Kidney stone disease is one of the important causes of chronic kidney failure, with uncomfortable symptoms such as severe pain, nausea and vomiting, loss of labor with these symptoms.
Kidney stone surgery becomes a good option in the presence of a stone that cannot or cannot be passed and causes obstruction in the urinary system.
Kidney stone operations may differ according to the size of the stone, its localization, the experience of the surgeon, the factors of the patient and the technical possibilities of the hospital.
Today, increasing technological possibilities allow us to perform kidney stone surgeries with the least invasive (without incision) and endoscopic methods as possible.
In this article, we will try to explain the frequently used stents in endoscopic kidney stone surgeries.
With optical systems that enable imaging in men and women, stones can be found in both the bladder, the ureter and the kidney by entering the urethral meatus (the hole of micturation). Through these systems, the laser is directed to the stone. The stone is then fragmented (laser stone removal). Then, stent placement is also applied to the kidney, usually after ureter or kidney stone surgeries.
After kidney stone operations, polyurethane or carbotan-coated, soft-consistent, both ends J-shaped catheters called Double J stent are used. Generally, stents with a diameter of 6 fr (2 mm) and a length of 24-26 cm are used for adults.
Even the simplest surgical operations carry risks. However, endoscopic stone surgeries performed with the aid of semi-rigid, flexible ureterorenoscopes and laser are the most comfortable kidney stone surgeries that can be performed without any incision. After these surgeries, patients can usually be discharged within 12-24 hours and return to their normal lives and work within 2-3 days.
In these surgeries, the operation costs vary according to the size and location of the stone, other factors of the patient, the technical infrastructure of the hospital, stent placement, the need for additional sessions and the experience of the surgeon.
In particular, kidney stones located in the ureter (the tubes) or in the main pool called the renal pelvis block the entire kidney and affect the function of the kidney for a certain period of time. In order to quickly recover this function, stent insertion in the kidney may become essential both before and after laser lithotripsy.
In addition, edema due to kidney stones, mucosal damage, pressure created during surgery, comfortable expulsion of fragmented stones and stenosis detected in the ureter also require kidney stent placement. The most commonly used type of stent is the Double J stents (DJ stent, JJ stent) with one end extending to the kidney and the other end to the bladder, and both ends are J-shaped.
As it can be used in other situations, it is most commonly used in the following subtypes of kidney stone surgery.
If there is no long-term obstruction in the kidney, if there is no significant edema, if there is no mucosal damage during the operation, if there is no stenosis in the ureter and if the kidney and ureter are stone free at the end of the surgery, these operations can be performed without stenting.
DJ (Double, Double J) stents placed in the kidney provide rapid recovery after stone surgery, relieve congestion and are essential in some cases. It does not harm the kidney. However, it can sometimes increase susceptibility to infection and rarely this condition can become serious. Double J stents that are neglected and left for longer than planned begin to damage the kidney.
After endoscopic kidney stone operations, it is usually requested to stay the stent for 2-4 weeks. In some special cases, this period may be shortened or extended. However, it is definitely not recommended for our patients to extend this period due to the problems in their private lives, except for the doctor's recommendation.
The maximum life of standard DJ stents is 3 months, and as the duration increases, stents may lead to petrification, adherence to the ureter and kidney, and severe infections, and serious complications may occur.
There may be some negativities in patients with stent insertion in laser kidney stone removal. Of these; mild pain, frequent urination, burning in urination, sometimes urinary incontinence and pinkness in the urine are expected side effects and should not worry patients. Medications to reduce these symptoms will be given by your doctor. However, infection can develop after these surgeries.
I recommend that you consult your doctor or the emergency services of the hospital where you have surgery, as hospitalization may be required, especially in cases of severe back pain, fever, and severe weakness.
Yes, these stents extending from the kidney and advancing to the bladder may cause mild side pain, fullness, and discomfort. It can also cause dark urine and bleeding, and this should not scare you. All symptoms will improve after stent removal.
One of the most frequently asked questions after both URS and RIRS (laser surgeries) is the difficulty of removing the kidney stent. There is this concern, especially in patients who or their relatives had previous stone surgery and subsequently had stent removal from the kidney. Unfortunately, this procedure, which is performed under local anesthesia, causes pain and anxiety.
This procedure is completely painless and can be performed in a few minutes when optimal conditions are provided. Considering the wishes of the patients, sedation and regional anesthesia can be applied easily and the patients can return to their normal lives within a few hours.
If there is no significant occlusive residual stone, there is no pain after DJ stent removal. The discomfort caused by the stent also goes away in a few hours. Consult your doctor if you experience severe pain after removal of the stent.
One of the most curious and asked questions is "Can I have sexual intercourse after kidney stone surgery?", "When can I have sexual intercourse after a stent is placed in the kidney?" Before or immediately after kidney stone surgery, patients with DJ stent inserted or removed do not have any sexual restrictions. It is wrong to think that sexual intercourse can damage the stent..
DJ stents made of polyurethane are generally used in kidney stone surgeries. There is no harm in performing MR imaging with these stents.
As a result, kidney stone surgery, which is an important cause of chronic kidney failure in the long term, apart from its symptoms such as severe pain, can be varied according to the location of the stone, its size, the experience of the surgeon, the factors of the patient and the technical possibilities of the hospital.
It is a safer and correct approach to perform these kidney stone surgeries in sessions. In particular, stents placed in the kidney are beneficial in both function and tissue healing. I recommend that you consult a urologist for kidney stone disease, which is a health problem that cannot be neglected.
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