What do you mean by DJ Stenting?

DJ stenting is a minimally invasive procedure where a small, flexible tube called a double-J stent is placed into the ureter to relieve a blockage in the urinary system. The stent, shaped like a "J" at both ends, keeps the ureter open, allowing urine to flow freely from the kidney to the bladder. This procedure is often performed when there is an obstruction, such as a kidney stone or swelling, that prevents proper urine drainage.

In addition to the DJ stent, other types of medical stents, such as Blueneem Biliary Stent and Devon D J Stent Both End Open, may be used for different purposes, such as treating bile duct obstructions. Shaili Endoscopy Biliary Stent Pusher is an instrument used in procedures involving biliary stents. Other types of stents, such as Ureteral Stents and Biliary Stents, are used to manage blockages in the urinary and bile ducts, respectively.

Additionally, urinary catheters such as blueneem, devon are commonly used in various medical procedures to assist with urinary drainage. For healthcare professionals, medical equipment apps can help manage and track the use of these devices, ensuring the right stent or catheter is selected for each patient’s needs.

When is DJ Stenting Performed?

A DJ stent in ureter is used to relieve the sharp pain caused by kidney stones and to help with urine drainage, especially when there’s an infection. It also helps small and medium-sized kidney stones pass more easily. The stent is often placed before procedures to break stones in the upper and middle parts of the kidney (the calyces) or in the renal pelvis, the area where the kidney's chambers meet. It may also be inserted as a precaution during surgeries, such as those for uterine cancer. After surgeries like ureteroscopy, the stent helps with healing and prevents narrowing or blockages in the urinary tract.

The DJ Stenting Procedure

The procedure is typically done with spinal anaesthesia, although in some cases, local anaesthesia may be used instead. Local anaesthesia is often enough because the bladder doesn't have pain nerves, so there's no sensation of pain. The procedure begins by inserting a thin tube called a cystoscope, which has a camera and light at the end, through the urethra (the tube that carries urine from the bladder) to reach the bladder. The doctor then locates the point where the ureter (the tube connecting the kidney to the bladder) enters the bladder. Using a guiding wire, the DJ stent is carefully placed into the ureter. Once the stent is positioned correctly, the cystoscope is removed. The patient is then taken to a recovery room where they are monitored for vital signs, such as pulse, blood pressure, and breathing. After the anaesthesia wears off, the patient may be given pain relief and other medications to ensure comfort before being discharged.

Preparing for DJ Stenting

Before the procedure, a few preparatory steps are usually required. The doctor may order some blood tests to check the patient's overall health, particularly kidney function, and to rule out any infections or other issues that could affect the procedure. These tests may include a complete blood count (CBC), kidney function tests, and sometimes tests to check for any underlying infections in the urinary system.

Imaging studies, such as an ultrasound or CT scan, may also be performed to help locate the kidney stones or determine the cause of the blockage. These images give the doctor a clear view of the urinary system and help plan the best approach for placing the DJ stent.

In addition, the patient may be asked to fast for several hours before the procedure, particularly if anaesthesia is involved. The doctor will also discuss any medications the patient is taking, as some may need to be temporarily stopped, especially blood thinners. The patient will be given detailed instructions to ensure they are fully prepared for the procedure.

Benefits of DJ Stenting

1. It helps ease the sharp pain caused by kidney stones or urinary blockages.
2. The stent keeps the ureter open, ensuring smooth urine flow from the kidney to the bladder.
3. By relieving pressure on the kidney, it reduces the risk of kidney damage from urine buildup.
4. It helps small to medium-sized kidney stones pass more easily.
5. After procedures like ureteroscopy, it helps prevent narrowing and supports recovery.
6. It can be used to keep the ureters open during surgeries, reducing complications.

Types of DJ Stents

There are several types of DJ stents, which vary mainly in the materials they are made from and whether they are coated. The most common types include:

Silicone Stents: These are the most widely used type. Silicone is soft, flexible, and biocompatible, which makes it less likely to cause irritation or complications. Silicone stents are often chosen for their comfort and durability, and they are commonly used for short to medium-term stenting.

Polyurethane Stents: These stents are more rigid than silicone but can be more resistant to encrustation (deposits of minerals or salts). Polyurethane stents are often used in situations where a stent may need to stay in place for a longer time. They tend to be slightly less comfortable than silicone but offer a more durable option for extended use.

Coated Stents: These stents are made from silicone or polyurethane but have an additional coating, such as a polymer or antimicrobial layer. The coating can help reduce the risk of infection and encrustation, which can be a problem with long-term stenting. Coated stents are often used when infection or stone formation is a concern.

Risks and Complications of DJ Stenting

Up to 80% of people with DJ stenting experience some of the following:

1. Bladder irritation, bladder spasms (painful cramps), and frequent urination.
2. The stent may become blocked, broken, or dislodged.
3. Blood in the urine (hematuria) or painful urination.
4. Infections, including urinary tract infections (UTIs).

Caring for a DJ Stent

After the procedure, follow these care instructions to ensure proper healing and prevent complications:

1. Drink plenty of fluids, especially water, to help flush the urinary system and maintain kidney and bladder function. Aim for at least 2-3 liters of water per day, unless otherwise instructed by your doctor.
2. You may be prescribed pain medications or anti-inflammatory drugs. Take these as directed to manage discomfort.
3. If prescribed, complete the full course of antibiotics to prevent infections, even if you feel better before finishing the medication.

Monitoring for Complications:

Be aware of the following signs that may require immediate medical attention:

1. Intense pain in the lower abdomen, back, or side that doesn’t improve with medication.
2. A fever over 100.4°F (38°C) could signal an infection.
3. A significant amount of blood in your urine or if blood clots block urine flow.
4. Difficulty or pain while urinating that doesn’t improve.
5. If you’re unable to pass urine or feel you can't fully empty your bladder.
6. Severe nausea, vomiting, or signs of infection can indicate a complication.
7. Avoid heavy lifting, strenuous activities, or sexual activity for a few days as you recover.
8. Follow your doctor’s recommendations for resuming normal activities.

DJ Stent Removal

The removal of the stent should always be done by a doctor. If the stent is in place for a short period (typically less than a week), a string is attached to the lower end of the stent, which extends outside the body through the urethra. In this case, the doctor can simply pull the string to remove the stent.

For longer-term stents, no string is used, and the stent is removed under anaesthesia. The process is similar to the insertion: a cystoscope is passed through the urethra to reach the bladder. The cystoscope has a grasping tool at its tip, which is used to securely hold the stent and remove it.