DJ Stent Placement

Q 1. What is a DJ stent?

A.  A stent is a soft, hollow, plastic tube. Ureteral stents are placed temporarily into the ureter which is the tube that drains urine from the kidney into your bladder. The stent allows drainage around a stone or can speed up healing after stone surgery.

A double-J stent is a ureteral stent with curving ends that prevent the stent slipping into the bladder or the kidney

Q 2. What is this procedure?

A. This procedure involves telescopic inspection of the bladder and urethra combined with insertion, removal or changing of a soft plastic tube (DJ Stent) placed between the kidney and the bladder.

This usually includes cystoscopy and X ray screening.

Q 3. What are the indications of DJ stent placement?

A. Ureteric stents are inserted for many reasons but the commonest indications are:

  • Blockage of the ureter (the tube draining urine from the kidney to the bladder) or
  • As a prelude to lithotripsy (shockwave treatment) for a large kidney stone.

DJ Stent Placement

 

Q 4. What are the alternatives to this procedure?

A. Observation, placement of a tube directly into the kidney through the back (Per-cutaneous nephrostomy) or open surgical treatment.

Q 5. What should I expect before the procedure?

A. You will usually be admitted a day before or on the same day as your surgery. You will normally undergo pre assessment on the day of your clinic or an appointment for pre assessment will be made from clinic, to assess your general fitness and to perform some baseline investigations. After admission, you will be seen by members of the medical team which may include the consultant, junior urology doctors and your named nurse. An x-ray may be taken in advance of surgery to confirm the position of your stone(s).

You will be asked not to eat or drink for six hours before surgery and, immediately before the operation, you may be given a pre-medication by the anaesthetist which will make you dry-mouthed and pleasantly sleepy.

Please be sure to inform your urologist in advance of your surgery if you have any of the following:

  • Co-morbidities like Diabetes, Hypertension, Coronary artery disease or, stroke, epilepsy
  • Any transmissible disease like HIV/AIDS, Hepatitis B or C etc
  • Presence of implants, pacemakers, graft etc
  • You are taking prescription drugs like-
    • Blood thinners/ anti-platelets i.e. Warfarin, ecosprin, clopidogrel etc
    • Anti-epileptics like phenytoin, valproate etc

Q 6. What happens during the procedure?

A. Normally, a full general anaesthetia or spinal anaethesia will be used and you will be asleep throughout the procedure. You will usually be given injectable antibiotics before the procedure, after checking for any allergies.
A telescope is inserted into the bladder through the water pipe (urethra) to inspect both the urethra itself and the whole lining of the bladder. A stent is then inserted into the ureter, using the telescope, under x-ray guidance. A bladder catheter may be left in place.

DJ Stent Placement

Q 7. What happens immediately after the procedure?

A. You will normally be allowed home once you have passed urine satisfactorily. If a catheter
is left in place, this will normally be removed within 24 hours and you will be discharged once you have passed urine satisfactorily.

The average hospital stay is 12 to 36 hours.

Q 8. What are the side effects?

A. Most procedures have a potential for side effects. You should be reassured that, although all these complications are well recognised, the majority of patients do not suffer any problems after a urological procedure.

Common (greater than one in 10)

  • Mild burning or bleeding on passing urine for short period after operation
  • Temporary insertion of a catheter
  • Temporary discomfort from tube causing pain, frequency and occasional blood in urine

Occasional (between one in 10 and one in 50)

  • Infection of bladder requiring antibiotics
  • Occasionally we cannot pass the stent requiring alternative treatment
  • Permission for telescopic removal/ biopsy of bladder abnormality/stone if found

Rare (less than one in 50)

  • Delayed bleeding requiring removal of clots or further surgery
  • Injury to the urethra causing delayed scar formation

Q 9. What should I expect when I get home?

A. When you leave hospital, you will be given a discharge summary of your admission. This holds important information about your inpatient stay and your operation.

When you get home, you should drink twice as much fluid as you would normally to flush your system through and minimise any bleeding. You should aim to keep your urine permanently colourless to minimise the risk of further stone formation.

You may experience pain in the kidney over the first 24 to 72 hours, due to the swelling caused by insertion of the instrument or by the presence of a stent.

Anti-inflammatory painkillers will help this pain which normally settles after 72 hours.
It will take at least 10 days to recover fully from the operation. You should not expect to return to work within seven days.

You may find that, when you first pass urine, it stings or burns slightly and it may be lightly bloodstained.

In approximately 60% of patients some discomfort, similar to cystitis, persists until the stent is removed.

Simple painkillers will usually help but there is nothing to be gained from treatment with antibiotics unless there is a proven urinary infection. Occasionally, this pain can be severe enough to merit early removal of the stent.

Q 10. What else should I look out for?

A. If you develop a fever, severe pain on passing urine, inability to pass urine or worsening bleeding, you should contact your urologist immediately. Small stone fragments may also pass down the ureter from the kidney, resulting in renal colic; in this event, you should contact your urologist immediately.

Q 11. What all can I do after my discharge?

A. Try to drink enough fluids daily (in small quantities) throughout the day to help urine flow and small stone fragments to drain spontaneously.

  • Eat more vegetables and less meat to have a softer stool—if you do not have to squeeze during the toilet visit, it will help the inner healing process.
  • Give your body a rest during the first week after the procedure. Be careful lifting heavy objects and doing strenuous exercises

Q 12. When to contact my doctor?

A. When you have:

  • Fever higher than 38.5 degrees; Nausea and vomiting
  • Chest pain and difficulty breathing
  • Large amounts of blood in your urine, and it does not go away with rest or hydration
  • Severe pain in your side, despite taking pain medicine
  • A serious burning sensation (not mild) when urinating
  • Inability to urinate
  • Tell your doctor right away if bleeding or pain is severe or if problems last longer or worsen after you leave the hospital.

Q 13. What is the follow-up after surgery?

A. A follow-up appointment will be scheduled with you prior to discharge from the hospital. This appointment might be necessary for:

  • Laboratory results
  • Ultrasound or X-rays to check for stones
  • Removal of double-J stent
  • Further treatment like PCNL, URSL, Pyeloplasty etc

Q 14. How long will I have the stent?

A. From several days to a few weeks, depending on why it was placed. Your doctor will tell you when the double-J stent needs to be removed.

Q 15. How is a stent removed?

A. Stents can be removed two different ways. Sometimes a string has been left attached to the end of the stent. This string is allowed to come out of the patient’s urethra. The string can be used to pull on the stent and remove it.

If a string is not attached, a small camera called a cystoscope is inserted into the urethra. The cystoscope is advanced into the bladder along with a grasping instrument, which grasps and removes the stent.

Q 16. Do I need to get re-admitted for DJ Stent removal?

A. Yes, you will need day-care admission. DJ stent will be removed under short general anesthesia.