Ureteric stent (JJ stent)
An internal tube running from kidney to bladder to keep the ureter open. The ED problems: stent symptoms that mimic a UTI, infection in a stented system (urosepsis), and the forgotten stent that encrusts.
Also called: ureteric stent, JJ stent, double-J stent, double pigtail stent, DJ stent, ureteral stent, kidney stent, pig-tail stent
What it is
A ureteric stent is a soft internal tube that runs from the kidney down to the bladder, curled at each end to stay put, keeping the ureter open when it is blocked or healing - it is a small, hollow tube that is put inside your ureter
. It is entirely internal - nothing shows on the skin - so you learn about it from the history or imaging.
Three things bring these patients to the ED. First, stent symptoms (frequency, urgency, loin pain on voiding, blood in the urine) that mimic a urinary tract infection
and are often benign. Second, a genuine infection in a stented system, which can escalate to urosepsis because the drainage is compromised. Third, the forgotten stent: left too long, a stent encrusts and becomes difficult or impossible to remove, so every stent needs a removal date. Stents are used in adults and children.
How to recognise it
- No external component - the stent is known from the clinic letter, the discharge summary, a stent card, or imaging (a curled tube from kidney to bladder on x-ray/CT).
- A patient recently treated for a stone, or with ureteric obstruction, who has typical stent symptoms: loin or bladder pain worse on voiding, urinary frequency/urgency, and visible blood.
- A patient who is unsure when - or whether - the stent is due to come out; the stent may have been in far longer than intended.
What it gets confused with
A nephrostomy is an external tube draining the kidney through the back into a bag; a ureteric stent is entirely internal with nothing on the skin. Both relieve ureteric obstruction. If you can see a tube and bag on the back, it is a nephrostomy.
What goes wrong
Infection in a stented system (risk of urosepsis)
Fever, worsening loin or bladder pain, increasing haematuria and feeling systemically unwell in a patient with a stent. BAUS: Having a stent, together with an underlying kidney problem, makes you more likely to get infection in your urine.
Red flag
Infection in an obstructed or stented upper tract can become urosepsis quickly. Treat sepsis actively - cultures, antibiotics, fluids - and involve urology; the stented kidney may still be inadequately drained.
Severe stent pain / stent symptoms
Loin pain radiating on voiding, suprapubic pain, frequency, urgency and haematuria - the recognised stent-symptom complex, which can be severe.
Red flag
Most stent symptoms are managed with analgesia and fluids, but BAUS flags urgent review if you experience constant, unbearable pain associated with your stent
- and pain with fever shifts the concern to infection or obstruction.
The forgotten, encrusted stent
A stent that has been in far longer than planned, sometimes in a patient who lost follow-up, now with pain, recurrent infection or bleeding.
Red flagOccasionally, encrustation of stents can be problematic, making it difficult for the urologist to change or remove the stent
- a retained stent can become a stone-encrusted, fragmented, non-removable problem. Flag it to urology urgently so removal is planned; it will not resolve on its own.
Migration or dislodgement
A change in symptoms, a stent that has slipped so a thread/end protrudes, or one that has fallen out.
Red flag
A displaced stent may no longer be relieving the obstruction. Contact urology; do not pull on a visible thread unless removal is intended and sanctioned.
The first ten minutes
- Decide first whether this is infection or just stent symptoms. Fever, rising pain and feeling unwell point to infection in the stented system - treat as potential urosepsis.
- For sepsis, resuscitate and treat - cultures, antibiotics, fluids - and call urology, because a stented kidney with infection may still be obstructed.
- For stent symptoms without infection, give analgesia and fluids and arrange urology follow-up.
- Establish when the stent was placed and when it is due out. A stent in longer than planned is a safety problem - escalate to urology for a removal plan.
- Do not pull a stent or its thread in the ED unless removal is specifically intended.
- Involve urology for infection, unbearable pain, a migrated stent, or a forgotten/overdue stent.
Do not
Who owns it
Urology owns the stent and its removal. Tell them when it was placed and when it is due out, whether the patient is febrile/septic, and the nature of the symptoms. If the patient is on a stent-tracking register, say so.
Who to call
The team and the criteria are national. The phone number is local, and this tool does not know it. Find it once, now, and write it on the department's own card — that is the part no website can do for you.
- Say the device name first
- Open with laryngectomy, LVAD, shunt — the single word changes who comes and what they bring. Do not bury it in the history.
- Say what you have already established
- Whether the device is patent, whether it has been removed or disturbed, and what you have already tried. The specialist is deciding whether to walk or run.
- Ask who owns it out of hours
- Device ownership and the on-call route often differ from the implanting specialty, and it is frequently a regional centre rather than your own hospital.
- The patient's own team is a resource, not an afterthought
- Named nurse specialists, home-care companies and device helplines answer questions nobody else can, and the patient usually has the number.
When the device is not the problem
A patient with a device gets pneumonia, sepsis, pulmonary oedema and myocardial infarction at the same rate as everybody else. The device is the most visible thing about them and it attracts the whole assessment.
- The NTSP says it out loud
- The project's own manual warns that
patients with tracheostomies can become unwell with all the problems that other patients get too. It is easy to become fixated with the tracheostomy.
The same sentence applies to every device in this tool. - Clear the device, then leave it
- Establish that the device is doing its job — the stoma is patent, the line draws back, the pump is running — and then assess the patient as you would anyone else.
- The anchoring runs both ways
- The opposite error is treating a device complication as a medical illness: a blocked gastrostomy read as vomiting, a baclofen pump failure read as sepsis.
- NTSP manual — Red flags · read in full
What the patient will be carrying
Patients should carry a record of the stent and its planned removal date (many urology units run a stent register); ask the patient or check the clinic letter for when it is due out.
Scope of this page
This page covers the ED response to a patient with a ureteric stent: telling infection from benign stent symptoms, treating urosepsis, pain, and recognising the forgotten/encrusted stent. It does not teach stent insertion or removal, or definitive stone management (a urology matter). Stents are used in adults and children; paediatric care is directed by paediatric urology.