RIRS Surgery and Double J Stenting

RIRS  Surgery & Double J  Stenting :-

Double – J  stent commonly known as D – J Stent is a self retained stent placed in the ureter. Commonly used D – J  stent is made of polyurethane. The name D – J stent refers to J shape at each end of the stent. One J shaped end remains in the collecting part of Kidney called the pelvicalyceal system   & the other J is placed in the Urinary bladder. This D-J stent is a thin tube usually 5 or 6 French in diameter & 26 to 30 cm. in length.

D-J stenting before RIRS Surgery :- Prestenting for RIRS Surgery  is some times used several days before the patient actually undergoes RIRS Surgery. The placement of a D-J stent in the ureter dilates the ureter & prepares the same for easy passage of an access sheath or a flexible ureteroscope. We do not practice prestenting as a routine in R P Stone Clinic, however in case of narrow ureters it sometimes become necessary to adapt this procedure of prestenting.

D-J stenting after RIRS Surgery:- In most of the cases, D-J stent is routinely placed after RIRS Surgery for an average period of 1 to 2 weeks. We rarely leave these stents for longer times as these are associated with several side affects in the stented patients.

D-J stenting after RIRS Surgery in Prestented patients:- We invariably avoid reinserting D-J stents after RIRS Surgery in patients who already have been stented before undergoing RIRS Surgery.

D-J stenting with stent extraction strings after RIRS Surgery:- We resort to this type of stenting quite often  where stent extraction strings are attached to the D-J stents. This avoids an additional procedure of Cystoscopy & stent removal after RIRS Surgery. These strings are lying outside human body & can be easily removed  along with stent even by patient himself or herself. However, this type of stent can not be used in infected cases as it adds to the infection. Even in non infected cases, there is a small risk of ascending urinary tract infection in this type of stenting. We do not leave these stents in patients for more than 3 to 4 days.

No D-J stenting after RIRS Surgery:- We sometimes perform RIRS Surgery with out D-J stenting. We do this in select group of patients who have small stones & surgery time is short. These patients are either found to have stones in their Kidneys during routine Medical examination before joining job in Army or before sailing as Navy Merchant or when they need to be stone free for any other job or reason. These patients usually have small kidney stones & are mostly asymptomatic. We are treating these patients for over 20 years now & we have performed RIRS Surgery in hundreds of this category of patients who are otherwise asymptomatic.

All D-J stents after RIRS Surgery need to be removed better sooner than later.

Most important issue of D-J stenting is problems associated with D-J stenting. Here is a list of  these problems:-

   

1.  Frequency of urination.

2.  Stent discomfort

3.  Stent intolerance

4.  Blood in Urine

5.  Burning & Pain during urination

6.  Pain in Lower abdomen & Lumbar region on the side of stenting during urination & lasting for sometime after urination

7.  Urinary tract Infection

8.  Encrustation of D-J stents if left longer

9.  Several other rare problems including forgotten stents & migrated stents.