Ureteric stents, also known as ureteral stents, double J stents, JJ stents or retrograde ureteric stents, are urological catheters that have two "J-shaped" (curled) ends, where one is anchored in the renal pelvis and the other inside the bladder.
Stents are used for the free passage of urine from the kidney to the bladder, in adverse conditions such as postoperative urologic procedures, and previously for lithotripsy and ureteral obstructions.
Ureteric stents may be placed from an antegrade approach by an interventional radiologist or a retrograde approach by a urologist. Stent placement may replace a percutaneous nephrostomy that has been performed in the acute setting. This is popular with patients as it 'internalises' the method of obstruction bypass without the negatives of a nephrostomy.
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Indications
Stents may be used for a short or long term period depending on the indication:
obstruction causing acute pyelonephritis, anuria or sepsis where ureteric stents placement maybe urgently needed to relieve the obstruction 2
malignant obstruction (typically pelvis malignancies)
benign strictures
Contraindications
Content pending.
Procedure
Preprocedure evaluation
Content pending.
Room setup
Content pending.
Equipment
The majority of stents are plastic, but metallic stents are now available for use in malignancy to reduce the chance of ingrowth into the stent. It is a trade-off as these stents are significantly more expensive than traditional stents.
A variety of delivery systems exist:
pusher mechanism
string release
sheath (similar to an IVC filter)
Equipment required includes:
angled 0.035 150 cm hydrophilic wire
145 cm 0.035 Amplatz super-stiff wire
8F sheath
ureteric stent (typically 6F, 28 cm)
8F catheter (for covering nephrostomy)
analgesic and sedative medications (e.g. meperidine, midazolam)
Technique
Content pending.
Post-procedural care
Content pending.
Complications
failure to insert, typically due to a stricture that is impassable. Rate of failure can range from 12.2% to 34.6% 2
one end of the stent may migrate or in rare circumstances completely dislodge. Distal migration into the urinary bladder or pelvis can be up to 9.5% 2
urosepsis following the process of insertion
blockage (although the urine may also pass outside, not through the tube)
ureteric stent encrustation - making replacement difficult 2
Outcomes
Stents are typically left for a maximum of 3-6 months. If long-term stents are required exchanges (replacement) are usually due to encrustation.
History and etymology
Somewhat surprisingly the word 'stent' is actually an eponym, originally named after Charles Stent (1807-1885), a largely forgotten British dentist. He invented an improved material for forming dental impressions and set up a company to manufacture it. During the Great War, J F Esser, a Dutch surgeon used a mold of Stent's Compound as a fixative for skin grafting in injured infantrymen. This innovative use was rapidly adopted into practice, and stenting as a concept rapidly segued into multiple specialities. Despite its eponymic origin, the word stent is not routinely capitalized.
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