Emergency DJ stenting for infected kidney stone: what does it mean?

A DJ stent, also called a double-J stent, is a soft plastic tube placed inside the ureter. The ureter is the natural tube that carries urine from the kidney to the bladder.

The stent has a curl at both ends. One curl stays inside the kidney and the other stays inside the bladder. This keeps the stent in position.

When a stone blocks the ureter, urine cannot drain properly. If infection is also present, infected urine may collect under pressure inside the kidney. Emergency DJ stenting bypasses the blockage and allows the kidney to drain.

This is usually a temporary life-saving drainage step, not the final stone-removal surgery.

Why is an infected blocked kidney dangerous?

A simple kidney stone attack can be painful. But a blocked kidney with infection is different.

The dangerous combination is:

This condition may be called obstructive pyelonephritis or pyonephrosis. Pyonephrosis means pus or infected urine trapped inside a blocked kidney.

Antibiotics are important, but antibiotics alone may not work well when infected urine is trapped behind a stone. The infected system often needs urgent drainage. EAU infection guidance also emphasises prompt drainage when urinary tract obstruction is present.

When is emergency DJ stenting needed?

Emergency DJ stenting may be needed when a kidney or ureteric stone is seen along with signs of infection, obstruction or worsening kidney function.

Common warning signs include:

• Fever with kidney stone pain.
• Chills or shaking episodes.
• Severe flank pain with vomiting.
• Burning urine with fever.
• Pus cells in urine.
• High white blood cell count.
• Raised creatinine.
• Hydronephrosis on ultrasound or CT scan.
• Reduced urine output.
• Low blood pressure.
• Drowsiness, confusion or severe weakness.
• Diabetes, elderly age or low immunity with stone and fever.

A stone with fever should not be treated as just pain. It needs urgent assessment.

What happens in the emergency room?

The first goal is to check whether the patient is stable.

You may need:

• Temperature, pulse, BP and oxygen monitoring.
• IV fluids.
• IV antibiotics.
• Pain control.
• Blood tests such as CBC, creatinine and electrolytes.
• Urine routine and urine culture.
• Blood culture if sepsis is suspected.
• Ultrasound KUB.
• CT KUB when needed.

NICE recommends urgent low-dose non-contrast CT within 24 hours for adults with suspected renal colic, while ultrasound is preferred first in pregnancy and in children.

If infection with obstruction is suspected, the urologist decides whether the kidney should be drained by DJ stent or nephrostomy.

How is emergency DJ stenting done?

Emergency DJ stenting is usually done in an operation theatre.

The urologist passes a small telescope called a cystoscope through the urinary passage into the bladder. The ureter opening is identified. A guidewire is passed up towards the kidney. The DJ stent is then placed over the guidewire so that one end curls inside the kidney and the other end curls inside the bladder.

The procedure may be done under spinal anaesthesia or general anaesthesia, depending on the patient’s condition and anaesthesia assessment.

In very sick patients, ICU monitoring may be needed before or after drainage.

Is the stone removed during emergency DJ stenting?

Usually, no.

This is one of the most important points for patients and family members to understand.

During active infection, the safest first step is drainage. Breaking or manipulating the stone immediately can increase the risk of bacteria and toxins entering the bloodstream.

So the usual treatment sequence is:

1. Start antibiotics.
2. Drain the kidney with DJ stent or nephrostomy.
3. Stabilise fever, BP, urine output and kidney function.
4. Review culture reports.
5. Plan definitive stone treatment later.

EAU guidance specifically recommends urgent decompression in sepsis with obstructing stones, urine culture after decompression, immediate antibiotics and delaying definitive stone treatment until sepsis has resolved.

Risks of emergency DJ stenting

Emergency DJ stenting is commonly performed, but possible risks include:

• Failure to pass the stent beyond the stone.
• Need for nephrostomy if stenting fails.
• Persistent fever despite drainage.
• Blood in urine.
• Burning and frequency.
• Stent pain.
• UTI recurrence.
• Stent migration.
• Encrustation if the stent is forgotten.
• Need for another procedure.

In infected obstructed stones, the main risk usually comes from the infection and sepsis, not from the stent itself.

What should you avoid after emergency DJ stenting?

Avoid these mistakes:

• Do not assume the stone has been removed.
• Do not stop antibiotics early unless advised.
• Do not miss urine culture follow-up.
• Do not ignore fever after discharge.
• Do not delay planned stone surgery.
• Do not keep the DJ stent for months without review.
• Do not take repeated painkillers without checking kidney function.
• Do not self-medicate with leftover antibiotics.

A forgotten DJ stent can become infected, encrusted and difficult to remove.

Red flags after discharge

Seek urgent medical care if you develop:

• Fever or chills.
• Severe flank pain.
• Persistent vomiting.
• Reduced urine output.
• Drowsiness or confusion.
• Heavy bleeding or clots in urine.
• Inability to pass urine.
• Severe weakness or fainting.
• Worsening burning with fever.
• Severe stent pain not improving with medicines.

A stent helps drainage, but infection can still worsen in some patients.