Marc Laniado MD FRCS(Urol) FEBU
CONSULTANT IN UROLOGY

Table of Contents

1. What is a JJ stent?
2. What's the reason for having a JJ stent?
3. What are the disadvantages of having a JJ stent?
4. What problems can arise with a stent?
5. How does a stent interfere with daily life?
6. What additional care is necessary when a stent is in place?
7. When might it be necessary to call a doctor?
8. How is a stent inserted?
9. What are the alternatives to a JJ stent?
10. How is a stent removed?

What is a JJ stent?

A JJ stent is a specially designed hollow tube, made of a flexible plastic material that is placed in the ureter. The ureter is the natural tube that transmits urine from the kidney to the bladder. The length of the stents used in adult patients varies between 24 to 30 cm.

There are different types of stents, and some of these differences allow a stent to provide different benefits depending on the situation of the .

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What's the reason for having a JJ stent?

A JJ stent may be placed for several reasons.

It allows urine to flow from the kidney to the bladder even when the ureter is blocked for one reason or another. This way, the kidney keeps working and is not damaged by being obstructed and avoids the severe pain that can occur when a kidney does not drain properly. The chance of an infection is also reduced significantly.

A stent protects the ureter and allows the ureter to heal even when damaged. If a stent is not placed and the ureter is hurt in some way or other, it can become too narrow when it heals forming what is called a stricture. Having a stent can prevent that from happening and makes it more likely that the ureter will work well afterwards.

Sometimes, a stent is placed because it makes a narrow ureter wider over a period of time. This can be important when access through the ureter is needed to pass instruments or remove stones. This would typically occur when an attempt to go up the ureter to get a stone has failed because it was too narrow. Inserting a stent makes it more likely that later attempts to get up the ureter will be successful.

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What are the disadvantages of having a JJ stent?

It is not possible to predict who will or will not have side-effects with a stent. Some people tolerate stents without problems. Others find they have problems described below. Such problems may be present only at the beginning of having a stent and resolve over a few days or weeks. Other people may find their symptoms persist through out the period of the stent being present.

Stents can cause blood to appear in the urine at various times. Usually, physical activity of one kind or other results in movement of the stent inside the body. This can give rise to blood in the urine. Pain may be felt in the back (loin), bladder area, groin, penis in men or urethra in women, and sometimes the testicles. The discomfort or pain may be more noticeable after physical activities and after passing urine.

The stent can cause irritation of the bladder and so make it necessary to pass urine more frequently including the need to get up at night to pass urine.  These symptoms can sometimes be improved by medication. Rarely, a stent may cause a woman to leak urine.

Once the stent has been removed, these side-effects go away.

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What problems can arise with a stent?

Sometimes, stents can become calcified and develop a coating similar to stones.  Stents can also move out of position. When this happens, the stent usually moves into the bladder causing a deterioration in bladder symptoms i.e. going to the toilet to pass urine more frequently, discomfort in the area of the bladder and perhaps blood in the urine.

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How does a stent interfere with daily life?

You can still go to work and play sports when you have a stent in place. However, you may feel more tired and experience discomfort during the day limiting your performance. In addition, you may need to visit a toilet more frequently and so need convenient access to a toilet.

Travel is possible, although medical attention may be required rarely. As stents can have side-effects, your ability to enjoy yourself may be limited as a result.

There are no restrictions on sexual activity, although there may be less enjoyment as a result of the side-effects described above

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What additional care is necessary when a stent is in place?

• drink at least 1½ to 2 litres (approximately four pints) of fluids a day
• discuss with your doctor if you have troublesome side-effects

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When might it be necessary to call a doctor?

You should contact a doctor if

• constant and unbearable pain related to the stent
• symptoms of a urine infection (fever, rigours, feeling unwell and pain passing urine
• the stent falls out
• if there is a significant increase in the amount of blood in the urine

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How is a stent inserted?

A stent is inserted usually under a general anaesthetic often in combination with another procedure depending on the reason for the stent. A telescope called a cystoscope is passed through the urethra (water pipe) and into the bladder. The stent is passed through the cystoscope and into the ureter. The position of the stent is checked with x-rays.

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What alternatives are there to a JJ stent?

Sometimes, it may be reasonable not to leave a JJ stent if obstruction is likely to be transient. This may be risky and depends on the circumstances. If several procedures have been performed, there is often swelling making obstruction and pain a distinct possibility.

Occasionally, it may be possible to place a tube internally draining the kidney that comes out through the urethra (water pipe). This can simply be removed by pulling it out without needing a further procedure of any kind. The disadvantage is that it can remain for only a day or so.

Another alternative is to have tube placed directly through the skin and into the kidney. This is called a 'nephrostomy'. This is placed under guidance by ultrasound and the kidney has to be distended to get into the correct place without difficulty. As this is outside the body, it is slightly more inconvenient and can sometimes get pulled out by accident. Its advantage is that it usually drains better than a JJ stent which can be important if there is infection with obstruction of the kidney ('pyonephrosis').

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How is a stent removed?

A JJ stent is removed with a cystoscope performed under local or general anaesthetic. A special flexible telescope is passed through the urethra. The stent is picked up and removed. Please see flexible cystoscopy.

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