PROCEDURE DEMONSTRATION DJ Stenting

Double-J stents are silicone tubes with a J formed on each end by a fine strand of silicone rubber. While the stent is passed up the ureter, the J hooks are straightened with a wire and when the wire is removed, the J's are formed. Indications for stent use 1. Ureteral injury: a. Cicatricial obstruction (scarring) b. Suture obstruction (adhesions) c. Obstructive edema (hydroureter) 2. External pressure on ureter (e.g. Tumors, impacted feces etc.) 3. Post-operative drainage 4. Retroperitoneal fibrosis 5. Multiple calculi (MOST IMPORTANT INDICATION) Problems and complications during stent drainage 1. Hematuria - usually due to traumatic insertion (maybe early or late complication) 2. Infection - foreign body reaction (late complication) 3. Crystalloid encrustations 4. Reflux 5. Trigonal erosion (due to wrong positioning of distal J of the stent in the bladder) 6. Inadequate drainage (due to encrustations or external obstruction) 7. Stent migration in proximal and distal directions. A DJ stent can be placed for a maximum of 6 months following which it has to be replaced. With time the risk of the above complications esp. infection increases. Measures to be taken a) High fluid intake b) Adjuvant medications, urine acidifiers, antibiotics to increase the solubility of urinary crystalloids. c) Close patient follow-up (control of stent position and patency with pyelogram, cystogram and endoscopically). Retrieval of DJ stents This is well accomplished by the use of: a) A cystoureteroscope with C-arm consult b) A transurethral biopsy forceps