What is a DJ stent?

A stent is a tiny hollow flexible plastic or metallic tube that is inserted into a blocked canal or a blood vessel to keep the passage open. A DJ stent is a removable ureteric plastic stent placed in the urethra with its upper curved end in the kidney and lower curved end in the bladder. Both the ends are curved like the alphabet “J” to retain the stent in its position, prevent damage or slipping of the stent either into the kidney or bladder, hence the name J-J or double-J stent. 

Under what situations is the DJ stent inserted?

• DJ stent is primarily used to reduce the shooting pain experienced with the kidney stone and to facilitate easy drainage when an infection is present.
• It helps in the easy passage of small and medium-sized kidney stones.
• It is placed as a prerequisite for breaking stones in the upper and middle chambers (calyces) of the kidney and in the renal pelvis (the central area in the kidney where these chambers meet)
• As a precautionary measure, the DJ stent is placed during surgeries such as cancer of the uterus.
• The stent is placed after surgeries such as ureteroscopy to aid in healing and prevent any narrowing or blockage.

How does a DJ stent function?

• The DJ stent keeps the ureter passage open all the time. 
• The stent has multiple holes on its surface. This creates an uninterrupted path for the urine to travel to the bladder and avoids the building of any negative pressure within the kidney.
• Post-injury (because of the stone) or surgery, the stent helps in the healing process by preventing the narrowing of the tube.
• Since the body tries its best to push any foreign object out of the body, the DJ stent will become that foreign substance which will make it easier for the stone to come out.
• Every time an individual with the DJ stent moves or runs, there is a movement within the kidney which will help the stone to come out easily. 

How is the DJ stent inserted into the body?

The procedure is usually performed under the cover of spinal anaesthesia and in some cases, local anaesthesia may also be considered. Local anaesthesia can be sufficient because the bladder has no pain nerves, hence no pain sensation is experienced. As a next step, a thin tube called a cystoscope which has a camera and guiding light on the end is inserted through the urethra (the tube that carries out urine from the bladder) to reach the bladder. The bladder is visualised and the point where the ureter (the tube that carries urine from the kidney to the bladder) connects with the bladder is located. With help of a guiding wire, the DJ stent is passed through the cystoscope and inserted into the ureter. Once the stent has reached its designated position, the cystoscope is retrieved. The patient is then shifted to a recovery room and kept under observation. The pulse, blood pressure and breathing will be continuously monitored. Once the effect of anaesthesia wears off, medications such as pain killers and others will be prescribed to make the patient feel better and subsequently discharged from the hospital. 

What care needs to be taken post DJ stent insertion?

After the placement of the DJ stent, one may experience some level of discomfort while passing urine. Therefore drinking water more than usual (at least 8-10 glasses of water) in the initial 24 hours will help to establish the urine pathway back at the earliest and reduce the discomfort. Intake of an adequate amount of water can also reduce the chances of the stone getting deposited on the stent. Also, avoid exerting physical activities such as lifting heavy objects, bending over, etc. for the first 24 hours. One can slowly get back to normal after a day of stent insertion. 

How does it feel after having a DJ stent inserted?

After the placement of the DJ stent, one may experience few initial symptoms which can be bothersome. 

• A “pulling” sensation may be experienced during urination
• Increased and sudden urge to urinate 
• Discomfort in the bladder
• Pain in the lower abdomen (pelvic pain).

In most cases, these symptoms fade away with time. Reach out to your doctor for help if these symptoms prolong and affect day-to-day functioning. Also, there are chances of noticing blood in the urine. This usually happens due to increased activities, driving a car for long, etc. and is caused due to the increased friction by the stent on the bladder. In such situations, take adequate rest and consume more water than usual until no traces of blood is seen in the urine. 

Can a DJ stent be inserted permanently like a cardiac stent?

The main difference between a DJ stent and the cardiac stent is that the DJ stent cannot be permanently placed in the ureter like the cardiac stent. At the maximum, the stent can stay inside the body for not more than 3 months. If the stent remains inside the body beyond this time, adverse reactions such as ureter getting blocked, formation of kidney stones and infection can complicate the situation. Even if the stent is required to stay for a longer period, it has to be replaced every 3 months to avoid any complications. 

How is the DJ stent removed?

The removal of the stent should be performed only by the doctor. When a stent is placed for a short duration such as less than a week or so, a string is attached to the lower end of the stent and is allowed to come out of the individual’s urethra. Such stents are removed by carefully pulling the string and removing the stent. When the stent is inserted for a longer duration, no such string is attached and therefore it is removed under the cover of anaesthesia. Similar to the insertion process, a cystoscope is introduced through the same path to reach the bladder. There will be a grasping instrument at the end of the cystoscope which will grasp and remove the stent. 

Conclusion

DJ stent is most commonly advised in the treatment of kidney stones. They help in maintaining the urine flow, avoid narrowing of the ureter and reducing pain. A DJ stent can improve day-to-day functioning and subsequent quality of life. 

At Chennai Kidney care, a highly specialised team of urologists offer sophisticated care with utmost passion using the latest techniques and technology. At the hospital, the stent insertion and removal procedure is performed smoothly keeping the affected individual’s health and comfort in mind. Complete care and support are offered during the procedure and adequate time and attention are given to the patient to recover post-treatment until he/she is discharged from the hospital.