Double J Stent Infections and Kidney Pain After Surgery

Regarding the infection issues after the placement of a double J stent?

Hello Doctor: I recently underwent a left ureterolithotomy and had a double J stent placed due to a narrowing issue.
Four days later, I experienced pain in both sides of my lower back, along with fever, hematuria, and renal swelling.
Urine culture revealed Klebsiella pneumoniae causing a urinary tract infection.
The doctor then urgently removed the stent.
After removal, the pain in my left side improved, but I still have a dull ache on my right side.
I would like to ask if the infection could affect the right side even though the surgery was on the left.
Also, should the sizes of both kidneys be symmetrical, or is it possible to have one larger than the other? Thank you for your clarification.

yuna, 40~49 year old female. Ask Date: 2016/03/10

Dr. Lin Wenxu reply Urology

1.
Having stones increases the likelihood of urinary tract infections, so after undergoing endoscopic stone fragmentation and removal, there is a confirmed risk of developing acute urinary tract infections.
2.
Naturally, the side that underwent surgery has a higher risk of infection, but the other side may also be affected (potentially due to hematogenous spread of bacteria or contaminated urine refluxing and infecting the kidney).
3.
Typically, the sizes of the kidneys are not symmetrical.

Reply Date: 2016/03/10

More Info

The situation you are experiencing after the placement of a Double J (DJ) stent is not uncommon, especially following a ureteral stone removal procedure. The symptoms you describe—flank pain, fever, hematuria (blood in urine), and renal swelling—are indicative of a urinary tract infection (UTI), which can occur due to the presence of a stent. In your case, the urine culture revealed Klebsiella pneumoniae, a type of bacteria that can cause such infections.

To address your primary concern: yes, infections can affect both kidneys, even if the procedure was performed on only one side. The urinary system is interconnected, and bacteria can ascend from the infected ureter to the kidney on the opposite side through the bloodstream or via retrograde flow of infected urine. This is particularly true if there is any obstruction or if the urinary flow is compromised, which can happen with stent placement or due to anatomical variations.

Regarding your question about kidney size, it is indeed normal for kidneys to vary in size. While many people have kidneys that are roughly symmetrical, it is not uncommon for one kidney to be slightly larger or smaller than the other. This asymmetry can be due to various factors, including congenital differences, previous surgeries, or conditions affecting kidney function. In your case, the persistent pain on the right side after the removal of the stent could be due to several reasons, including referred pain from the left kidney, residual infection, or even a separate issue unrelated to the stent or the recent surgery.

The pain you are experiencing could also be related to the irritation caused by the stent itself, which can lead to inflammation in the urinary tract. After stent removal, many patients report a significant decrease in discomfort, but it may take some time for all symptoms to resolve completely. If the right flank pain persists, it is essential to follow up with your healthcare provider for further evaluation. They may consider imaging studies, such as an ultrasound or CT scan, to rule out any complications or issues in the right kidney.

In summary, your symptoms are not unusual following the placement of a DJ stent, and the potential for bilateral kidney involvement in the context of a UTI is a valid concern. It is also normal for kidneys to vary in size. If your symptoms continue or worsen, please consult your healthcare provider for a thorough evaluation and appropriate management. It is crucial to address any ongoing issues to prevent further complications.

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