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DJ STENTINGS {DOUBLE ‘J’ STENT}

  • Posted on- Dec 19, 2017
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What is a DJ stent? 

'J' can be considered as the short form DJ stent. DJ Stent is small in size that is passed inside the body from 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. While the placed stent help the body to gain its shape again.

What does the DJ stent do?

The DJ stent does the following:-

It has multiple holes and even

  • It helps the uterus to stay open always.
  • 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 in preventing strictures or narrowing during the healing process. If there is any injury or obstruction due to a stone then the healing process would narrow the lumen. Whereas, DJ stent prevent 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. DJ stent is considered as foreign body inside our body and our body reacts with it and tries to throw it out and with help of stent removal stone is thrown out of the body.

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. DJ stenting helps to remove all the stone present inside it. 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.
  • If kidney stones are broken, then they prevent broken fragments to flush out and prevent them from blocking the passage. The broken fragments can line up and form what is called Steinstrasse which means Stone Street.
  • After surgeries on the renal pelvis or ureter to prevent stricture formation.
  • Different kinds of stents are used during the surgery like endoscopic surgery performed for hydronephrosis.

Stent placement

Patency of ureter is ensured by ureter stents, which may be compromised, for example, by a kidney stone or a procedure. Indwelling times of 12 months or longer are indicated to hold ureters open, which are compressed by tumors in the neighborhood of the ureter or by tumors of the ureter itself. Most of the cases reveal that tumor can't be treated and in that cases stent are used to flush out urine through ureter. If drainage is compromised for longer periods, the kidney can be damaged.

Stents should be placed inside the ureter that has been irritating and scratched during an ureteroscopy procedure that involves the removal of a stone, sometimes referred to as a 'basket grab procedure'. Stents placed for this reason are normally left in place for about a week. Stents are placed inside the ureter to prevent spasm and collapse after the trauma had been faced during procedure.

How is the DJ Stenting carried out?

The DJ stenting is carried out under spinal anesthesia and in women it is taken out 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 cyst scope is used for the procedure. In this procedure, a wire is passed in kidney through ureter. The DJ stent is then passed over the guide wire and pushed in using a pusher.

Stents can be removed by the thread within few seconds by stretching it out. This is often done by a nurse, but can be done by the patient. While removing the stent constant and steady force is applied for the abundance of starting and stopping. A bowl or another carriage matter should be placed below the patient to catch the urine flooded out during the removal of stent.

Stents without a thread are removed by a doctor using a cyst scope. The stent is removed by cystoscopy, an outpatient procedure. Cystoscopy involves placement of a small flexible tube through the urethra (the hole where urine exits the body). If the time taken by the procedure is less and it gives a little discomfort to the patient then it is performed in the outpatient clinic and ambulatory surgery centre.

Immediately before the procedure, sterile lubrication containing local anesthetic is instilled into the urethra and for the procedure performed no line or anesthesia is inserted to reduce. You do not have to be accompanied by anyone else, you can eat normally before and after the procedure.

A ureteric stent may also be retrieved without the use of a cyst scope by means of a magnetic removal system. Inserted stent consist of small earth magnet which is stucked to its bladder end and dangles freely within the bladder. If the stents are needed to get removed, a tiny catheter with mini magnet is inserted into the bladder, two magnets gets attached then catheter and stent can be easily removed. This eliminates the need for a costly and invasive cystoscopy in both adults and children.

Side effects and complications

The main complications with urethral stents are dislocation, infection and blockage by encrustation. Formerly stents with greased coatings of herapin were clarified to reduce the infection and encrustation to reduce the number of stent exchanges.

Other risk may include increased urgency and frequency of urination, blood in the urine, leakage of urine, pain in the kidney, bladder, or groin, and pain in the kidneys during, and for a short time after urination. These effects are considered as temporary and get vanishes with the removal of stent. Drugs used for the treatment of OAB (over active bladder) are sometimes given to reduce or eliminate the increased urgency and frequency of urination caused by the presence of the stent.

There is a thread inside the stent used for the removal of stent and stays outside the body. This thread may cause irritation of the urethra. This may be increased for patients who were born with Hypospadias or other conditions that required a similar corrective surgery. Care should be taken to ensure that thread is not pulled due to stent could be relocated.

There will be no change in the normal activities while stent is placed within the body. However, the stent may cause some discomfort during strenuous physical activity. All the daily activity would be considered as usual, sex is possible with in the presence of stents but it can create hindrance in the sex. The stent also can rest on the prostate gland in men, and with ejaculation/orgasm, the prostate may have movement that is discomforting to the patient, similar to severe cramping or irritation.

DJ stents costs minimum Rs.12000 to Rs.24000 maximum.

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