What are DJ Stenting and Why DJ Stenting?

What is a DJ stent?

DJ stent is the short form for double “J’ stent. It is a small tube that is placed in the body from the Kidney to the Urinary bladder. It is kept for about six weeks. The lower portion which is in the Urinary bladder is shaped like a usual “J” while the upper portion is like a mirror image. The shape helps in retaining the stent in the body.

What does the DJ stent do?

The DJ stent does the following:

• It maintains the Ureter open all the time.
• It has multiple holes and even if there is block in the path urine can travel through these holes and prevent back pressure changes and Kidney destruction.
• It helps the ureter dilate. The ureter or the passage from the Kidney to the urinary bladder enlarges to about two and a half to three times.
• It helps prevent strictures or narrowing during the healing process. If there is injury or obstruction due to a stone the healing process would narrow the lumen [tube]. The DJ stent prevents this from happening.
• It can flush the stones out of the Kidney. The person’s movement especially during walking or running creates movement of urine in the Kidney that facilitates movement of the stone out of the Kidney.
• It helps the Kidney push out stones. The DJ stent is a foreign body and the body tries to push it out and these movements help the stones to come out.

What are the uses of DJ stents?

The following are the instances when DJ stents are used.

• To facilitate the passage of small and medium sized stones in the Kidney to pass. With DJ stenting almost all the Kidney stones less than 7 mm and about half the stones of sizes 7 to 12 mm would pass by themselves if there is sufficient intake of water.
• As a precursor for breaking stones in the renal pelvis, upper or middle calyces.
• As a precautionary measure in retroperitoneal surgeries for example surgeries for cancer of the Uterus.
• For keeping the Ureters patent in conditions like retroperitoneal fibrosis. If Ureters are not patent they can cause Kidney failure.
• After breaking ureteric stone to help the fragments pass and to prevent stricture formation.
• After breaking Kidney stones to help the broken fragments to pass and prevent the broken fragments from blocking the ureter. The broken fragments can line up and form what is called Steinstrasse which means Stone Street.
• To aid pus from the Kidney to pass out easily into the bladder.
• After surgeries on the renal pelvis or ureter to prevent stricture formation.
• Special kinds of DJ stents are used after surgeries like endoscopic surgery for hydronephrosis.

How is the DJ stenting carried out?

The DJ stenting could be carried out under spinal anesthesia and in women even under local anesthesia. Local anesthesia is possible as there are no pain nerves in the bladder and only distention of the Kidney is painful. The cystoscope is used for the procedure. First a guide wire is passed through the ureter to the Kidney. The DJ stent is then passed over the guide wire and pushed in using a pusher.

What are the precautions that are necessary?

The following are important.

• It is necessary to drink sufficient water or fluids to pass about three and a half liters of urine a day. This would help achieve the purpose for which the stent is placed.
• Initially there might be some discomfort as while passing urine normally there is no reflux or back flow of urine into the Kidneys. With the placement of DJ stent the valve that prevents reflux cannot function well and there might be some reflux that causes some funny sensations.
• Usually 6 weeks of placement of the DJ stent should suffice. Since it is a foreign body it is very important that it should not be kept for more than 3 months. It should be removed before that at any cost. Patients have died after procedures for removing the stents kept for a long time.
• Stones can get deposited over the stent if there are insufficient water intake and causes encrustations.
• There might be some pain in the loin or back when the stone fragments come down the Ureter.

What if stents are needed for a longer time?

Even if they are needed for a long time like in retroperitoneal fibrosis they need to be replaced before three months ideally every two months.

What are the facilities available at SEESHA?

DJ stenting facilities are available at the SEESHA Karunya community hospital at Karunya at the SEESHA surgical camps at Bethesda Hospital Aizawl, Sielmat Christian Hospital at Churachandpur at Manipur, Family Health Hospital at Dimapur and the other places where the Bethesda Hospital Aizawl conducts diagnostic camps.

Dr. J. Gnanaraj MS, MCh [Urology], FICS, FARSI, FIAGES is a urologist and laparoscopic surgeon trained at CMC Vellore. He has been appointed as a Professor in the Electronics and Instrumentation Engineering Department of Karunya University and is the Director of Medical Services of the charitable organization SEESHA. He has a special interest in rural surgery and has trained many surgeons in remote rural areas while working in the mission hospitals in rural India. He has helped 21 rural hospitals start minimally invasive surgeries. He has more than 150 publications in national and international journals, most of which are related to modifications necessary for rural surgical practice. He received the Barker Memorial award from the Tropical Doctor for the work regarding surgical camps in rural areas. He is also the recipient of the Innovations award of Emmanuel Hospital Association for health insurance programs in remote areas and the Antia Finseth innovation award for Single incision Gas less laparoscopic surgeries. During the past year, he has been training surgeons in innovative gas less single incision laparoscopic surgeries.

Image: Ureteral stent (pigtail or double J stent). Author: Hildpeyi. 7 March 2008. Access the original Image information here: https://commons.wikimedia.org/wiki/File:Ureteral_stent.jpg

Image: X-ray of the abdomen, with nefrolithiasis and a double-J catheter. Author: Lucien Monfils. 25 July 2008. Access the original Image information here: https://commons.wikimedia.org/wiki/File:DoubleJ.jpg