DJ Stent Procedure
When the ureter is blocked or in danger of becoming so, a thin, flexible tube called a Double-J stent or pigtail catheter is inserted into the urinary tract to keep urine flowing across the kidney, ureter, and bladder. Because both ends are curled to resemble the letter J in order to prevent migration, it is known as “Double-J.” The urinary bladder will house the lower end of J, while the renal pelvis will house the upper end. Prior to lithotripsy, a urologist performs the stenting procedure.
1. DJ Stent Procedure – Step-by-Step
A. Pre-Procedure
- Medical history and physical examination
- Urine analysis,culture and sensitivity urine analysis (UTI must be treated first)
- CT scan, plain KUB, or kidney ultrasound/X-ray
- Knowledgeable consent
- Anesthesia can be either local, spinal, or general (depending on the patient and hospital).
B. Procedure Steps
1. Cystoscopy
Cystoscope having a thin camera is passed through urethra to visualize into the urinary bladder.
2. Identify ureteric opening
Ureteric openings either left or right will be localized.
3. Guidewire insertion
Then a soft guide wire is passed up the ureter up to the kidney.
4. Stent placement
The double J (DJ) stent is advanced over the guide wire until both ends coil:
- One “J” curl up in the kidney pelvis
- One “J” curl down in the urinary bladder
5. Verify position
After DJ stent insertion its correct placement/position will be verified by Fluoroscopy or X-ray plain KUB.
6. Remove cystoscope
After stent placement cystoscope is removed and the Patient is monitored for some time and usually discharged the same day.
Duration: This whole procedure usually takes 5–15 minutes as a whole.
2. Patient Care Instructions After DJ Stent Placement
A. Expected (Normal) Symptoms
- Lower uniray tract symptoms (LUTS)
- Burning during urination
- Urgency/frequency
- Mild flank pain when urinating
- Mild hematuria (Blood color or pink urine)
- These usually settle in a few day
B. Medications Usually Given
- Non-steroidal anti-inflammatory drugs (NSAID) or diclofenic sodium/acetaminophen for pain
- Narcotic analgesics (e.g.,tamadol) in case of severe pain
- Antispasmodics (e.g., solifenacin, hyoscine)
- Alpha-blockers (e.g., tamsulosin) to reduce stent irritation/discomfort
- Antibiotics only if any urinary infection is present
C. Activity & Lifestyle
- Patient can perform daily routine activities
- Drink plenty of water (1–2 litres/day) but do not over burden
- Avoid heavy lifting for initial 48 hours
- No sexual activity for 2–3 days if painful
- Avoid delaying urination
D. Red Flags – Seek Care If There Is:
- High fever (may indicate urinary infection)
- Severe flank pain not improving with medication
- Heavy continuous bleeding in urine
- Inability to urinate at all
- Foul-smelling urine with fever (may indicate urinary infection)
E. Stent Removal
- Usually stent is removed within 4–6 weeks after improving initial obstructive symptoms.
- Must NOT be forgotten — long-term placement causes calcium deposits over it or encrustation, blockage, or kidney infection leading to renal damage.
1. Indications
DJ stents are used in any condition where urine flow from the kidney is blocked or needs protection.
A. Obstructive Conditions
- Ureteric stones (before lithotripsy, after lithotripsy, or when causing hydronephrosis)
- Ureteral strictures (benign or malignant)
- Obstruction due to tumours
- Bladder cancer
- Prostate cancer
- Cervical cancer
- Retroperitoneal tumours/masses
- Ureteropelvic/pelviureteric junction (UPJ/PUJ) obstruction
B. Post-Procedure Protection of the Ureter
- After URS (Ureteroscopy)
- After PCNL
- After pyeloplasty, ureteral reimplantation, or other reconstructive surgeries
- Following endoscopic dilation of strictures
C. Infection/Emergency Situations
- Pyonephrosis (infected hydronephrosis)
- Obstructive uropathy with sepsis (as emergency decompression)
- Traumatic ureteral injuries
2. Contraindications
Absolute Contraindications
- Untreated urinary tract infection (UTI) or sepsis
- Stenting should be done only after starting appropriate antibiotics.
- Uncorrected coagulopathy (severe bleeding tendency)
Relative Contraindications
- Urethral strictures preventing cystoscope passage
- Severe urethral trauma
- Allergy to stent materials (rare)
- Pregnancy is not a contraindication, but careful technique is required
3. Complications
A. Early (During or Shortly After Insertion)
- Ureteral injury or perforation
- Bleeding/hematuria
- Wrong positioning or stent migration
- Pain or discomfort
B. Common Post-Placement Symptoms
- Increased urinary frequency
- Urgency
- Burning sensation/dysuria
- Flank pain during urination (due to reflux)
- Hematuria (usually mild)
These are usually normal side effects and not serious.
C. Infectious Complications
- Urinary tract infection
- Stent colonization with bacteria
D. Mechanical or Long-Term Complications
- Stent migration (upward or downward)
- Encrustation (particularly if left > 3 months)
- Stent blockage
- Stent fracture (rare)
- Formation of stones around the stent
- Forgotten stent syndrome
- Leads to large stone formation, hydronephrosis, and kidney damage.
Recommended Dwell Time
- 4–6 weeks for routine cases
- Up to 3 months if necessary
- Longer durations require specially designed stents