TAH BSO with Ureteral Stents

  1. Can someone enlighten me?

    We had a patient on the floor today (Med-Surg) that had a TAH BSO done. Additionally, a Foley catheter was placed with Ureteral Stents. What I believe to be the stents were visable and blue. The lady felt an overwhelming desire to void, and her bed kept getting soaked with yellow urine to pink urine. The foley appeared to be draining and a bladder scan done showed 200 cc of urine in the bladder.

    I have not had any experience with this, and could not find a nurse on the floor that had any experience with this either.

    I have tried to google to learn more about the stents for future reference (my floor is typically abd sx, ca, etc - we will be seeing more GYN sx in the future) and I am not coming up with much info. Does anyone have any info they can share? I am still a relatively new nurse on a floor of nurses even newer than me!

    Thanks,
    Jenn
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    About JustJen

    Joined: Feb '05; Posts: 67; Likes: 14
    ED
    Specialty: 5 year(s) of experience in Oncology, Med-Surg, ED

    10 Comments

  3. by   skipaway
    Yes, I believe those are stents. Stents are hollow, strawlike tubes that are placed in the ureters so that during surgery the doctors can feel the ureters and not accidently damage them. I usually see them placed in patients the doctor feels may have alot of adhesions or if there is tumor envolvement. The stents drain each kidney into the bladder and should be in the bladder. Sounds like one may have migrated out of the bladder and that is why you are seeing yellow, pink tinged urine on her bed sheets. The surgeon should come by and pull it. There is no need for it now. Sometimes stents have thread attatched to them and the surgeon will pull on the string to d/c the stents. Sometimes the surgeon has the surgical tech remove the strings. Hope this helps.
  4. by   Gompers
    Quote from skipaway
    Yes, I believe those are stents. Stents are hollow, strawlike tubes that are placed in the ureters so that during surgery the doctors can feel the ureters and not accidently damage them. I usually see them placed in patients the doctor feels may have alot of adhesions or if there is tumor envolvement. The stents drain each kidney into the bladder and should be in the bladder. Sounds like one may have migrated out of the bladder and that is why you are seeing yellow, pink tinged urine on her bed sheets. The surgeon should come by and pull it. There is no need for it now. Sometimes stents have thread attatched to them and the surgeon will pull on the string to d/c the stents. Sometimes the surgeon has the surgical tech remove the strings. Hope this helps.
    I had a ureteral stent in after I had my kidney stones removed, and I had to pull the little string and D/C it myself!!! They put it in because they scoped the ureter and didn't want it to swell shut as it was healing. I was instructed to pull it about 3 days post-op. It was like a foot long, with curled ends that would rest in the kidney and bladder. If you are seeing it, then I agree that it was coming out on it's own and the doc should be called to pull it. Don't know why the urine was pink, though. Unless they did any work on the bladder or kidneys, there shouldn't be blood in the urine...
  5. by   skipaway
    Quote from Gompers
    Don't know why the urine was pink, though. Unless they did any work on the bladder or kidneys, there shouldn't be blood in the urine...
    Sometimes the ureteral catheter itself causes some irritation to the ureters and the bladder, plus during surgery, the bladder is manipulated and manually retracted causing irritation. This can manifest itself by blood tinged urine.
  6. by   Marie_LPN, RN
    Blood-tinged urine can happen after stent insertion, escially if the stent wasn't easy to get in there. Think of it this was, you have a size 19 or 22 metal cystoscopy scope going into a urethra, moving all around. That's enough to cause irritation and bleeding. Some people experience bladder spasms after a cystoscopy or stent insertion.

    BUT, you say they are blue. When stents are in there should be a little length from each in the bladder, but the string from the stent should be the only thing seen from the outside (usually tiny and black and some docs may cut the string). If the stent is visible, the doc needs to either pull that thing or do a reinsertion (under anesthesia of course).
    Last edit by Marie_LPN, RN on Oct 27, '06
  7. by   Gompers
    Quote from Marie_LPN
    Blood-tinged urine can happen after stent insertion, escially if the stent wasn't easy to get in there. Think of it this was, you have a size 19 or 22 metal cystoscopy scope going into a urethra, moving all around. That's enough to cause irritation and bleeding. Some people experience bladder spasms after a cystoscopy or stent insertion.

    BUT, you say they are blue. When stents are in there should be a little length from each in the bladder, but the string from the stent should be the only thing seen from the outside (usually tiny and black and some docs may cut the string). If the stent is visible, the doc needs to either pull that thing or do a reinsertion (under anesthesia of course).
    Oh, I know with a scope there will be bleeding - I had a scope for my stones and it was like peeing cherry Kool-Aid for the rest of the day. I just meant with a hysterectomy, why would they be scoping the ureters? Makes sense that there would be scant blood though just from the stents themselves.
  8. by   skipaway
    Quote from Gompers
    Oh, I just meant with a hysterectomy, why would they be scoping the ureters? Makes sense that there would be scant blood though just from the stents themselves.
    See my above reply. Stents are placed by a urologist, with a ureteroscope, in alot of abdominal surgeries if pt's have tumors, adhesions or if the surgeons are for some reason concerned they'll damage the ureters during surgery. The stents allow the surgeons to feel where the ureters are during the procedure.
  9. by   Marie_LPN, RN
    I just meant with a hysterectomy, why would they be scoping the ureters?
    Sometimes stents are inserted because the ureters aren't easy to see or feel during surgery.

    We have a few surgeons who scope after a hysterectomy to make sure the bladder is ok (since it and the ureters are in such close proximity to the area being worked on during the hysterectomy), and to make sure the ureters are draining urine. Indigo Carmine is sometimes put in IV a few moments before closing the abdominal incision, this way the urine is more visual during scoping (which also explains why some women have blue or green urine in their Foley bag post-op).

    We have only had one pt. in the past 3 years that had a ureteroscopy (a smaller scope that scopes inside of the ureters, up to the kidney) post-op, and that was because one of the pt.'s ureters was 3 times its normal size, and a hard mass was felt during a hysterectomy. It was later determined that this pt. had a HUGE stone, and luckily this was taken care of while she was still in the hospital, because she may have gone home with that stone, and never would have known it, until it was very painful, or worse.
    Last edit by Marie_LPN, RN on Oct 28, '06
  10. by   JustJen
    Thanks for all of your replies!

    I work nights, so if this happens in the future - would it be something to call the doc about at 3 am, or would you wait til 7? I have not so worried about the blood tinged urine, all her parts had been very manipulated. I was more concerned that I could see the stents(or what I believe to be the stents).

    THanks again for all of you help and interesting stories!
  11. by   Marie_LPN, RN
    I work nights, so if this happens in the future - would it be something to call the doc about at 3 am, or would you wait til 7?
    Our urologists tell the nurses to call them.
  12. by   JustJen
    Thank you for the above info Marie! My gut was telling me it was appropriate to call ....being a new nurse, it is gratifying to know my gut was right!

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