DJ Stent Removal: Procedure, Cost, Complications

Uro-surgeons use various medical tools for promoting urine passage and avoiding obstruction. However, these tools require regular updation through surgical means. One such technique employed is DJ stent removal as it requires a replacement between 6 weeks to 6 months.

Wondering why the operation is required? It helps in preventing complexities like encrustation (deposition of minerals on the stent surface). In this blog, we will delve into the intricacies of the DJ stent removal procedure, exploring other reasons for placement and associated costs. Read on to find out.

The DJ stent full form is "double-J stent," referring to the unique shape of the stent, resembling the letter "J". It is a medical device used in urology to address conditions related to the urinary system.

The stent is designed to be inserted into the ureter, the tube connecting the kidney to the bladder. The primary DJ stent use is to facilitate the urine drainage from the kidney to the bladder.

Some other reasons why the doctors would prefer this method are:

1. Breaking kidney stones to stop obstruction.

2. Preventing ureter blockage as a result of postoperative swelling.

3. Treating blood clot-related ureteral complications.

4. Controlling the accumulation of scar tissue from diseases such as endometriosis.

5. Removing obstacles caused by inflammatory bowel disease (IBD).

Note: The DJ stent removal becomes necessary once it has served its purpose. Leaving it for an extended period may increase the risk of complications. Please get in touch with HexaHealth for detailed information. 

Anatomy and Physiology of Kidneys

The kidneys are vital organs in the human urinary system. They have a significant role in maintaining fluid balance, electrolyte levels, and waste elimination.

The kidneys are situated retroperitoneally (anatomical space located behind the abdominal cavity). Each kidney is supplied (blood supply) by the renal arteries. It filters the blood to produce urine and then funnels the urine into the ureters for transport to the bladder.

The DJ stent is often employed in cases where the natural flow of urine is hindered. This can be due to conditions like kidney stones or surgical procedures. It is designed to traverse the renal pelvis and ureter, facilitating the urine drainage.

Here's a brief exploration of the critical anatomical parts of the kidneys:

1. Renal Cortex: It contains functional units called nephrons responsible for filtering blood and forming urine.

2. Renal Pelvis: A funnel-shaped structure that collects urine produced by the nephrons. It serves as a transition point for urine as it moves toward the ureter for drainage.

3. Ureters: They facilitate the urine flow from the kidneys to the bladder. DJ stent are often placed in the ureters to address various urinary tract conditions.

4. Bladder: An organ that collectsurine until it is ready to be discharged from the body through the urethra. DJ stent, when placed, aid in the unobstructed passage of urine from the kidneys to the urinary bladder.

5. Urethra: The tube-like organ which carries urine from the bladder to the external environment.

While the stents are necessary for managing specific urological issues, taking them out is equally significant. Here are some common conditions treated with DJ stent removal:

1. Kidney Issues: The DJ stent may be removed once the stones are naturally passed or treated through interventions.

2. Ureteral Obstruction: The stent is taken out to restore normal urine flow. 

3. Post-Surgery Drainage: The DJ stent is extracted once the surgical site has healed.

Who needs a DJ stent removal?  

The decision to do a double J stent removal is made by a urologist based on the patient's condition. Generally, the procedure may be recommended for individuals in the following situations:

1. People with kidney stones that have naturally passed or been treated surgically.

2. Individuals whose ureteral obstructions have been addressed successfully.

3. Anyone whose ureteral strictures have been adequately treated.

4. A person having infections like bladder infection (cystitis), kidney infection (pyelonephritis) or other issues due to the DJ stent.

5. Patients with healed sites following urological procedures.

The doctor removes the stent after thoroughly assessing the patient's overall health. The advantages of DJ stent removal may vary based on the specific condition being treated. The few expected benefits are listed below.

1. Reduced discomfort

2. Improved urinary flow

3. Decreased risk of infections, such as UTI

4. Prevention of long-term complications

5. Elimination of stent-related irritations

6. Lowered risk of encrustation

The complete pre-surgery and day-of-surgery preparations are essential for ensuring the patient's safety. They optimize surgical outcomes and facilitate a smooth recovery process.

Before Surgery

Before DJ stent removal, patients undergo thorough preoperative assessments, confirming readiness for the procedure. A detailed medical history is collected, and the surgery is scheduled. The surgical procedure is explained to the patient.

Note: Follow your urologist’s advice for a successful procedure. Please get in touch with HexaHealth for complete details.

On the Day of Surgery

On the day of kidney stent removal, healthcare providers guide the patients through the final preparatory steps. Initial paperwork is followed by patients changing into the procedural gown.The staff ensures the safekeeping of their valuables. The individual is then shifted to the OT room, where the surgical team prepares for the DJ stent removal.

This DJ stent removal is an outpatient procedure conducted by a urologist. It aims to conclude a patient's treatment journey successfully. Here are the critical steps on how to remove ureteral stents:

1. Patient Positioning: The patient is told to lie on their back on the operating table, with legs slightly elevated and apart. This placement facilitates easy access to the urethra, ensuring a smoother procedure.

2. IV Line Administration: An intravenous (IV) line is established to provide fluids and medications before the procedure.

3. Anaesthesia: This is to ensure comfort and pain control during the procedure. It is generally performed under local anaesthesia (LA).

4. Sterilisation of Surgical Site: The urethral opening is cleansed and sterilised to reduce the risk of infection. The drapes are then applied to maintain the aseptic conditions.

5. Monitoring of Vitals: Continuous observation of heart rate, BP, and oxygen saturation.

6. Urethral Access: The urologist inserts a cystoscope, a thin tube with a camera, into the urethra. The stent is gently grasped using specialised instruments and carefully pulled out. The whole process is guided by real-time imaging.

7. Post-Removal Assessment: Once the DJ stent is successfully extracted, the urologist may inspect the urinary tract using the cystoscope. They check for complications, such as bleeding or injuries.

8. Conclusion: The patient is closely monitored as they recover from anaesthesia. A follow-up appointment may be recommended to evaluate the patient's recovery.

Following the stent removal procedure, patients typically experience a brief recovery period in the hospital. During this, they are monitored for any immediate postoperative issues. 

The Recovery Process in Hospital 

Patients receive attentive care in the immediate recovery phase within the healthcare facility. Here's what to expect:

1. Vitals are checked, and the effects of anaesthesia are carefully tracked.

2. Once stabilised, patients are discharged from the hospital.

3. Emphasis is placed on pain management, infection prevention, and mobility, as needed.

Recovery Process/Expectation After Hospital Discharge 

After hospital discharge, patients may expect a progressive improvement in their overall well-being. They are advised to adhere to post-removal care instructions.

1. Discomfort and transient urinary symptoms are common. They are expected to improve over the next few days.

2. Urination is usually more frequent and causes moderate burning sensations.

3. Individuals are advised to follow a balanced diet and stay hydrated.

4. Strenuous activities should be limited initially to support the recovery process.

First Follow-Up Appointment

The initial appointment is pivotal for the healthcare provider to assess the patient's progress. Listed below is what one can expect:

1. Evaluation of Recovery: The urologist will assess the healing progress, examining for any signs of complications.

2. Additional Assessments: Tests may be prescribed to ensure complete resolution of the underlying condition.

3. Prescription: The doctor might recommend medicines to manage and prevent DJ stent removal complications.

4. Further Care Instructions: They will provide guidance on activity restrictions and any necessary lifestyle modifications.

The Double J stent removal is generally considered a routine and well-tolerated procedure. Still, there are potential risks involved. 

1. Discomfort: After the removal of the DJ stent, patients may experience temporary mild pain. This is often managed effectively with prescribed medications.

2. Loss of Blood: There is a risk of minor bleeding during or after the stent removal procedure. While this is usually self-limiting, the severity of this may require additional interventions.

3. Infection: This is one of the potential DJ stent removal complications, especially if sterile techniques are not followed. Symptoms such as increased pain or changes in urine colour should be promptly reported.

4. Ureteral Injury: Ureteral perforation may occur, leading to complications such as leakage or strictures.

5. Urinary Leakage: If the ureteral walls have not entirely healed,  the urine can escape into the abdominal cavity. This requires prompt attention.

6. Fistula Formation: It could develop between the ureter and nearby organs or tissues, potentially causing urinary and faecal matter to mix.

7. Stenosis: The removal process or the healing afterwards may lead to the narrowing of the ureter. This can impede the normal flow of urine, causing discomfort.

8. Obstruction of the Urinary Tract: This may result from blood clots, tissue swelling, or other factors, leading to impaired urine drainage.

When to consult a doctor?

Consult a doctor promptly if you experience any of the following after DJ stent removal or during the recovery period:

1. Persistent or worsening pain

2. Uncontrolled bleeding or significant blood in the urine

3. Fever or signs of infection

4. Difficulty urinating

5. Changes in urine colour or odour

6. Swelling or tenderness in the abdominal or pelvic region

7. Inability to pass urine

Delaying the double J stent removal can pose several risks, potentially impacting a patient's urological health. Check the list below.

1. Encrustation: Over time, mineral deposits can accumulate on the surface of the stent. This can make it more difficult to remove and increase the risk of complications.

2. Increased Risk of Infections: The prolonged presence of a stent raises the possibility of getting a UTI. Bacteria can adhere to the material surface and ascend into the urinary system.

3. Stent Migration: The material may move from its intended position. This can result in discomfort and urinary obstruction.

4. Stone Formation: Urinary stasis and changes in urine composition can contribute to the formation of new kidney stones. This poses an additional risk to the patient's renal health.

The DJ stent removal cost can be impacted by a number of variables. Knowing these elements can help with the decision-making process. Here’s the estimated price range:

Factors that may affect the DJ stent removal price include:

1. Healthcare Facility: The choice of clinic or hospital can impact the overall cost. Hospitals often have higher overhead costs compared to specialised clinics.

2. Geographic Location:  The expense of medical services varies significantly between different regions within India. Urban areas with higher living costs may charge more.

3. Surgeon's Fees: Highly experienced or seasoned doctors may charge a higher price.

4. Pre and Post-Surgery Tests: Additional costs may be associated with diagnostic evaluations and follow-up care.

5. Health Insurance: This plays a crucial role in determining the out-of-pocket expenses for patients. The extent of coverage, deductibles, and co-payments will influence the final bill.

DJ stent removal is a crucial step in the management of various urological conditions. The benefits of removing the stent on time far outweigh any temporary inconveniences. Patients need to communicate openly with their healthcare providers and address any concerns.

At HexaHealth, we understand the importance of patient education and support throughout the DJ stent removal procedure. Our platform connects patients with reputable doctors, facilitating informed decision-making. Your health is our priority. Get in touch!