Cystoscopy with Double-J (JJ) ureteral stent placement

Cystoscopy with Double-J (JJ) Ureteral Stent Placement is a minimally invasive endourological procedure involving access to the urinary bladder and ureteral orifice, followed by the insertion of a stent into the ureter to maintain its patency and ensure urine drainage from the kidney to the bladder.

The procedure is performed through the natural urinary tract, without skin incisions.

A Double-J (JJ) ureteral stent is a thin, flexible tube with curved ends. Once positioned, one end lies within the renal collecting system and the other within the urinary bladder. Its shape helps maintain the stent in the correct position and allows urine to drain through the ureter when urinary flow is obstructed or there is a risk of obstruction.

The stent is generally temporary, and the duration of placement is determined individually by the urologist based on the cause of obstruction and the patient's clinical progress.

The primary purpose of the procedure is to restore or maintain urine drainage from the kidney to the bladder when the ureter is obstructed or there is a significant risk of obstruction.

Indications

• Ureteral obstruction caused by urinary stones;
• Hydronephrosis secondary to ureteral obstruction when drainage is required;
• Ureteral obstruction associated with edema or stenosis;
• Extrinsic compression of the ureter, including certain tumor-related conditions;
• Need for decompression of the upper urinary tract;
• Need to provide temporary urinary drainage before definitive treatment;
• Postoperative or postprocedural conditions requiring maintenance of ureteral patency;
• Other urological conditions in which the physician considers ureteral stenting necessary.

In cases of an obstructed kidney associated with signs of systemic infection/sepsis and/or anuria, urinary tract decompression constitutes a urological emergency.

The indication and optimal drainage method are determined by the urologist.

Procedure

The procedure is performed under the type of anesthesia determined according to the clinic's protocol and the anesthesiologist's recommendations.

The cystoscope is inserted through the urethra into the urinary bladder. The physician identifies the corresponding ureteral orifice and gains access to the ureter.

Under endoscopic guidance, the Double-J stent is advanced into the ureter so that its proximal end is positioned within the renal collecting system and its distal end within the urinary bladder.

After confirming the correct position of the stent, the endoscopic instruments are removed.

The patient is subsequently monitored according to the type of anesthesia and clinical condition.

Limitations

Ureteral stenting is a drainage method and, in certain situations, does not constitute definitive treatment of the condition causing the obstruction. Further treatment is determined by the urologist according to the underlying cause.

Temporary symptoms may occur after stent placement, including:

• frequent urination or urinary urgency;
• burning or discomfort during urination;
• mild hematuria (blood in the urine);
• suprapubic discomfort;
• lumbar pain or discomfort, sometimes more pronounced during urination.

The patient should seek medical evaluation if fever or chills, severe or progressive pain, inability to urinate, significant hematuria, or deterioration of general condition occurs.

Contraindications

Contraindications to the procedure are not specified in the text provided by the physician.

Advantages

Double-J stent placement may contribute to:

• decompression of the upper urinary tract;
• restoration of urine drainage in the presence of ureteral obstruction;
• preservation of renal function in the context of obstruction;
• reduction of the consequences of urinary stasis;
• temporary maintenance of ureteral patency;
• provision of urinary drainage until definitive treatment of the underlying cause of obstruction is performed.

Medical sources:

https://uroweb.org/guidelines/urolithiasis
https://pubmed.ncbi.nlm.nih.gov/30220023/
https://d56bochluxqnz.cloudfront.net/documents/full-guideline/EAU-Guidelines-on-Urolithiasis-2026.pdf
https://my.clevelandclinic.org/health/treatments/21795-ureteral-stents