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| LETTER TO EDITOR |
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| Year : 2013 | Volume
: 18
| Issue : 2 | Page : 147-148 |
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DJ stent: Boon or curse
Aditi S Agrawal, Siddharth Rao, Dilip O Gupta
Department of Surgery, Mahatma Gandhi Institute of Medical Sciences, Sewagram, Wardha, Maharashtra, India
| Date of Web Publication | 6-Sep-2013 |
Correspondence Address:
Aditi S Agrawal
B/607, Lok Tirth, Marve Road, Malad-West, Mumbai - 400 064, Maharashtra
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0971-9903.117800
How to cite this article:
Agrawal AS, Rao S, Gupta DO. DJ stent: Boon or curse. J Mahatma Gandhi Inst Med Sci 2013;18:147-8 |
Sir
Double J (DJ) stent constitutes an important armamentarium in the hands of an urosurgeon. It is used to drain urine from the kidney to the bladder and is usually well tolerated by the patient. However, different complications may occur with short- or long-term use of these stents. These complications may be of minor nature such as hematuria, dysuria, frequency, low backache, and suprapubic pain or may be more major such as vesicoureteric reflux, migration, encrustation, urinary tract infection (UTI), stent fracture, and secondary vesical calculus formation. [1] Herewith, we report on a rare case of formation of large secondary vesical calculus in a patient, in whom the DJ stent remained in situ for more than 6-8 months.
A 34-year-old male patient came to our outpatient department (OPD) with complaint of recurrent suprapubic pain associated with dysuria, burning micturition, and occasional hematuria. His past history revealed that he had undergone open surgery for calculus on left side 6-8 months back. Patient came from low socioeconomic strata and never returned to the treating doctor for follow-up. His general examination was unremarkable and he had no scar tenderness. His urine examination revealed 10-20 pus cells and few red blood cells (RBC's). Plain radiograph of kidney, ureter, and bladder system (KUB) revealed presence of a DJ stent on the left side with radio-opacity in the urinary bladder most likely vesical calculus. Vesical calculus was large in size and to perform lithotripsy would be difficult. We cater to rural population and do not have facility for endoscopic lithotripsy so open cystolithotomy was done to remove the calculus along with embedded DJ stent.
Complications with short-term DJ stent urinary drainage are not known. However, indwelling DJ stents can cause serious complications; such as migration, incrustration, and fragmentation. DJ indwelling should be as short as possible. An ideal ureteral stent should be biocompatible, radio-opaque, cost-effective, relieve intra/extra ureteral obstruction, resist encrustation, resist infection, and cause little discomfort; however such an ideal stent does not exist. The DJ stents being used these days are made of vortek, biosoft duo, pellethane, or blended polymers of polyurethane. The plastic tubes (polyurethane) create problems due to the nonopacification on conventional radiography. However, all stents are prone to degradational effects especially in the acid medium. Organic components in the urine, crystallize on bacterial biofilm formed on the stent. The adherent bacteria hydrolyzes urea to produce ammonia. The elevated urinary pH favors the precipitation of magnesium and calcium in the form of struvite and hydroxyl apatite which results in formation of a calculus. [2],[3]
Indwelling time increases prevalence and consequences of all complications. Serious complications, even death, may happen as a result of cases of forgotten stents that stay longer than initially planned or more than 6 months. [4] Although endourology can provide all necessary solutions for the management of forgotten indwelling stents, the best treatment remains prevention. In order to avoid encrustation, it has been reported that a time period of between 2 and 4 months is considered optimal for DJ stent removal or replacement. [5],[6] Ather et al., [7] have proposed a computerized tracking program for removal of stents. [7]
Careful monitoring of patients could exclude any possibility of a stent being forgotten at all. In a short duration of 6-8 months, this patient developed a vesical calculus. In developing country like ours where people live on hand to mouth existence, lack of money besides ignorance and awareness of need for DJ stent removal are important reasons for retention of stent. Such incidences are thought provoking as to whether they are beneficial or pose a greater problem when used in patients who will not return back to healthcare center owing to loss of daily wages, poverty, and ignorance.
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