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Double-J (DJ) Ureteral Stent

The double-J (DJ) ureteral stent is the workhorse internal drainage device of urology — a soft polymer tube with curled retaining coils at each end ("pigtails" in the renal pelvis and bladder) that holds the stent in place while draining urine from kidney to bladder.

Design​

  • Soft polymer tube — polyurethane, silicone, or hybrid; 4.7–8 Fr typical
  • Graduated stiffness — stiffer at the coils for retention, softer in the shaft for patient comfort
  • Multiple side holes along the shaft — backup drainage paths if one fills with debris
  • Graduated markings for length assessment during placement
  • Lengths: 22, 24, 26, 28, 30 cm are standard; up to 32 cm available for unusually long ureters

Common Products​

  • Percuflex (Boston Scientific) — the classic polyurethane stent
  • Polaris (Boston Scientific) — softer, hydrophilic-coated
  • BioSoft Duo / Sof-Flex — softer variants for patient comfort
  • Universa (Cook) — commonly used generic tapered-end stent
  • Contour (Boston Scientific) — hybrid firmness

Indications​

Short-term (days to weeks)​

  • Post-ureteroscopy / stone extraction
  • Post-ureteral reconstruction (ureteroureterostomy, ureteroneocystostomy, Boari flap, psoas hitch)
  • Post-pyeloplasty
  • Post-renal transplantation — ureteral anastomosis protection
  • Obstruction from stone, clot, or transient injury

Intermediate (weeks to months)​

  • Ureteral stricture awaiting definitive reconstruction
  • Tumor-related obstruction awaiting definitive management
  • Extrinsic compression awaiting resolution
  • Urine leak awaiting tract closure (urinoma, post-traumatic)

Long-term​

  • Chronic obstruction in patients unfit for definitive surgery
  • Malignant ureteral obstruction when permanent diversion is not feasible — see metal / long-term ureteral stents

Placement Routes​

  • Retrograde (cystoscopic) — most common; over a guidewire, stent delivered through a ureteric catheter
  • Antegrade (percutaneous) — through an existing nephrostomy tract
  • Open / laparoscopic / robotic — placed at the time of reconstruction across an anastomosis

Complications​

  • Stent-related symptoms (frequency, urgency, hematuria, flank pain with voiding — the "stent symptom syndrome") — affects 60–80% of patients to some degree
  • Encrustation — surface encrustation with retained time; encrusted stents can be difficult to extract
  • Stent migration — up or down the collecting system
  • Fracture — particularly after prolonged indwelling time
  • Infection — biofilm formation is universal after weeks; frank UTI or pyelonephritis in a minority
  • Forgotten stent — retained beyond intended dwell time with progressive encrustation and functional loss of the kidney in extreme cases

Dwell Time​

  • Standard polyurethane stents: exchange recommended every 3–6 months if chronic
  • Silicone and some hybrid stents: longer dwell acceptable in specific applications
  • Metal stents: 12+ months — see the dedicated page

See also: Nephrostomy Tube, Nephroureteral Stent, Metal / Long-Term Ureteral Stents, The Ureters.