A Double J stent is a temporary, flexible tube placed within the ureter, the narrow passage connecting the kidney to the bladder. This medical device ensures the continuous flow of urine, bypassing any obstruction that might prevent drainage from the kidney. The purpose of the stent is to protect the kidney from damage caused by urine backup, known as hydronephrosis. It is a common urological tool used to allow the urinary tract to heal or to manage a blockage.
Structure and Purpose
The device is named a “Double J” stent because of its distinct shape, featuring a curved or “J” curl at both ends. One J-shaped end coils securely within the kidney’s urine-collecting area, the renal pelvis, while the opposite end curls inside the bladder. This design, often called a pigtail, prevents the stent from migrating out of position down the ureter.
These stents are constructed from flexible polymers, most commonly polyurethane or silicone. While the dimensions vary based on a patient’s anatomy, they are typically between 12 to 30 centimeters long. The stent’s primary function is to maintain the patency of the ureter, keeping the tube open and ensuring a clear path for urine to travel from the kidney to the bladder.
Common Reasons for Placement
The most frequent indication for placing a Double J stent is to relieve a blockage in the ureter. Kidney stones are a leading cause of obstruction, requiring stent placement to restore urine flow. When a stone is too large to pass naturally, the stent provides immediate relief from the painful pressure buildup in the kidney.
A stent is also used to manage ureteral strictures, which are abnormal narrowings that impede urine passage. Additionally, the device is routinely placed following urological surgeries, such as ureteroscopy for stone removal. In these post-operative cases, the stent acts as a splint to allow the ureteral lining to heal from trauma or swelling and to prevent scar tissue formation.
Insertion and Removal Procedures
The insertion of a Double J stent is typically performed endoscopically, meaning the procedure is minimally invasive. A urologist uses a thin, lighted instrument called a cystoscope, passed through the urethra and into the bladder. Once the opening to the ureter is located, a guidewire is advanced up to the kidney, and the coiled stent is then threaded over the wire into its final position.
Placement is confirmed using fluoroscopy, a continuous X-ray imaging technique, ensuring the upper J-curl is seated in the kidney and the lower curl rests in the bladder. This procedure is commonly done under sedation or general anesthesia. The removal of the stent is usually a quick, separate outpatient visit.
For removal, a cystoscope is re-inserted into the bladder, a small grasping instrument retrieves the bottom J-curl, and the stent is gently pulled out. In some cases, a thin retrieval string is left attached, extending outside the body through the urethra, allowing the patient to remove the stent at home under a doctor’s instruction.
Life with a Ureteral Stent
Many individuals experience noticeable symptoms while living with a Double J stent, which can affect their quality of life until the device is removed. A common complaint is flank pain, often referred to as “stent pain,” felt in the back or side, which may radiate down to the groin. This pain often intensifies during urination because the bladder muscle contracts, squeezing the lower end of the stent and causing urine to momentarily reflux back up to the kidney.
The presence of the stent in the bladder can also act as an irritant, leading to increased urinary frequency and a strong urge to urinate. Patients may also notice hematuria, or blood in the urine, which is usually mild and becomes more noticeable after physical activity or exercise.
To manage these common side effects, staying well-hydrated is recommended, as drinking plenty of fluids helps to dilute the urine and reduce irritation. Patients are typically advised to limit strenuous activities and heavy lifting, which can exacerbate the flank pain. Certain medications, such as alpha-blockers, may be prescribed to relax the ureter and bladder muscles, helping alleviate some of the stent-related discomfort.
Patients must be aware of warning signs that require immediate medical attention to prevent serious complications. Prompt contact with a healthcare provider is warranted if any of the following occur:
- A fever of 100.4°F (38°C) or higher, which can indicate a serious urinary tract infection.
- Severe, unrelenting pain not relieved by prescribed medication.
- A complete inability to urinate.
- A sudden, significant increase in blood in the urine.
- The stent accidentally falls out.