A ureteral stent is a thin, flexible tube inserted into the ureter (the channel connecting the kidney to the bladder) to restore or maintain urine flow. The Double J Stent is a common internal ureteral stent used in urology. Its primary function is to bypass an obstruction, ensuring urine drains freely from the kidney down to the bladder. This temporary device prevents the harmful buildup of urine pressure in the kidney, known as hydronephrosis.
Structure and Function
The Double J Stent is a thin, hollow tube, typically constructed from biocompatible materials like polyurethane or silicone, allowing it to remain flexible. Its defining feature is the curled or “pigtail” shape at both ends, which gives the device its name and resembles the letter “J” on each side. The stent runs the entire length of the ureter, with one curved end positioned inside the kidney’s urine-collecting area (renal pelvis) and the other secured within the bladder.
These curved ends are essential because they anchor the stent in place, preventing it from migrating. The stent acts as a scaffold to keep the ureter open, ensuring a continuous channel for urine drainage. The stent’s presence can also help the ureter dilate or widen slightly, which is beneficial when preparing for certain stone removal procedures.
Conditions Requiring Placement
The most frequent reason for placing a Double J Stent is to manage ureteral obstruction. Kidney stones (nephrolithiasis) are the leading cause, as a stone lodged in the ureter can completely stop urine flow and lead to severe pain and potential kidney damage. Placing a stent relieves this obstruction immediately by creating a bypass channel.
The stent is also used to manage strictures, which are abnormal narrowings of the ureter often caused by scar tissue or inflammation. It facilitates urine drainage when the ureter is compressed by external masses, such as tumors in the pelvis or abdomen. Surgeons also place the stent as a prophylactic measure after complex urological surgeries to ensure proper healing and prevent swelling from causing a new blockage. In these cases, the stent acts as a mold to support the ureter during post-operative recovery.
The Patient Experience: Common Side Effects
The presence of a Double J Stent often causes uncomfortable symptoms referred to as “stent syndrome,” affecting up to 80% of patients. Common complaints include increased urinary frequency and urgency, resulting from the stent’s lower end irritating the bladder lining. Patients may also feel a burning sensation during urination (dysuria).
Flank pain or discomfort in the lower back is another frequent side effect, often occurring during or immediately after urination. This pain is caused by vesicoureteral reflux, where urine flows backward up the stent to the kidney when the bladder contracts, causing a sudden pressure increase. Hematuria (blood in the urine) is also common and often increases with physical activity as the stent rubs against the ureteral wall.
Managing these symptoms involves increasing fluid intake and taking pain medication, which may include alpha-blockers or anticholinergics to calm bladder spasms. Patients should seek immediate medical attention if they experience warning signs such as:
- A fever over 101°F (38.3°C).
- Severe pain that cannot be managed with medication.
- A sudden inability to urinate.
These symptoms may indicate a severe infection or a blocked stent.
Insertion and Removal Procedures
Insertion
Double J Stent insertion is typically performed using cystoscopy, a minimally invasive endoscopic technique. The patient receives sedation or general anesthesia while the urologist inserts a thin, lighted instrument (the cystoscope) through the urethra into the bladder. The surgeon locates the ureter opening and guides a wire into the kidney.
The stent is advanced over this guide wire into the correct position, confirmed using fluoroscopy (real-time X-ray imaging). The procedure is often completed in under an hour, and patients typically go home shortly after recovering from anesthesia. The duration the stent remains in place varies widely, from a few days to several months, depending on the underlying medical issue.
Removal
Stent removal is also done using a cystoscope in a quick, outpatient setting, often requiring only local anesthetic gel. The urologist inserts the scope, grasps the lower coiled end of the stent with a small instrument, and gently pulls it out through the urethra.
In some cases, a string is left attached to the lower end of the stent and secured outside the body. This allows the patient or healthcare provider to remove the stent by simply pulling the string. The removal process is generally brief, lasting only a few minutes.