JJ (double-J) stent insertion and removal

A JJ (double-J) stent – a ureteral stent – is a thin, soft tube with a curl at each end: one end sits in the renal pelvis, the other in the bladder, and the body of the tube runs through the ureter. This lets urine drain from the kidney even when the ureter is blocked by a stone, swelling or a narrowing.

The stent is a temporary aid, not a treatment for the cause. Dr Penev inserts it during endoscopic stone treatment or when a blocked kidney needs to be relieved urgently, and he decides when it should be removed – that date is the most important thing to know if you have a stent.

When it is recommended

• for a blocked and dilated kidney (hydronephrosis) caused by a stone in the ureter, with severe pain that cannot be controlled;
• for a blockage with infection and a fever – draining the kidney is urgent, and the stone is treated once the infection is under control;
• after endoscopic stone removal, to protect the swollen ureter while it heals;
• before shock wave lithotripsy (ESWL) of a larger stone, and for narrowings of the ureter or pressure on it from outside.

How it is done

Insertion

Insertion is a short endoscopic procedure under spinal or general anaesthetic, most often carried out during the main operation. A thin guidewire is passed through the urethra and the bladder into the ureter, and the stent is slid along it up to the kidney under X-ray guidance; it takes approximately 15–20 minutes and leaves no incisions.

While the stent is in place

The stent is a foreign body and most patients can feel it: frequent urges to pass urine, burning, a dull ache in the lower back while passing urine, slightly pink urine after physical activity. The symptoms are strongest in the first few days and usually ease; if needed, Dr Penev prescribes medicines that relax the ureter and calm the bladder. What is normal and what is not is explained in the advice article after stone surgery: the JJ stent.

Seek emergency help (an emergency department or 112, the European emergency number) if you have a fever and shivering, if you cannot pass urine, if your urine is heavily bloodstained with clots, or if you have pain that does not respond to medicines.

Removal

The stent usually stays in from a few days to 4–6 weeks; with special materials and at the doctor’s discretion it can stay longer, but never beyond the time limit set by the doctor. Removal is an outpatient cystoscopic procedure: a thin cystoscope reaches the bladder, the lower end of the stent is grasped and the stent is taken out in seconds. If it was left with a string coming out through the urethra, it is pulled out without cystoscopy.

Preparation

No special preparation is needed for the removal: you do not need to fast, take your usual medicines and bring your hospital discharge summary with the details of the stent. If you have burning or cloudy urine in the days before, let Dr Penev know – if there is an infection, the removal is postponed or done under antibiotic cover.

After the procedure

After the removal you may have slight burning, pink urine the first one or two times you pass it, and a dull heaviness in the lower back for a few hours. Drink enough fluids. The symptoms settle within days, and after that come a follow-up ultrasound scan and a plan to prevent new stones.

Where it is done

Insertion is a hospital procedure at the Department of Urology at Kaspela University Hospital (UMBAL Kaspela), 64 Sofia St, Plovdiv. Removal is a short outpatient procedure at the hospital or at the practice, depending on the equipment available. Consultations and follow-up ultrasound scans take place at Dr Penev’s practice in Plovdiv (5 Anri Barbyus St) and at Vita Med Medical Centre, Karlovo, by appointment.

Price

Initial consultation – €50, follow-up consultation – €30. The price for inserting and removing a stent is confirmed at the consultation.

If you have a stent and the date for removing it is approaching, or you have symptoms that worry you, book an appointment with Dr Penev.