Types for Double-J Stenting Surgery

Double-J Stenting Surgery, also called DJ stent Placement, is a commonly used urological procedure to ensure free flow of urine between the kidneys and the bladder. Double-J Stents are thin flexible tubes that have a “J” shape at both ends. They are placed in the ureter, the tube connecting the kidney and bladder. The curled ends of the stent prevent it from moving out of place, and secure its position within the urinary system.

The Double-J Stenting procedure is vital in treating ureteral obstructions and kidney stones. It can also be used to treat post-surgical swelling or ureteric injury. This minimally-invasive procedure has saved thousands of patients from serious complications, such as kidney damage and infections.

Why Double-J Stenting is Performed

Double-J stenting is a medical necessity.

• Ureteric obstruction: This is caused by kidney stones, tumours or fibrosis.
• Pre-operative and Post-operative Support – Used before or following surgeries such as ureteroscopy (Percutaneous Nephrolithotomy) or PCNL.
• After ureteral injury or reconstructive surgery, it is important to promote healing.
• Prevention of complications: Infections, renal failure or further stones formation.
• Drainage is recommended for infections, especially in cases like pyonephrosis.

Stenting is used to keep the ureter open, stop urine from flowing backwards, and promote healing when there has been trauma or inflammation.

Double-J Stenting: Types and Applications

The underlying condition, the anatomical factors and the patient’s needs are taken into consideration when selecting a surgical approach and stent type. Here are the main types of DJ Stenting procedures:
1. Stenting Double-J Retrograde:- This is the technique most commonly used in cystoscopy, a procedure that involves inserting a scope through the urethra and into the bladder.

• Procedure: A flexible or rigid cystoscope is used to place the stent through the bladder, up the ureter and into the kidney.
• Indications: Ureteric stone, post-ureteroscopy assistance, tumors compressing ureter.
• Benefits: Outpatient, minimally invasive procedure. No need for skin incisions.

2. Stenting Double-J in the Antegrade:- When retrograde access cannot be achieved due to obstruction or surgical limitations, this method is used.

• Procedure: The stent can be inserted into the kidney using fluoroscopic or ultrasound guidance.
• Indications: Post-PCNL, severe obstruction of the ureter, with inaccessibility from the bladder.
• Benefits: Allows precise placement of stents under radiologic guidance.

3. Ureteroscopic-Assisted DJ Stenting:– The DJ stent is placed during ureteroscopy, a procedure that diagnoses and treats issues in the ureter or kidney.

• The ureteroscope locates the stones or tumors and then places the stent.
• Indications: Ureteric stones or strictures.
• Benefits: Combination of diagnosis, treatment and stenting all in one session.

4. Post-Surgical DJ Stenting:– Stents can be used in reconstructive procedures like ureteral replacement or pyeloplasty.

• The stent can be placed intraoperatively in order to promote healing and uninterrupted urine drainage.
• Indications include: Congenital anomalies, ureteral injuries, and stricture corrections.
• Benefits: Promotes healing and prevents leakage by maintaining ureteral patency in the post-operative phase.

5. Stenting of Obstructive Uropathy with Emergency DJ Stenting:- It involves the urgent placement of stents in cases where acute kidney obstruction and sepsis are life-threatening.

• Procedure: This is usually done under local or general anesthesia, depending on the circumstances.
• Indications: Pyonephrosis (obstructed, infected kidney), urosepsis.
• Advantages: Life-saving, relieves obstruction quickly, buys time for definitive treatment later.

The Sizes and Materials of DJ Stents

• Material: For long-term use, polyurethane, silicone hydrogel coated, or metallic.
• Size: Ranges between 4.7 Fr and 8 Fr in diameter, with a length of 22-30 cm.
• Customization is also available: Pediatric stents and modified designs are available (with a string to remove).

What can you expect after DJ Stent Surgery

• Common Symptoms
• Mild to moderate pain in the flank
• Increased frequency in urination
• Burning during urination
• Blood in the urine on occasion (hematuria).Post-operative care
• Water is essential for good health. Drink 2 to 3 liters of water per day.
• Avoid strenuous activities for a couple of days

Follow-up for removal (typically 2-6 weeks, depending on condition).

DJ Stent Removal

Cystoscopy is usually performed under local anesthesia as an outpatient procedure

Some stents are equipped with a cord that makes it easy to remove them without the need for invasive tools

Risks and Complications

Although Double-J stenting in general is safe, complications can include:

• Migration or encrustation of stents (especially when kept for a long time)
• Infection or irritation
• Stent-related discomfort
• Rarely, hematuria or ureteral injury

Most complications can be avoided by timely removal and follow-ups.

Conclusion

Double-J Stenting Surgery is an important part of modern urological treatment. It is an effective method for ensuring smooth urine flow and protecting kidney health, whether it’s performed to remove obstructions caused by stones, as post-operative drainage or in emergency situations.

The choice of **surgical technique–retrograde, antegrade, or ureteroscopic-assisted–**depends on the cause, complexity, and individual patient factors. The DJ stenting procedure continues to improve, offering minimal discomfort and effective relief.

Understanding the purpose and type of DJ stenting can ease anxiety, and help improve the post-operative outcome. Consult a qualified urologist to determine the best treatment for your specific needs.