RIRS Surgery and Double J Stenting

What is RIRS Surgery?

Retrograde Intrarenal Surgery (RIRS) is an advanced endoscopic procedure used to remove kidney stones without making any incision or hole on the body.

Note: This page focuses on Double J (DJ) stenting. To learn more about RIRS surgery, including the procedure, its benefits, recovery and whether it is suitable for you, please visit our RIRS Surgery page by clicking the link below.

Click here to learn more about RIRS Surgery.

What is a Double J (DJ) Stent?

A Double J stent, commonly known as a DJ stent, is a thin, soft, flexible tube that is temporarily placed inside the ureter (the tube that carries urine from the kidney to the urinary bladder).

A Double J (DJ) stent has two curled, J-shaped ends. The upper curled end remains inside the pelvicalyceal system (the collecting system of the kidney), where urine is collected before entering the ureter. And the lower curled end remains inside the urinary bladder. These two curled ends keep the stent securely positioned while allowing urine to flow continuously from the kidney to the bladder.

Usually, a DJ stent is:

• Made of soft medical-grade polyurethane or similar biocompatible material.
• Generally 4 – 6 French in diameter.
• Around 26 – 30 cm in length, depending on the patient’s anatomy.
• Designed for temporary internal drainage of urine.

A DJ stent remains entirely inside the body unless a retrieval string has been intentionally attached.

Why is a Double J (DJ) Stent Used During RIRS Surgery?

Although RIRS itself is performed without any external incision, the urinary passage may temporarily become swollen after surgery. Small stone fragments, mild inflammation or manipulation of the ureter can occasionally slow the drainage of urine from the kidney.

To help prevent such problems, a Double J (DJ) stent may be placed in patients after RIRS surgery.

A DJ stent helps:

• Maintain uninterrupted drainage of urine from the kidney to the urinary bladder.
• Reduce pressure within the kidney after surgery.
• Allow the ureter to heal comfortably.
• Facilitate smooth recovery after kidney stone treatment.
• Reduce the chances of postoperative pain due to temporary urinary obstruction.
• Minimize the risk of blockage caused by swelling or tiny stone fragments.

The decision to place a DJ stent is individualized and depends on several factors, including the size and location of the stone, the condition of the ureter, the complexity of the procedure, and the surgeon’s clinical judgment.

No Stent RIRS – Is a DJ Stent Required for Every RIRS Surgery?

No. Although many patients undergoing RIRS benefit from temporary DJ stenting, it is not mandatory in every case.

The decision depends upon several clinical factors, including:

• Size of the kidney stone.
• Number of stones present.
• Stone location within the kidney.
• Duration and complexity of surgery.
• Condition and diameter of the ureter.
• Presence of swelling or inflammation.
• Any associated urinary tract infection.
• Overall safety and comfort of the patient.

At R P Stone Clinic, every treatment plan is individualized. The decision regarding DJ stenting is based on the patient’s specific clinical condition and the surgeon’s extensive experience, rather than following a routine approach.

DJ Stenting Before RIRS Surgery (Pre-Stenting)

We do not do pre-stenting as a routine. In some patients, a Double J (DJ) stent is placed a few days before RIRS surgery. This is known as pre-stenting.

The purpose of pre-stenting is to gently dilate (widen) the ureter, making it easier and safer to introduce the instruments used during RIRS. A well-prepared ureter allows smoother passage of the ureteral access sheath or the flexible ureteroscope, which may help reduce ureteral trauma in selected cases.

At R P Stone Clinic, routine pre-stenting is not practiced. Dr. Pawan K. Gupta believes that unnecessary procedures should be avoided whenever safely possible.

This selective approach helps many patients avoid an additional procedure while ensuring maximum safety for those who truly require it.

DJ Stenting After RIRS Surgery

After completing RIRS surgery, the surgeon carefully assesses the kidney, ureter and urinary drainage before deciding whether a DJ stent should be placed. In many patients, temporary stenting helps support healing during the immediate postoperative period.

At R P Stone Clinic, when a postoperative DJ stent is required, it is generally kept for only about 1 to 2 weeks.

The clinic prefers short-duration stenting, as prolonged stent placement is associated with a higher likelihood of discomfort and other stent-related complications.

DJ Stenting in Patients Who Were Already Pre-Stented

Some patients undergo RIRS after having a DJ stent inserted earlier for ureteral preparation or emergency drainage.

In these cases, the need for another postoperative stent is assessed carefully.

At R P Stone Clinic, reinsertion of a DJ stent after RIRS is generally avoided in patients who have already been pre-stented, whenever it is considered safe to do so.

DJ Stenting with Stent Extraction Strings

In selected patients, Dr. Pawan K. Gupta may use a DJ stent with an extraction string.

In this technique, a fine thread is attached to the lower end of the stent and extends outside the body through the urethra.

This allows the stent to be removed without requiring another cystoscopy in carefully selected cases.

Are Stents with Strings Suitable for Everyone?

No, stents with strings are not suitable for everyone. Although they offer several advantages, stents with extraction strings are not appropriate for every patient.

At R P Stone Clinic, they are not used in patients with urinary tract infection, as the external string may increase the possibility of ascending infection.

Even in patients without infection, there remains a small risk of urinary tract infection, which is one of the reasons these stents are reserved for carefully selected cases.

When a stent with an extraction string is used, it is generally removed within 3 to 4 days rather than being left in place for a longer duration.

Can RIRS Surgery Be Performed Without a DJ Stent?

Yes. In selected patients, RIRS can be successfully performed without placing a DJ stent.

This approach is appropriate only when the operating surgeon is satisfied that postoperative drainage is unlikely to be compromised.

Patients considered for RIRS surgery without D-J stenting generally have:

• Small kidney stones.
• Short and uncomplicated surgical procedures.
• Healthy ureters.
• No significant bleeding during surgery.
• No evidence of infection.
• No ureteric injury.

Not placing a stent in such carefully selected patients can help avoid unnecessary stent-related symptoms while still maintaining excellent treatment outcomes.

Why Does Individualized Stent Management matters?

One of the important aspects of successful RIRS surgery in Panipat is deciding whether a patient needs a DJ stent, what type of stent should be used and how long it should remain in place.

There is no universal approach that suits every patient. At R P Stone Clinic, each patient is carefully evaluated to ensure that everyone receives a treatment plan tailored to their specific needs rather than a routine protocol. All DJ stents placed after RIRS surgery should be removed as soon as they are no longer needed, as timely removal helps reduce the risk of stent-related complications.

Possible Side Effects and Problems Associated with a Double J (DJ) Stent

A Double J (DJ) stent is an extremely useful device that helps ensure proper drainage of urine and supports healing after RIRS surgery. However, like any temporary medical implant, it may cause certain symptoms while it remains inside the body.

Most of these symptoms are temporary, improve after the stent is removed and can usually be managed with medications, adequate hydration and appropriate follow-up.

It is important to remember that not every patient experiences these symptoms and their severity varies from person to person.

Below is a list of the problems patients might experience:

• Stent Discomfort
• Irritative bladder symptoms
• Hematuria
• Suprapubic and Lumbar pain on the side of stent during urination
• Urinary tract infection
• Stent Intolerance
• Forgotten DJ Stent

Why Timely Removal of a DJ Stent is Important?

At R P Stone Clinic, patients are advised not to delay DJ stent removal once it is no longer required.

Removing the stent at the appropriate time helps:

• Reduce stent-related discomfort.
• Lower the risk of infection.
• Prevent mineral deposition on the stent.
• Minimize the chances of stone formation over the stent.

As a general principle, all DJ stents should be removed as soon as the treating surgeon determines that they are no longer needed.

Expert RIRS Surgery and Personalized DJ Stent Management at R P Stone Clinic

Successful treatment of kidney stones is not limited to removing the stone alone. Equally important is ensuring safe postoperative recovery, which includes deciding whether a DJ stent is required, selecting the appropriate type of stent and removing it at the right time.

At R P Stone Clinic, Panipat, every patient receives an individualized treatment plan. Dr. Pawan K. Gupta has over 45 years of experience in urology and kidney stone treatment and has been performing advanced RIRS surgery since 1998. As pioneer of RIRS in India, he has organized numerous national and international workshops, contributed to research in endourology, and successfully treated thousands of patients with both routine and complex kidney stones.

Patients from Panipat, Karnal, Kurukshetra, Sonipat, Rohtak, Hisar, Ambala, Yamunanagar, other parts of Haryana, New Delhi, Chandigarh, Punjab, J & K, & UP and neighboring states visit R P Stone Clinic for advanced kidney stone treatment in Panipat, particularly for minimally invasive procedures such as RIRS surgery.

Choose Advanced RIRS Surgery with Expert Double J Stent Management

Whether a Double J (DJ) stent is required before or after RIRS surgery depends on several factors, including the size and location of the kidney stone, the condition of the ureter and the complexity of the procedure. An individualized approach helps ensure effective stone removal while minimizing unnecessary DJ stent discomfort and promoting a smooth recovery.

At R P Stone Clinic in Panipat, Haryana, every patient receives a personalized treatment plan based on careful clinical evaluation. With decades of experience in minimally invasive kidney stone treatment, Dr. Pawan K. Gupta provides safe and effective care for every patient.

If you would like to know more about RIRS surgery in Panipat, Double J stenting or the most suitable treatment for your kidney stones, feel free to contact R P Stone Clinic in Panipat, Haryana, and schedule a consultation with Dr. Pawan K. Gupta.