Managing Discomfort from Double J Stent: Blood in Urine and Pain Relief

The double J stent is too long, irritating the bladder trigone, leading to hematuria and a sharp pain sensation?

Four days ago, I underwent ureteroscopy due to a stone in the left ureter (which was not painful and did not cause complete obstruction).
After the procedure, the physician placed a double-J stent, and I was discharged the next day after the catheter was removed.
On the third day post-surgery, I noticed a sharp pain in the bladder when standing, and I experienced intermittent sharp pains while walking or moving, as if something was stabbing at the base of my bladder, which triggered a strong urge to urinate.
This instinctive reaction caused the pelvic floor muscles to contract (similar to holding in urine).
Therefore, on the fourth day post-surgery, I decided to return to the hospital to check whether the double-J stent had dislodged, which could lead to excessive bladder irritation and hematuria.

The X-ray results showed that while the double-J stent had not fallen out of the renal pelvis, the lower loop of the stent was indeed positioned at the base of the bladder (at the lowest point of the bladder trigone).
Upon closer inspection, the tip of the lower circular end of the double-J stent appeared to be angled slightly downward and to the right.
Consequently, during the final phase of urination, when the bladder contracts forcefully to expel residual urine, the stent would inadvertently poke into the bladder.
Each time this occurs, it causes pain and hematuria.
When standing, the weight of the upper organs exerts downward pressure, leading to pelvic contraction.
This, in turn, causes the bladder trigone to contract, effectively pinching the loop of the double-J stent, which results in the tip of the loop stabbing into the bladder and causing pain.
This has made it difficult for me to stand for long periods or walk for more than an hour.
When sitting, the pelvic muscles can relax, alleviating the pain.
I would like to ask: in this situation, is it advisable to remove the double-J stent directly (for example, by going to the emergency department for stent removal)? Additionally, during the X-ray examination, a small stone was found above the double-J stent.
If extracorporeal shock wave lithotripsy (ESWL) is performed while the double-J stent is in place, is there a risk that the stent could break? Furthermore, during the lithotripsy, will the double-J stent be subjected to vibrations that could potentially damage the renal pelvis, ureter, or bladder tissue along its path? I would appreciate any recommendations from the physician.
Thank you.

Xiao C, 40~49 year old female. Ask Date: 2016/06/25

Dr. Fu Shizhang reply Urology

1.
All symptoms are caused by the double J stent and are considered normal.
Based on the description, the position of the double J stent also appears to be appropriate.
It may be due to a more sensitive constitution.
As for whether it is suitable for removal, it must be determined based on the situation at the time of surgery and should be discussed with the operating physician.
2.
The chance of the double J stent breaking is very low.
3.
The likelihood of tissue damage due to the double J stent being subjected to shock is also very low.
Online consultations cannot replace a physician's in-person evaluation and physical examination; if there are health concerns, it is still recommended to seek care at a medical facility.

Reply Date: 2016/06/25

More Info

Managing discomfort after the placement of a double J stent can be quite challenging, especially when complications arise such as pain and hematuria (blood in urine). Your situation, involving discomfort from the stent pressing against the bladder wall and causing pain during urination, is not uncommon. The double J stent is designed to keep the ureter open and facilitate urine flow from the kidney to the bladder, but it can also lead to irritation and discomfort, particularly if it is positioned in a way that causes pressure on the bladder.

Pain Management and Stent Removal
Given your symptoms, it is crucial to address the discomfort effectively. If the pain is severe and persistent, it is advisable to consult your urologist as soon as possible. You might consider going to the emergency department if the pain becomes unbearable or if you experience significant changes in your urinary patterns, such as increased blood in the urine or inability to urinate.

In some cases, if the stent is causing significant discomfort and is not functioning properly, the urologist may decide to remove it. However, this decision should be made based on a thorough evaluation of your condition, including imaging studies to ensure that the stent is not obstructing urine flow or causing other complications.

Concerns About Extracorporeal Shock Wave Lithotripsy (ESWL)
Regarding your question about undergoing extracorporeal shock wave lithotripsy (ESWL) while having a double J stent in place, it is generally safe to perform ESWL with a stent. The stent is designed to withstand some degree of pressure and vibration. However, there are considerations to keep in mind:
1. Potential for Stent Damage: While the stent is typically resilient, there is a risk that the shock waves could cause movement or damage to the stent, especially if it is not positioned correctly. This could potentially lead to complications, such as stent migration or fracture.

2. Effectiveness of ESWL: The presence of a stent may help facilitate the passage of stone fragments after lithotripsy, but it is essential to ensure that the stent is not causing additional irritation or complications during the procedure.

3. Monitoring After ESWL: If you proceed with ESWL, close monitoring will be necessary to assess the effectiveness of the treatment and to ensure that the stent remains in the correct position and functions properly.

Recommendations
1. Pain Management: Discuss pain management options with your healthcare provider. Nonsteroidal anti-inflammatory drugs (NSAIDs) or other analgesics may help alleviate discomfort.
2. Follow-Up: Schedule a follow-up appointment with your urologist to discuss your symptoms and the possibility of stent removal or adjustment. It is essential to communicate all your symptoms clearly, including the nature of your pain and any changes in your urinary habits.

3. Emergency Care: If your symptoms worsen or if you experience severe pain, fever, chills, or inability to urinate, seek emergency medical care immediately.

4. Consideration for ESWL: If you are considering ESWL, discuss the timing and implications of the procedure with your urologist, particularly in relation to the stent's position and your current symptoms.

In conclusion, while the double J stent is a common and generally safe procedure, complications can arise that require careful management. Open communication with your healthcare provider is key to ensuring that your discomfort is addressed and that any necessary interventions are performed promptly.

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