WHAT YOU NEED TO KNOW ABOUT THE DOUBLE-J STENT

This article was translated from the original Portuguese. Português

1- WHAT IS IT?

The double-J stent is a thin, flexible polyurethane tube, approximately 3 mm in diameter and 8 to 35 cm long, widely used by urologists to ensure the flow of urine between the kidney and the bladder.

It is most often used after the treatment of kidney or ureteral stones. It may also be used in complex reconstructive procedures of the urinary system, such as in cancer treatment.

It is called “double-J” because of the curled shape of its ends, which prevents it from moving out of place within the urinary system.

The material is synthetic and flexible, and its ends have shape memory. These features make it easier to place the stent gently and with minimal trauma during surgery.

2- WHAT IS IT FOR?

It ensures the normal flow of urine from the kidney to the bladder. It can also be used after complex reconstructive procedures of the ureter, such as in the treatment of malignant tumors, to prevent small urine leaks into the abdominal cavity.

After surgery for kidney stones, the double-J stent helps eliminate tiny fragments that might otherwise become stuck along the urinary tract after the procedure.

3- WHEN IS IT NEEDED?

A double-J stent may be used whenever there is a risk of interrupting the normal flow of urine between the kidney and the bladder. Its most common use is after the removal of a kidney or ureteral stone.

This is because surgical manipulation of the ureter can cause edema (swelling) that lasts for a few days after the procedure. This can increase the risk of urinary drainage obstruction, even after the stone has been removed.

In special situations, such as after the treatment of certain abdominal cancers, a double-J stent may also be used.

4- WHAT IS IT MADE OF?

The vast majority of double-J stents are made of a plastic-based polymer and surgical-grade polyurethane.

Some stents become more flexible and less uncomfortable when they reach body temperature.

Other materials may also be used, such as platinum alloy and other flexible components based on surgical steel. These are reserved for very special situations, for example when a cancer that has not yet been controlled (with chemotherapy, radiotherapy or even surgery) invades the urinary drainage system.

5- DOES IT CAUSE ANY SYMPTOMS?

The most common symptoms related to the double-J stent are:

• back pain
• a sense of urgency to urinate
• pain or discomfort in the lower abdomen
• a small amount of blood in the urine
• burning when urinating

If fever, general malaise, chills or loss of appetite occur, the surgeon who placed the double-J stent must be informed immediately, because there is a risk of urinary tract infection associated with the stent.

In such situations, a physical examination and imaging and laboratory tests should be performed immediately. Intravenous antibiotics may also be indicated.

6- HOW IS IT PLACED?

Basically, there are three ways to place a double-J stent:

NOTE: In all of the techniques described below, the patient necessarily undergoes anesthesia, which may be general or spinal (depending on each case)

• Endoscopic: A micro-camera is inserted through the urethra to provide images of the inside of the bladder. In this approach, the surgeon identifies the ureteral orifice using a video monitor and real-time X-ray guidance. A guidewire is then advanced from the bladder up to the kidney, serving as a track for correct positioning of the double-J stent.
• Percutaneous: The percutaneous technique is simply a tract created from the skin of the back to the urine-collecting system inside the kidney. With this technique, the guidewire is passed through the tract created by the surgeon and the double-J stent is positioned with the help of real-time X-ray equipment.
• Surgical: The third option is abdominal surgery (open, laparoscopic or robotic). In this approach, the surgeon makes a small incision in the ureter to pass the guidewire and then places the double-J stent. The ureter is then closed with fine absorbable sutures.

7- HOW LONG DOES IT STAY IN THE BODY?

In general, double-J stents are designed to remain in the body for up to three months. Some stents are designed for long-term use of up to 1 year

In most cases, a double-J stent used after kidney stone treatment stays in place for less than 7 days.

8- CAN I HAVE SEX WITH THE STENT IN PLACE?

Yes, there is no contraindication to sexual intercourse while you have a double-J stent. However, some people may feel mild discomfort in the lower abdomen, which is usually not persistent and generally does not require medication for relief.

9- WHAT PRECAUTIONS SHOULD I TAKE?

Drink plenty of water, juices and other clear fluids to keep your urine clear and abundant.

In some situations, antibiotics, anti-inflammatory drugs and pain medication may be needed.

There is no risk of the double-J stent coming out on its own during walking, running or even more intense physical activities such as cycling.

10 - HOW IS IT REMOVED?

Removing a double-J stent is a simple, minor procedure. In some cases, the urologist attaches a thin nylon string to the end of the stent that sits in the bladder. The string is brought out through the urethra and taped to the inner thigh.

The patient is discharged from the hospital with instructions to return to the urologist’s office a few days after surgery. At the office, the urologist applies a local anesthetic gel (in the urethra) and removes the stent by gently pulling on the nylon string.

In special situations (such as complex surgeries and patients who have had the stent for a longer period), the stent may need to be removed in the operating room.

Under light sedation, the urologist inserts a micro-camera through the urethra, locates the double-J stent inside the bladder and removes it with a grasping forceps designed to hold the device.

11- DOES REMOVAL HURT?

When the procedure is performed with the patient awake and using local anesthetic gel, the patient usually feels only mild discomfort as the stent passes through the urethra.

When the procedure is performed under sedation, it is completely painless and the patient does not feel it.

The decision to remove the stent with the patient awake or sedated depends on several factors, such as the hospital facilities available locally, the extent of the surgery, and the preference of the patient or the urologist.

12- WHAT CAN I DO TO RELIEVE THE SYMPTOMS?

• Drink plenty of water
• avoid strenuous physical activity
• take the medications prescribed by your doctor at discharge
• avoid holding in the urge to urinate for long periods

by: Dr. Bruno Benigno

Urologist - São Paulo - SP

CRM 126265

Dr. Bruno Benigno
Urologist and uro-oncologic surgeon (CRM-SP 126.265 · RQE 60022). More than 1,500 robotic surgeries. Member of the AUA, EAU and SBU. Meet Dr. Bruno · In the Media

This content is educational and does not replace a medical consultation. Each case must be assessed individually, based on AUA, EAU and NCCN guidelines.