Double-J (JJ) ureteral stent removal

Double-J (JJ) ureteral stent removal is a urological procedure in which a previously inserted ureteral stent is removed. The stent is used to maintain ureteral patency and ensure urine drainage from the kidney to the urinary bladder.

A Double-J stent is a thin, flexible tube with a curved end positioned in the renal collecting system and another curved end positioned in the urinary bladder. It is temporarily used in various urological situations, including after ureteroscopy and urinary stone treatment, or to ensure drainage in cases of ureteral obstruction.

The stent must be removed or, in certain situations, replaced within the timeframe established by the urologist. Keeping the stent in place beyond the recommended period may promote encrustation, bacterial colonization, infection, obstruction, stent migration, and difficulties during removal.

Purpose of the procedure

The purpose of the procedure is the controlled removal of a Double-J ureteral stent once the indication for maintaining it has resolved or when the urologist determines that the device needs to be removed or replaced.

Removing the stent within the recommended timeframe is important because ureteral stents are temporary devices in most situations.

Prolonged stent placement may increase the risk of:

• encrustation and formation of mineral deposits on the stent surface;
• bacterial colonization and infectious complications;
• stent obstruction;
• migration or fragmentation of the device;
• difficulties during removal;
• the need for additional urological procedures to remove a complicated stent.

Indications

Double-J ureteral stent removal is indicated:

• upon completion of the stent placement period established by the urologist;
• after resolution of the ureteral edema or obstruction for which the stent was inserted;
• after the required drainage period following ureteroscopy or other endourological procedures;
• after urinary stone treatment, when continued stent placement is no longer necessary;
• when the physician determines that adequate ureteral drainage can be maintained without a stent;
• when ureteral stent replacement is required;
• in cases of stent-related complications, when removal is medically indicated.

The optimal timing of stent removal is determined individually by the urologist, depending on the reason for stent placement, the type of previous intervention, clinical progress, and the patient's individual characteristics.

Procedure

The procedure is performed under anesthesia, as indicated by the anesthesiologist.

The patient is positioned appropriately for the endoscopic procedure.

The cystoscope is carefully introduced through the urethra into the urinary bladder, allowing identification of the distal end of the Double-J stent.

Using a dedicated endoscopic instrument, the physician grasps the stent and removes it in a controlled manner through the urethra.

After stent removal, the patient is monitored according to the type of anesthesia used and their individual clinical characteristics.

Limitations

The following symptoms may occur temporarily after the procedure:

• burning or discomfort during urination;
• increased urinary frequency;
• urinary urgency;
• mild hematuria;
• suprapubic or lumbar discomfort.

These symptoms are generally temporary. Persistent or worsening symptoms require medical evaluation.

The patient should contact their physician or seek medical assistance if they experience fever or chills, severe or progressive pain, inability to urinate, significant hematuria, or deterioration in their general condition.

Medical sources:

https://pmc.ncbi.nlm.nih.gov/articles/PMC3673361/
https://uroweb.org/guidelines/non-neurogenic-male-luts/chapter/guidelines
https://my.clevelandclinic.org/health/treatments/21795-ureteral-stents
https://www.uhsussex.nhs.uk/resources/flexible-ureteroscopy-for-kidney-stones-urs/