The cirrculum states: knows: Emergency ureteric stenting for infected obstructing kidney
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- Pre-Procedure Preparation
- Obtain informed consent, discuss risks: infection, hematuria, stent migration
- Administer prophylactic antibiotics
- Review imaging (CT KUB, IVU) to identify obstruction and ureteric anatomy
- Position the patient in lithotomy
- General or spinal anaesthesia
- Equipment
- Rigid or flexible cystoscope
- Hydrophilic or PTFE guidewire
- Ureteric catheter (for contrast injection)
- Double J stent (typically 4.8–6 Fr, 22–28 cm in length)
- Fluoroscopy unit (C-arm)
- Contrast agent for retrograde pyelogram
- Step-by-Step Technique
- Cystoscopy
- Insert cystoscope into urethra and advance into bladder
- Identify bladder landmarks and locate the ureteric orifice
- Guidewire Insertion
- Pass guidewire into the ureteric orifice and advance up to the renal pelvis
- Confirm position with contrast injection (retrograde pyelogram) under fluoroscopy
- Stent Insertion
- Load stent over the guidewire and advance using the pusher
- Confirm the proximal loop in the renal pelvis and distal loop in the bladder under fluoroscopy
- Final Confirmation
- Remove guidewire carefully while holding stent in place
- Confirm urine drainage through stent and position of lower coil in bladder
- Remove cystoscope and complete the procedure
- Cystoscopy
- Post-Procedure Care
- Monitor for hematuria, pain, or signs of infection
- Check urine output and renal function