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Ureteral Stenting (Double J Stent, JJ Stent)

Ureteral stenting (also known as double J stent) is the procedure to place a thin, flexible plastic tube that is temporarily in the ureter to help urine drain from the kidney into the bladder in the case of a blockage.

The ureters carry urine from the kidneys to the bladder. (Each kidney is connected to one ureter.) In rare cases, both ureters may be blocked, in which case bilateral ureteral stents are placed, one in each ureter.

The stent may remain from days to weeks and even months, depending on the situation.

Purpose/Benefits

The ureters may become blocked as a result of a number of conditions, including:

  • Kidney stones
  • Tumors
  • Blood clots
  • Postoperative swelling
  • Infection

A ureteral stent may also be placed during or after urinary tract surgery to provide a mold around which healing can occur, to divert urine away from areas of leakage, to manipulate kidney stones or prevent stones from moving prior to treatment, or to make the ureters more easily identifiable during surgical procedures.

Ureteral obstruction may be diagnosed with a cystoscopy, where a thin tube is inserted into the bladder to visualize it, ultrasound, computed tomography (CT) scan, and/or pyelography, where x-rays are taken of the urinary tract after a contrast dye has been injected.

Placement of the stent is done using general anesthesia, so you will likely need to undergo a thorough health screening as well as blood tests, chest x-ray, and electrocardiogram (EKG). Please avoid all food and water for 6-8 hours before the procedure, or as recommended by the doctor. Please also let your doctor know about all medication that you are taking as some may need to be stopped before the procedure.

The doctor will insert a cystoscope through the urethra and into the bladder, visualizing the opening to the ureter. A thin wire is then guided through the cystoscope, up the ureter, and into the kidney. The stent is inserted over the wire. A fluoroscope, a kind of x-ray machine, may be used to position the stent. The wire and cystoscope are then removed.

When it is time to remove the stent, the same method is used. A cystoscope is inserted through the urethra and into the bladder and the stent is grasped with a small instrument and removed. You will be awake during this procedure and will only require a local anesthetic.

Some discomfort is normal while you have a stent. Certain movements may trigger pain or the need to urinate. You may also experience some soreness or pressure before or during urination. These symptoms usually disappear after the stent is removed.

You may be prescribed medication to for pain, infection, and/or bladder spasms. Make sure that you drink plenty of water to flush out the urinary tract. Blood in the urine is normal, caused by the irritation of the stent. It may occur on and off while you have the stent.

·        Bleeding

·        Pain in the back, bladder, groin, and penis (in men) or urethra (in women)

·        Urine leakage in some women

·        Catheter migration or dislodgement

·        Coiling of the stent within the ureter, causing abdominal pain during urination, urinary frequency, or blood in the urine

·        Infection, or worsening of an existing one

·        Penetration of adjacent organs

·        Reaction to anesthesia

·        If you are taking any blood-thinning medication/anticoagulant, please let your doctor know as some may need to be stopped before you travel for the procedure.

·        Travelers to Thailand should plan to stay in the country for at least 1 day or for the entire duration of treatment.

·        If you plan to return home after the procedure, please speak to your doctor before making travel arrangements. There are no restrictions for air travel.

·        During your follow-up appointment your medical team will assess your health and your incision and you will receive documents detailing your medical and treatment history and your "Fit to Fly" certificate (if needed).

 

The success of the procedure depends on a number of factors. Please discuss the likelihood of success with your doctor before the procedure.

 

What if the procedure is not performed?

Depending on why the stent is placed, complications will differ. If the ureter hasn’t healed sufficiently from surgery, it can be reinjured. If a stone is not removed, it will cause pain and can lead to other problems. If urine is blocked, infection will occur, among other serious complications.

If stenting is not possible for a ureteral obstruction, a nephrostomy may be an option. This procedure involves a tube that is placed through the skin on the back into the area of the kidney that collects urine. It’s then connected to an external drainage bag.

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