What is a double J catheter?
Since the introduction of the ureteral catheter in the late 70s of the last century (1), its use has taken an important position in clinical urology. The double J or double pigtail catheter is a small-diameter tube, which gets its name from the coiled shape of its ends. This flexible catheter is placed with one end in the kidney and the other in the bladder. Both coils prevent the catheter from moving.
What is the double J catheter for?
Mainly, the catheter serves to unblock the ureter and allow the passage of urine from the kidney to the bladder, preventing renal colic, kidney damage, and urinary tract infection. It has wide use in urology: lithiasis pathology (stones), urinary tract reconstruction, kidney transplant, inflammation of neighboring organs, and as a complement in oncological treatments that may cause ureteral obstruction (2).
Once the catheter is placed, usually through an endoscopic procedure via the urethra, which is generally uncomplicated, it is not visible outside the body. Its removal is also usually endoscopic and generally less complicated than its placement.
How long will a double J catheter be implanted for?
Every patient and every case is different. Bearing a double J catheter for a tumor is not the same as for kidney stones or for a stenosis (obstruction), etc. Therefore, the assessment must be exclusively medical. The urologist must decide how long the double J catheter should remain implanted. The times are very variable, and some people wear it for a few days, weeks, or months... However, there are extreme cases where, due to their pathology, they must wear it for life.
The Risk of Calcification of the double J catheter
The most severe complication associated with the use of the double J catheter is calcification and the potential impossibility of extracting the ureteral catheter (3,4). The encrustation process that leads to calcification has been described as the "encrustation cycle" (5,6). This cycle begins with the growth of certain bacteria around the catheter or urinary infection, which contribute to an alkalinization of the urine and a decrease in the solubility of minerals in urine, facilitating the possibility of calcification. This process occurs faster in some patients than in others, suggesting that some patients are more prone to this complication (7).
Various studies have demonstrated the importance of controlling urinary pH (pHv) to determine the frequency of catheter calcification (8-10), making this measure a variable to consider in the management of catheterized patients. Urinary pH is influenced by various factors, but it is especially sensitive to diet (10). For this reason, hygienic-dietary interventions (exercise, diet, fluid intake, etc.) are a very useful preventive measure for catheter encrustation, although their effectiveness is subject to patient adherence.
Lit-control®pH Down is a food supplement with an acidifying effect on urine, which helps prevent complications derived from urine alkalinization. It contains functional ingredients such as phytate and L-methionine.
According to the European Association of Urology (EAU), urinary acidification with L-methionine to pH 5.8 – 6.2 is recommended as a therapeutic measure for certain kidney stones at doses of 600-1500 mg/day13. This recommendation is based on the results observed in various clinical studies (8). Therefore, to guarantee the therapeutic doses of L-Methionine (1500mg/day), the Lit-control®pH Down regimen to follow would be equivalent to 3 capsules per day (500 mg/capsule).
How can I know that my urine is in the adequate pH range?
There is a device on the market: Lit-control® pH Meter which is a medical product that allows patients to self-monitor their pH daily at home, enabling exhaustive control of pH and the level of incrustation risk.
References
1. Finney, RP. Experience with new double J ureteral catheter stent 1978. J Urol 2002 167:1135-8.
2. González-Ramírez MA, Méndez-Probst CE, Feria-Bernal G. Factores de riesgo y manejo en la calcificación del catéter doble J. Rev Mex Urol 2009;69(1):7-12.
3. El-Faquih SR, Shamsuddin AB, Chakrabaarti A et al. Polyurethane internal stents in treatment of stone patients: Morbidity related to indwelling times. J Urol 1991;146:1487-91.
4. Mohan-Pillai K, Keeley FX Jr, Moussa SA et al. Endourological management of severely encrusted ureteral stents. J Endourol 1999; 13:377-9.
5. Getliffe K. Care of urinary catheters. Nurs Stand. 1995; 10(1): 25–9.
6. Gibney, Linda E. "Blocked urinary catheters: can they be better managed?." British Journal of Nursing 25.15 (2016).
7. Kunin CM, Chin QF, Chambers S. Formation of encrustations on indwelling urinary catheters in the elderly: a comparison of dierent types of catheter materials in `blockers' and `non- blockers'. J Urol 1987; 138: 899-902.
8. Hedelin H, Bratt CG, Eckerdal G, Lincoln K (1991) Relationship between urease producing bacteria, urinary pH and encrustation on an indwelling catheter. Br J Urol 67(5): 527–32.
9. Kohler-Ockmore J, Feneley R (1996) Long term catheterization of the bladder: prevalence of morbidity. Br J Urol 77(3): 347–51.
10. Burr RG, Nuseibeh IM (1997) Urinary catheter blockage depends on urine pH, calcium and rate of flow. Spinal Cord 35(8): 521–5.
