What are the guidelines for inserting and managing a Double J (Double J ureteral stent) stent in patients?

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Last updated: June 3, 2025 • View editorial policy

From the Guidelines

Double J ureteral stent insertion and management should be guided by the most recent and highest quality evidence, which emphasizes the importance of proper patient selection, antibiotic prophylaxis, and careful stent placement and removal techniques to minimize complications and improve patient outcomes.

Key Considerations

  • Patient selection: typically those with ureteral obstruction, post-urological surgery, or kidney stone management 1.
  • Antibiotic prophylaxis: a single dose of fluoroquinolone (such as ciprofloxacin 500mg) or cephalosporin (such as cefazolin 1g IV) 30-60 minutes before the procedure 2.
  • Stent placement: cystoscopically under fluoroscopic guidance, with one curl positioned in the renal pelvis and the other in the bladder, confirming proper placement with imaging 1.
  • Stent length selection: typically ranging from 22-30cm based on the patient's height and ureteral length 1.
  • Stent duration: varies by indication, with longer indwelling times increasing encrustation risk, so timely removal is essential 1.
  • Patient education: inform about common side effects including dysuria, frequency, hematuria, and flank pain during urination, which typically improve within a few days 1.
  • Hydration: maintain adequate hydration (2-3 liters daily) while the stent is in place to reduce irritation and encrustation 1.
  • Alpha-blockers: like tamsulosin 0.4mg daily may be prescribed to reduce stent-related symptoms 1.
  • Stent removal: typically performed as an outpatient procedure using cystoscopy under local anesthesia, with a maximum recommended duration for most stents of 3-6 months 1.

Preventing Infections

  • Use of preprocedural antimicrobials with clean–contaminated procedures is indicated for elective PCNT and ureteral stent placement and exchange 2.
  • Periodically reassessing the need for these devices to determine whether their removal is possible is the best approach to prevent infections 2.
  • Postprocedural preventive strategies, including maintaining a clean exit site area with antiseptic use, regular dressing exchange, and placement of a closed urinary drainage collection bag under the PCNT insertion site, may help decrease the rate of infection 2.

From the Research

Guidelines for Inserting and Managing a Double J Stent

  • The insertion of a Double J stent is a common urologic procedure, but it carries a comparatively high morbidity, with infection being one of the most common stent-associated morbidities 3.
  • To prevent stent-associated infections, the basic principles of antibiotic prophylaxis at the time of insertion, avoiding contamination, and minimising dwell times remain the best methods 3.
  • A study found that the incidence of urinary tract infections (UTIs) after Double J stent insertion for urolithiasis was 6.3%, and that prophylaxis can reduce the rate of UTIs 4.
  • The use of Double J stents in neonates and infants with severe primary nonrefluxing megaureter has been evaluated, and while it allows for effective internal drainage, it is associated with a 70% morbidity rate and various technical drawbacks 5.
  • In kidney transplantation, long-term Double-J stenting has been shown to be superior to short-term Single-J stenting in reducing urological complications and being cost-effective 6.
  • Understanding the pathogenesis of ureteral stent-associated infection and sepsis is crucial, as it can lead to further morbidity and even urosepsis, with a mortality rate of up to 50% of severely infected patients 7.

Key Considerations for Double J Stent Management

  • Antibiotic prophylaxis is essential to prevent stent-associated infections 3, 4.
  • Minimising dwell times and avoiding contamination can also help prevent infections 3.
  • The use of Double J stents should be considered on a case-by-case basis, especially in patients with decreased renal function 5.
  • Long-term Double-J stenting may be preferred over short-term Single-J stenting in certain situations, such as kidney transplantation 6.
  • Understanding the bacterial mechanisms involved in ureteral stent-associated infections can help in the development of prevention and treatment strategies 7.

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.