Retrograde Intrarenal Surgery (RIRS) is probably the most sophisticated method developed in the last decade, as it allows for an advanced, but at the same time, minimally invasive approach to kidney stone treatment. The most frequently asked question after RIRS, however, is, do I need a DJ (Double J) stent? Patients are, and rightfully so, worried about the discomfort, side effects, and the actual purpose of a DJ Tube placed in the urinary tract.
In this blog, we will evaluate the role of a DJ stent after RIRS in detail, including indications for use, advantages, possible disadvantages, as well as the necessity to have it at all times.
Understanding RIRS and DJ Stent
RIRS is one of the most advanced endoscopic techniques of surgical management of kidney stones. During the surgery, the patient is placed under general anesthesia, and a flexible scope or ureteroscope is passed through the urethra, bladder and into renal pelvis and broke into pieces using laser. This technique is ideal for patients as no major incision is made, which makes it much more comfortable for people who suffer from stones located in areas that are not easily accessible.
A DJ stent is an example of simple urinary diversion. It is a thin, flexible tube with coils placed at both ends that is placed inside the ureter, the tube that connects the kidney to the bladder. The primary function of a DJ stent is to maintain ureter patency, thereby allowing urine to drain from the kidney to the bladder after surgery like RIRS is performed.
What Are The Reasons Behind Inserting a DJ Stent After RIRS?
Even though it may not always be required, a DJ stent is often placed for a number of reasons.
1. Avoids Ureteric Inflammation and Obstruction
Due to the passing of surgical instruments and the melting of kidney stones, the ureter may become swollen or irritated. As a result, the ureter can get blocked and urine flow may be impaired. This can lead to a great deal of discomfort and complications. A ureteral DJ stent is used to maintain patency and avert such occurrences.
2. Aids in the Movement of Stone Fragments
While RIRS is effective in removing or breaking stones into tiny fragments, it is possible that some pieces are left in the kidney or ureter. The stent allows those pieces to move past the area without causing a blockage.
3. Minimizes Pain and Problems After Surgery
Post RIRS, certain patients may have flank pain, discomfort during urination, or intestinal type colic due to muscle spasm or obstruction caused by fragments of stones. A DJ stent is useful in reducing the discomfort associated with these symptoms, as it helps with the continuous drainage of urine.
4. Promotes Healing, and Decrease Stricture Risk
Ureteric scarring and stricture formation is a possible complication due to certain surgical procedures. The use of a ureteral stent may help prevent scarring and provide a mechanism to reduce stricture formation while the ureter heals.
5. Improves Kidney Function
A DJ stent, by enabling urine outflow, assists in preserving kidney function following surgery and minimizes the chances of developing hydronephrosis (the swelling of the kidney as a result of urine retention).
When is DJ Stent Not Indicated Following RIRS?
Although a DJ stent is beneficial, it may not be warranted in every scenario. There are circumstances outlined below which your urologist may elect not to use a stent.
- Small uncomplicated stones: Such stones, which are small in size and devoid of any significant ureteral trauma, may be removed easily.
- No ureteral obstruction or injury: The absence of any injury or swelling of the ureteral region after the surgery is conducted.
- No residual fragments: The absence of any stone fragments remaining after the procedure can also be ensured.
In certain situations, particularly where the patient’s kidney function is good and the likelihood of surgical complication is low, RIRS can be performed without a stent.
Common Side Effects and Complications Experienced with a DJ Stent
While serving a useful purpose, a DJ stent has the potential to induce additional complications and side effects such as:
- Increased frequency of urination: The bladder may become inflamed due to stent insertion resulting in increased frequency of urination.
- Mild burning: Some patients may notice a burning sensation while passing urine.
- Flank or Abdominal pain: Feeling spasm like discomfort is common especially on changing positions and urinating, but it is manageable with ease.
- Hematuria: This usually self resolves in a couple of days. It is normal for blood to be present in urine in a mild form.
- Bladder irritation: Stents can give a feeling of a bladder that has not been fully emptied.
How Long Does a DJ Stent Stay After RIRS?
Multiple factors will determine the duration of a DJ stent placement such as the complexity of the RIRS procedure and the patient’s recovery.
- Short term (5-7 days): Stent replacement is done when there is no significant swelling or residual fragments.
- Moderate term (2-3 weeks): In cases where mild swelling or small fragments remain.
- Long term (4-6 weeks): In patients with severe swelling and multiple stone fragments, and/or ileal ureter injury.
To remove the stent, your Physician will arrange for it to be removed via a simple endoscopic procedure that’s quick and nearly painless.
Managing Discomfort During Stenting
The discomfort that occurs after RIRS can be managed in various ways, especially if the installation of the DJ stent is necessary.
- Stay heavily hydrated to help sink irritation water, and flush out any remaining stone fragments.
- Intense exercises, heavy lifting, and other strenuous activities should be avoided in order to prevent any stent discomfort which stent can cause.
- Medicines to take: Painkillers and anti-spasm medications may be prescribed by your doctor to alleviate discomfort.
- Observe the color of the urine: Some blood is normal but blood in your urine that is in excess should be reported by you to your doctor.
- Regular follow up: Visit for check-ups so that the stent can be checked for placement and timely removal.
Closing Thoughts: Is a DJ Stent needed Following RIRS?
The prescription for a DJ stent following RIRS differs from one patient to another. Most often, it is not a requirement, but for various reasons, we may need to insert it. These reasons include the desire to avoid complications, promote healing, and provide unobstructed urine passage. When a stent is suggested, it is most probably for the right reasons and the negative consequences of the stent become minor in comparison.
Deepanshu Gupta – Specialist Urologist based in Gurgaon
Dr. Deepanshu Gupta has extensive experience in the urology field. He thinks the decision to place a DJ stent after RIRS should be based on individual patient needs. It could be that not some patients do not need it and other patients stand to gain a lot from enhanced urine drainage and reduced complications.
If you have concerns about a DJ stent, speak with your urology specialist for the best level of assistance for your situation. Timely action with skilled attention enables smooth recovery.
For top notch kidney stone treatment in Gurgaon, get in touch with Dr. Deepanshu Gupta who offers expert urological consultation!