After kidney stone surgery: the JJ stent and what to expect

Surgery for stones in the kidney or ureter is nowadays most often endoscopic – through the natural passages, without an incision – and recovery is quick. The first weeks, however, have their own particular features, and many of the symptoms are caused not by the operation itself but by the JJ (double-J) stent, which is often left in the ureter for a while.

Dr Penev operates on patients with stones at the Department of Urology at Kaspela University Hospital (UMBAL Kaspela), Plovdiv, and follow-up and stent removal are done as an outpatient.

What a JJ stent is and why it has been put in

A JJ (double-J) stent is a thin, soft tube running from the renal pelvis to the bladder, with both ends curled like the letter J. It is put in after endoscopic stone treatment – ureteroscopy (URS), PCNL and sometimes shock wave lithotripsy (ESWL) – to keep urine draining while the swelling of the ureter goes down and the fragments pass. Without it, a temporary blockage could cause renal colic and swelling of the kidney (hydronephrosis). The stent is temporary: it usually stays in from a few days to about four weeks, and the doctor decides how long.

What is normal in the first few days

The lower end of the stent irritates the lining of the bladder, so the following are common:

• frequent and urgent urination, including at night;
• mild burning and a feeling that the bladder has not emptied completely;
• pink or light red urine, especially after exertion – the colour comes from a very small amount of blood;
• a dull ache in the lower back when passing urine – urine briefly flows back up the stent to the kidney;
• after ESWL – passing small fragments (“gravel”), sometimes with short-lived colicky pain.

The symptoms are strongest in the first few days, then ease and disappear after the stent is removed. If they are more severe, Dr Penev may prescribe medicines that relax the ureter and bladder.

Fluids, medicines and diet

Drink about two to two and a half litres a day, unless you have been told to limit fluids because of heart or kidney disease – this helps the fragments pass and lowers the risk of infection. Take painkillers as prescribed and do not add anti-inflammatory medicines on your own, especially if you have only one kidney or reduced kidney function. Take an antibiotic only if it has been prescribed, and finish the course. Strain your urine through a fine sieve and keep the fragments – analysing what they are made of is the basis of prevention.

Activity, work and daily life

Walk from the first day – moving helps the fragments pass and protects against blood clots. Avoid heavy lifting and intense sport while the stent is in place; after greater exertion the blood in the urine may increase for a day or two, which is not dangerous. Office work is usually possible after a few days, physical work after the stent has been removed. Drive once you are no longer taking strong painkillers.

Stent removal – on time

The most important rule: the stent must be removed by the set date. A forgotten stent becomes coated with crystals, can become the core of new stones, and removing it becomes more complicated. Write down the date. JJ stent removal is a short outpatient procedure that Dr Penev performs in Plovdiv – usually with a thin flexible cystoscope and anaesthetic gel; it takes a few minutes and as a rule does not need a general anaesthetic. Exactly where it will be done – at the practice or at Kaspela University Hospital – is confirmed when you book. In some patients the stent has a string that comes out through the urethra, and it is pulled out even more easily. After removal there may be mild burning, a little blood and sometimes brief pain in the lower back for a day or two.

A few weeks later, a follow-up ultrasound confirms that the renal pelvis is not swollen and that no stones are left in the kidneys. If you have repeated stones, Dr Penev arranges metabolic tests, and the advice on diet and fluids for kidney stones is the surest protection against stones coming back.

When to see a doctor urgently

Slight bleeding and discomfort are expected; the following signs are not. Go to an emergency department or call 112 (the European emergency number) if you have:

• a temperature above 38 °C with shivering – when urine cannot drain properly, the infection can spread to the blood within hours;
• severe pain in the lower back despite painkillers, or vomiting that will not stop;
• inability to pass urine when your bladder is full;
• heavy bleeding with clots;
• a stent that is showing at the urethra or has fallen out.

Do not wait for a booked appointment – these conditions need to be seen within hours; with milder but persistent symptoms, contact the practice for an earlier check. You will find what to do for severe pain until you see a doctor in the advice on first aid for renal colic.

A few weeks of patience, enough fluids and having the stent removed on time – that is the price of a kidney that drains freely again. If you have questions about your recovery, or when the date for stent removal is approaching, book an appointment with Dr Penev in Plovdiv or Karlovo.