Bladder Training in Bilateral DJ Stenting with Urosepsis
Bladder training should NOT be performed in a patient with bilateral DJ stenting and active urosepsis—the immediate priority is urgent urinary decompression with intravenous antibiotics and hemodynamic stabilization, not bladder rehabilitation exercises.
Acute Management Priorities
The focus in urosepsis with bilateral obstruction is life-saving intervention, not bladder training:
- Urgent decompression of the collecting system is required in cases of urosepsis with obstructing pathology 1
- Ureteral stent placement has been shown to be safe and effective in the presence of sepsis with an overall decreased duration of hospital stay and intensive care unit admission rate 2, 3
- Intravenous antibiotics and hemodynamic stabilization take precedence over any bladder rehabilitation measures 2
Why Bladder Training is Inappropriate in This Context
Bladder training is a behavioral intervention for urinary incontinence or overactive bladder in stable patients—it has no role in acute urosepsis management:
- The patient requires immediate intervention to prevent septic complications, not elective bladder rehabilitation 1
- Definitive stone treatment (if applicable) should be delayed until sepsis is resolved 1
- Patients with urosepsis may temporarily lack decision-making capacity due to altered mental status from infection, pain, and medication effects 1
Post-Acute Phase Considerations
Once the patient has recovered from urosepsis and the stents remain in place:
- DJ stents are associated with lower urinary tract symptoms and pain, which can temporarily alter quality of life 3
- These stent-related symptoms (urgency, frequency, dysuria) are mechanical in nature and will not respond to bladder training exercises 3
- The symptoms typically resolve after stent removal, which requires secondary cystoscopy unless a pull string is attached 3
Common Pitfall to Avoid
Do not confuse post-stent urinary symptoms with conditions amenable to bladder training. The irritative voiding symptoms from bilateral DJ stents are caused by:
- Mechanical irritation of the bladder trigone and ureteral orifices by the stent material 3
- Vesicoureteral reflux induced by the stent 3
- These symptoms are not due to detrusor dysfunction that would benefit from behavioral modification 3
Appropriate Timeline for Any Bladder Considerations
- Monitor for resolution of sepsis with normalization of temperature, white blood cell count, and inflammatory markers 2
- Address stent-related complications such as bacterial colonization (occurs in approximately 30% of cases, increasing with indwelling time) 4, 5, 6
- Plan for stent removal once the underlying pathology is definitively treated and infection cleared 3