We are based at Kent and Canterbury Hospital as part of the Urgent Care Centre. We have a team of Nurses and Urology registrars and Consultants on call for any advice and guidance. This walk in service is provided 24 hours a day and 7 days a week, if you need urgent medical care please call NHS 111. Many of our renal colic patients who present with renal colic pain, vomiting and a fever and associated symptoms with renal colic can be reviewed here and then will be reviewed and referred to our very skilled Stone team.
What can our team do to treat Renal colic Patients?
When you arrive to urgent care Centre our team will assess your vital signs and give you appropriate pain relief, they will make a note of your medical history. If required you will have CT or x-ray KUB completed to assess your kidney stone and to determine if there is an obstruction. If there is an obstruction or maybe hydronephosis (this is a build up of access fluid) you may be offered to go to theatre to place a stent and then to come back for further surgery when the issue resolves . You will also be sent home with pain relief and medication called tamsulosin. This known as an Alpha blocker and it helps to relax the ureter and surrounding muscles to help prevent an obstruction from becoming worse or happening. If your symptoms become worse you may have to have a nephrostomy inserted.
What is a nephrostomy tube?
As the kidneys make urine, the ureters take the urine to the bladder to be stored until you void or pass urine. When a ureter is blocked by a kidney stone, urine can build up in the kidney instead of the bladder. This causes pain, inflammation and infection (Sepsis). A nephrostomy tube is a narrow tube that is placed through the skin into the kidney to help drain urine, this will help to restore kidney function and provide an entrance into the kidney to take out the stone(s). The Nephrostomy procedure is done by a Radiologist. You will be asked to lie on your side so that the blocked kidney is facing upwards. You will be given a local anaesthetic to freeze the area on your back while you are awake. Sedation and pain control medication can be given through an IV line in your arm if required. The Radiologist then makes a 1 cm (¾ inch) incision in your back. You may feel pulling and tugging on your back when the tube is inserted. A balloon will then be inflated at the end of the tube to hold it in place. Sometimes a Stitch may be needed. You can resume most of your normal activities but we advise that you do not play any contact sports or do heavy lifting for 2 weeks. With regards to hygiene it is important to keep the area clean to prevent infection. You can wash with soap and water in a basin and keep the area clan and dry .You cannot have a tub bath because it will make the incision wet and put you at risk for infection.
The nephrostomy tube will stay in for 2 or more days depending on the obstruction or size of stone. It may be required to stay in until you have your surgery or treatment .Before the tube is taken out, you will have an x-ray called a nephrostogram. A nephrostogram test maybe required this is carried out by our radiology team and diagnostics. The doctor puts a dye into the nephrostomy tube. As the dye moves through the kidney, the doctor checks to see if the kidney stone is gone. If the test is clear, the doctor will order the tubing be clamped. If there are no problems from the tube being clamped, the doctor will take the tube out. A dressing will be applied on the skin where the tube came out. You then have to sit upright for about 4 hours after the tube is pulled.
British Association of Urological Surgeons - Nephrostomy Insertion patient leaflet
What is urosepsis?
Urinary infections can happen to anyone at anytime. Urosepsis happens because of a complication within the urinary system due to infection or an untreated infection. This can happen in our renal colic patients and is quite common. It can be life threatening situation and requires immediate medical care. The signs and symptoms to stay alert for include:
- Pain near the kidneys, on the lower sides of the back
- Nausea with or without vomiting
- Extreme fatigue reduced urine volume or no urine
- Trouble breathing or rapid breathing
- Confusion
- Raised anxiety levels
- A change in heart rate, such as palpitations or a rapid heartbeat
- Weak Pulse
- High fever or low body temperature
- Profuse sweating
Sepsis can lead to severe sepsis, septic shock, or multi-organ failure in some cases. We advise patients to attend our urgent care centre at Canterbury hospital for treatment where our highly skilled team will complete blood tests, a CT to find out the reason ? If there is a stone obstruction. You will be given Intravenous (vein) Antibiotics. Sometimes a urinary catheter will be inserted to monitor your urine output. You may be required to stay in hospital for monitoring.
Ureteric Stent
A ureteric stent is a thin, soft, flexible, plastic tube inserted into the ureter (the tube that carries urine from the kidney to the bladder) to prevent or treat obstruction of the urine flow from the kidney. The length of the stent varies between 8 -11 inches and comes in different diameters. One end of the stent coils inside the kidney and the other end coils in the bladder. The stent allows urine to drain around/through the blockage (stone, stricture, compression, etc.). This helps reduce the pain caused by the obstruction, drain the infected urine and allows your kidney function to improve.
The ureteric stent is placed by the Urologist usually under a short general anesthesia. Alternatively, it can be done under spinal anaesthesia or sedation using a cystoscope placed along the urethra/waterpipe inside the blader over the thin wire under X-Ray guidance. It takes approximately 10 minutes. The patient usually stays in hospital overnight but occasionally may go home the same date based on the Urologist’s assessment.
The Surgeon decides on the length of time the stent remains in the ureter.
Stent Insertion Video https://m.youtube.com/watch?v=rLFVFzyYZ1Y
The British Assoication of Urological Surgeons - Stent Insertion Patient leaflet
