What should be discussed with patients about double J (Double J ureteral stent) placement?

Patient Counseling for Double J Ureteral Stent Placement

Patients receiving a double J stent must understand that this device will cause bothersome urinary symptoms that are mechanical in nature and will resolve only after stent removal, not through behavioral modifications or medications.

Essential Pre-Procedure Discussion Points

Purpose and Indication

• Explain the specific reason for stent placement in clear terms: relieving obstruction from stones, infection, or maintaining drainage after surgery 1, 2
• Emphasize that the stent provides immediate pressure relief in the kidney, which is critical for preventing complications like kidney damage or sepsis 1, 3
• For patients with infection/sepsis, stress that the stent is an urgent intervention to prevent life-threatening complications 1, 2

Expected Symptoms (Most Important Discussion)

• Warn explicitly that irritative voiding symptoms are universal and expected: urgency, frequency, dysuria, and bladder discomfort 1
• Explain the mechanical cause: the stent irritates the bladder trigone where it sits, and causes reflux of urine back toward the kidney during voiding 1
• Clarify that these symptoms are not due to infection, cannot be "trained away" with bladder exercises, and will persist until stent removal 1
• Flank pain during urination is common due to vesicoureteral reflux induced by the stent 1

Duration and Removal Planning

• Specify the anticipated duration the stent will remain in place (typically weeks, not months) 4, 5
• Explain that stent removal requires a second procedure (cystoscopy) unless a pull string is attached 1
• Warn that stents left beyond 8 weeks have increased risk of obstruction from encrustation 4
• Schedule the removal appointment before the patient leaves to ensure compliance 1

Complications to Discuss

Common Issues

• Urinary tract infections can occur and require prompt antibiotic treatment 4
• Stent migration is possible (occurs in approximately 3% of cases) and may require repositioning 5
• Hematuria (blood in urine) can occur, especially initially 4

Warning Signs Requiring Immediate Contact

• Fever, which may indicate infection or obstruction 6
• Severe, unrelenting flank pain suggesting stent occlusion 6
• Complete inability to urinate 6
• Enlarging abdominal swelling or severe ileus symptoms 6

Quality of Life Management

Symptom Mitigation Strategies

• Irritative symptoms may respond partially to anticholinergic medications or alpha-blockers, though relief is limited due to the mechanical nature 1
• Adequate hydration helps prevent encrustation but may worsen frequency 4
• Avoid activities that dramatically increase intra-abdominal pressure if causing severe discomfort 1

Setting Realistic Expectations

• The stent will temporarily alter quality of life through lower urinary tract symptoms 1
• These symptoms are not a sign of treatment failure or complication—they are the expected consequence of having foreign material in the urinary tract 1
• Symptoms typically resolve completely within days after stent removal 1

Special Circumstances

Bilateral Stenting

• If bilateral stents are placed, explain that symptoms will be more pronounced due to irritation of both sides of the bladder 2
• Bilateral stenting is only performed when both kidneys require intervention, not for unilateral problems 2
• The complication risk and symptom burden are doubled with bilateral stents 2

Patients with Urinary Diversions

• Internal double-J stents occlude more quickly in ileal conduits due to mucous plugging 6
• More frequent monitoring and earlier stent changes may be necessary 6

Common Pitfalls to Avoid

• Never tell patients their urinary symptoms will improve with time while the stent remains in place—this creates false expectations 1
• Never delay scheduling stent removal, as prolonged indwelling time increases obstruction risk 4
• Never dismiss patient complaints about stent symptoms as "just something to tolerate"—acknowledge the real impact on quality of life while explaining the temporary nature 1
• Never attempt bladder training or rehabilitation while a stent is in place—the symptoms are mechanical, not functional 1