Double J-stent

This information on double-J stent placement explains the procedure, includes an animation of what happens during placement, and answers the most frequently asked questions.

What is a stent?

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.

What is a Double-J stent?

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

Why is a stent needed?

Stents are used for various reasons in patients with kidney stones. They can be placed to help reduce sharp pain from a stone (renal colic) or to allow drainage when infection is present or when a stone prevents a kidney from working adequately. Stents are commonly placed after surgery for stones (for example, ureteroscopy) to allow healing and to ensure that swelling does not block the drainage of urine after the procedure.

How is the procedure performed?

The procedure is usually performed with the patient asleep (under general anaesthesia). Sometimes a local anaesthetic, with or without sedation, is administered.

During this procedure, a tube with a tiny optic camera is inserted through the urethra into your bladder. The bladder is inspected, and the ureteric opening is located. The urologist may use x-ray images taken with a contrast agent (dye) in the ureters to assess the urinary tract and to locate the obstruction.

The stent is placed during surgery by sliding it over a guidewire placed in the ureter (the tube that drains urine from the kidney into your bladder).

Fig 1. A Double-J stent is inserted to make sure urine can flow through the urinary tract.
Fig 1. A Double-J stent is inserted to make sure urine can flow through the urinary tract.

How to prepare for the procedure

Always ask your doctor about the treatment steps and any special instructions. These can differ by hospital and country.

Instructions may include:

  • when to stop certain medications, such as blood thinners
  • when to stop eating and drinking before the procedure to prepare for anaesthesia
  • when to empty the bladder before the procedure
  • when to arrange pain medication after the procedure, if necessary—discuss this early with your nurse and/or doctor
  • arranging for a ride home after your hospital discharge

Before surgery, someone from your health care team—usually the anaesthesiologist—will assess which type of anaesthesia is appropriate for you.

Depending on the country you live in and your hospital, types of anaesthesia can include:

  • General anaesthesia
  • A local anaesthetic with or without sedation
  • You may be asked to give a urine sample before the procedure to test for a urinary tract infection.

Medical team

It is important that your care team is informed about your treatment. This includes the doctor and nurses in the hospital, who are responsible for your treatment, as well as your general practitioner and other caregivers with whom you are in contact.

Support and questions

Having your partner, relatives, or friends read the information about the procedure can help and can make you feel more comfortable. Write down all your questions to remind you of any important points you need to discuss with your doctor or nurse.

Let someone accompany you to an appointment to help you remember any questions you need to ask.

The operation

This animation shows what happens when you undergo double-J stent placement.

 

What to expect after the procedure

The stent will be removed later on. Sometimes it is used temporarily before stone removal with another procedure.

Depending on the hospital’s protocol, you will proceed to the recovery room or to your own room after the procedure. Your blood pressure, heart rate, and pain will be checked regularly. Ask your nurse about visiting hours for friends and relatives.

You will likely leave the hospital shortly after the procedure, when you are able to empty your bladder sufficiently and you have no fever or not in too much pain.

You may feel mild to moderate pain in your lower abdomen, and you may have a strong urge to urinate. These symptoms are usually caused by the inserted stent. Medication is available to treat these symptoms. Do ask your doctor.

What to expect back home

At hospital discharge, your doctor or nurse will give you instructions for rest, driving, and doing physical activities after the procedure.

Because surgical instruments were inserted into your urinary tract, you may experience urinary symptoms for some time after surgery. These symptoms usually disappear in a few weeks.

Symptoms may include:

  • a mild burning feeling when urinating
  • small amounts of blood in the urine
  • mild discomfort in the bladder area or kidney area when urinating
  • need to urinate more frequently or urgently
  • pain resulting from an internal abrasion that needs time to heal

Try to drink fluids often but in small quantities. Sometimes a blood clot can cause pain (colic). The urine contains a substance (called urokinase) that will dissolve this clot.

If the pain remains despite use of pain medication, contact the hospital or your doctor.

What can I do the first week after surgery ?

  • Try to drink enough fluids: 1.5 litres daily (in small quantities) throughout the day to facilitate urine flow and the spontaneous loss of small stone fragments.
  • Try not to have sex within the first week after the procedure to avoid urinary tract infections.
  • Eat more vegetables and less meat to have softer stool—the inner healing process will be helped if you do not have to squeeze when using the toilet.
  • Allow your body to rest during the first week after the procedure—you are allowed to lift a maximum of 5 kg and to go for walks. You can start cycling and exercising after this period.

When should I call the hospital or my general practitioner?

  • When you have a fever higher than 38.5°C
  • When you experience a serious burning sensation (not mild) when urinating
  • When you are unable to urinate
  • When you see large amounts of blood in your urine and it does not go away with rest and hydration
  • When you continue to have severe pain in your side, despite use of pain medication

Tell your doctor right away if bleeding or pain is severe or if problems last longer or worsen after you go home from the hospital.

Your doctor may prescribe an antibiotic to treat or prevent an infection or to relieve your pain. Report any signs of infection––including severe pain, chills, or fever—to your doctor right away.

Follow-up

When is the double-J stent removed?

During an appointment in the hospital, your doctor will tell you when the double-J stent needs to be removed. This can be in several days or within a few weeks.

How is a stent removed?

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 tube that transports the urine from the bladder to the outside of the body). The string can be used to pull on the stent and remove it. If a string is not attached, numbing medication is usually administered, and 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.

When the stent was placed during a procedure for stone removal

If a stone is removed during the procedure, it is sent to the laboratory to determine its composition. This may take several weeks. Based on the laboratory results, along with blood and urine tests taken before treatment, your doctor can determine whether you are at high risk of forming new stones (recurrence).

The results will be discussed with you during an appointment in the hospital or with your doctor (the follow-up).

What if the doctor suspects that I have a high risk of forming new stones?

If the results show that you have a high risk of forming more stones, your doctor will do a metabolic evaluation. This is a series of blood and urine tests to determine the possible causes of your stone formation. Depending on the test results, your doctor will recommend preventive measures or further tests. Besides changes in your lifestyle, you may be advised to take medication that reduces the risk of stones recurring. Generally, the medication will cause few to no side effects.

Changes in your lifestyle

Even if you have a low risk of forming another stone, your doctor and nurse will advise you to make some lifestyle changes.

Lifestyle changes may include:

  • Increasing fluid intake: Drink 2.5-3.0 litres per day to neutralize the pH of your urine
  • Adopting a balanced diet with less meat and alcohol and more vegetables and fibre to have normal calcium levels and less intake of animal proteins
  • Maintaining a healthy weight and adequate physical activity

FAQs

How long will I have the stent?

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.

Should I take an antibiotic?

Your doctor may prescribe an antibiotic to treat or prevent an infection or to relieve your pain. Report any signs of infection––including severe pain, chills, or fever—to your doctor right away.

I’ve had pain with the urge to urinate since the stent was placed. Is that normal?

You may feel mild to moderate pain in your lower abdomen, and you may have a strong urge to urinate. These symptoms are usually caused by the inserted stent. Ask your doctor about medication to treat these symptoms. Call the hospital or your doctor if you experience a serious burning sensation (not mild) when urinating or if you continue to have severe pain despite use of pain medication.

I’ve had blood in my urine since the stent was placed. Is that normal?

Small amounts of blood may be present in the urine after stent placement and usually disappear in a few weeks. Call the hospital or your doctor if you see large amounts of blood in your urine and it does not go away with rest and hydration.

Will the stent move inside me?

Yes, the stent is flexible and will move with your body.

Can the stent fall out?

The curved ends of a double-J stent usually keep it in place. In rare cases, however, the stent may slip into the bladder or the kidney.

If the stent falls out, what should I do?

It is very rare for a stent to fall out of the body. If this happens, wash the stent and place it in a plastic bag. Contact your doctor and bring the stent with you to your appointment.

How is a stent removed?

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, numbing medication is usually administered, and a small camera called a cystoscope is inserted through a flexible tube into the urethra. The cystoscope is advanced into the bladder along with a grasping instrument, which grasps and removes the stent.

Will I be asleep when the stent is removed?

Removal is very quick. A local anaesthetic is usually administered to numb the area.

Will I be in pain after I have the stent pulled?

You may experience some mild discomfort immediately afterwards. Some patients have severe pain that is temporary and resolves within a few hours.

Should I take pain medication before the stent pull?

Taking an NSAID (for example, ibuprofen) prior to stent removal can help minimise pain afterward. Always ask your doctor about treatment steps and any special instructions before a procedure.

Why is there pain after the stent is removed?

A medical device was present in your urinary tract, so some mild discomfort is expected when it is removed. More severe pain may result if the ureter spasms or swells. These symptoms disappear in a few hours. Taking an NSAID (for example, ibuprofen) before stent removal can help minimise pain.