ureter, then the stent will allow urine to flow either upstream or downstream more easily now. Ureteral stents are not left in place long term because of this. Generally they are removed 4-6 weeks after placement. 3 months is a long time to leave one in place. You may want to discuss this with your urologist for their rationale for this time period.

A URETHRAL stent, mentioned by gjnl above, is a completely different device, placed for a completely different reason.

Here is a diagram of a ureteral stent in place.



(KLD)

[fuentejps]

thx KLD. I was just guestimating. he didn't give a removal time. wanted to see followup ultrasound which was done last week and showed kidney back to normal, its been in 3 weeks today. my followup is next week at 4 weeks.
yes had vid urodynamics done last fall showed reflux at 350-450 ml, however when I do cath I rarely am over 400ml.

I think SCIfor55 has a good point. If you are refluxing urine up your ureter due to high bladder pressures, especially when reflex voiding (which can be determined by doing a videourodynamics study), having the ureteral stent in place can actually now make it easier for colonized urine to go from your bladder to your kidney, causing a true UTI.

If your stent was placed because of a swollen or scarred ureter, then the stent will allow urine to flow either upstream or downstream more easily now. Ureteral stents are not left in place long term because of this. Generally they are removed 4-6 weeks after placement. 3 months is a long time to leave one in place. You may want to discuss this with your urologist for their rationale for this time period.

A URETHRAL stent, mentioned by gjnl above, is a completely different device, placed for a completely different reason.

Here is a diagram of a ureteral stent in place.



(KLD)

[SCI-Nurse]

In general then, I would recommend cathing more than only once daily to reduce your residual urine. Do you know what your residual is when you reflex void?

(KLD)

[fuentejps]

yah, it varies a bit. they had me void when doing ultrasound, had 300ml left 1x and 225ish last time. it's weird, normally my voids(I use a urinal as I have sensation when I am going to void, I'm incomplete) are around 10oz(300ml) normally and sometimes nearly 400ml.

In general then, I would recommend cathing more than only once daily to reduce your residual urine. Do you know what your residual is when you reflex void?

(KLD)