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Kremel D, Siatos D, Al Jaafari F. Ureteroscopy in the day case setting: it’s worth it! Retrospective single surgeon outcomes analysis during service relocation (inpatient to daycase) in a DGH. JOURNAL OF CLINICAL UROLOGY 2021. [DOI: 10.1177/2051415820962872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: Due to advances in surgical techniques and anaesthesia, day surgery is now becoming the standard care pathway for many complex procedures traditionally treated through inpatient pathways. Our aim was to study outcomes for patients undergoing rigid and flexible ureteroscopy before and after moving this service from a district general hospital to a day surgery unit. Methods: This was a retrospective observational study of 136 consecutive patients undergoing elective ureteroscopy for stone treatment. Half of the patients ( n=68, inpatient group) underwent treatment according to the standard inpatient pathway, while the other half underwent treatment following relocation of this service to a day case unit ( n=68, day case group). Outcomes were length of stay, readmission rate and complications. Results: In the inpatient group, 12 patients (17.6%) were discharged home the day of surgery (day 0), 42 patients (61.8%) stayed in hospital for one night. In the day case group, 58 patients (85.3%) were discharged on day 0, nine patients (13.2%) stayed for one night. Length of stay in the day case group was significantly shorter ( P<0.001). Rates of postoperative complications and readmissions were not significantly different. Conclusion: Day case ureteroscopy for stone treatment is feasible and safe. It is associated with a significantly reduced length of stay without an increase in postoperative complications or readmission.
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Affiliation(s)
- Darja Kremel
- Depatment of urology,Victoria Hospital, NHS Fife, Scotland, UK
| | | | - Feras Al Jaafari
- Depatment of urology,Victoria Hospital, NHS Fife, Scotland, UK
- School of Medicine, University of St Andrews, Scotland, UK
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Chandna A, Kumar S, Parmar KM, Sharma AP, Devana SK, Mete UK, Singh SK. Comparison of stent related symptoms in patients taking mirabegron, solifenacin, or tamsulosin: A double blinded randomized clinical trial. Urologia 2021; 89:589-596. [PMID: 34596484 DOI: 10.1177/03915603211048153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The present study aims to assess the efficacy of mirabegron, a novel beta-3 agonist for ameliorating stent related symptoms (SRSs) as compared to tamsulosin and solifenacin. METHODS Total of 150 patients undergoing ureteral stent placement following ureteroscopic lithotripsy, percutaneous nephrolithotomy, or laparoscopic/robotic pyeloplasty were randomized in 1:1:1 fashion to receive mirabegron 50 mg (group A), solifenacin 5 mg (group B), and tamsulosin 0.4 mg (group C) OD respectively. Patients were followed at POD10 (I visit), 4 weeks (II visit) after surgery, and 2 weeks post-stent removal. Validated vernacular version of ureteric stent symptoms questionnaire (USSQ) was administered to the patients at each visit. RESULTS Out of 150 patients randomized, 123 patients (A; n = 41, B; n = 40, and C; n = 42) completed the study. The groups were comparable in terms of urinary index score of USSQ at I and II visits (p = 0.119 and 0.076, respectively). A lower proportion of patients in group B experiencing bodily pain at II visit (p = 0.039), however, pain scores were comparable. Significantly lower general health index scores were observed in group A at I visit and over 4 weeks (p = 0.007). No significant differences were observed in other domains of USSQ. Age, sex, and surgical procedure undertaken did not significantly impact the scores in various USSQ domains. CONCLUSION Mirabegron demonstrates comparable benefit in alleviating SRSs with better general health indices and may be an effective alternative for SRSs, especially when tamsulosin or solifenacin are contra-indicated or poorly tolerated.
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Affiliation(s)
- Abhishek Chandna
- Department of Urology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Santosh Kumar
- Department of Urology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Kalpesh M Parmar
- Department of Urology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Aditya P Sharma
- Department of Urology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Sudheer K Devana
- Department of Urology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Uttam K Mete
- Department of Urology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Shrawan K Singh
- Department of Urology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
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Segalen T, Lebdai S, Panayotopoulos P, Culty T, Brassart E, Riou J, Azzouzi AR, Bigot P. Double J stenting evaluation after ureteroscopy for urolithiasis. Prog Urol 2019; 29:589-595. [PMID: 31506249 DOI: 10.1016/j.purol.2019.08.266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 06/17/2019] [Accepted: 08/07/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVES During ureteroscopy for urolithiasis, postoperative ureteral drainage with double J stent is frequently used. It may reduce acute postoperative pain and late ureteral stenosis. Double J stent can have negative impact on life quality. After uncomplicated intervention, double J stent is not mandatory. Objective of our study was to evaluate pain and complications after ureteroscopy with or without stent. METHODS We retrospectively analyzed ureteroscopy performed between May 2014 and January 2017. Interventions were compared regarding ureteral drainage with double J stent or not. Our primary outcome was early postoperative pain evaluated with an oral pain scale form 1 to 10 on day one after intervention. Clinical characteristics, per- and postoperative data were collected. We also looked for risks factors of complications. RESULTS Three hundred and sixty-six interventions were included, 259 (70.8%) with and 107 (29.2%) without double J stent. Stone burden was higher in stented group (18.3 vs 9.4mm, P<0.0001). Patients without postoperative stents had more ureteral preparation with double J stent (78.5% vs 62.5%, P=0.0032) and had more ambulatory interventions (75.7% vs 52.5%, P<0.0001). Postoperative pain was not different (22% vs 17.75%, P=0.398). Complication rate was similar (29% vs 20.5%, P=0.1181), so was rehospitalization rate (0.8% vs 0.9%, P=1). In multivariate analysis, complications factors were unprepared ureter, experienced surgeons and access sheath. CONCLUSION Not stenting after ureteroscopy do not increase pain or complications. Stenting should not be used after uncomplicated interventions for centimetric stones. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- T Segalen
- Department of urology, Angers university hospital, 4, rue Larrey, 49000 Angers, France.
| | - S Lebdai
- Department of urology, Angers university hospital, 4, rue Larrey, 49000 Angers, France
| | - P Panayotopoulos
- Department of urology, Angers university hospital, 4, rue Larrey, 49000 Angers, France
| | - T Culty
- Department of urology, Angers university hospital, 4, rue Larrey, 49000 Angers, France
| | - E Brassart
- Department of urology, Angers university hospital, 4, rue Larrey, 49000 Angers, France
| | - J Riou
- MINT, université d'Angers, Inserm U1066, CNRS 6021, université Bretagne Loire, 49000 Angers cedex, France
| | - A R Azzouzi
- Department of urology, Angers university hospital, 4, rue Larrey, 49000 Angers, France
| | - P Bigot
- Department of urology, Angers university hospital, 4, rue Larrey, 49000 Angers, France
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Pereira JF, Bower P, Jung E, Parkhomenko E, Tran T, Thavaseelan S, Pareek G. Ureteral stenting practices following routine ureteroscopy: an international survey. World J Urol 2019; 37:2501-2508. [PMID: 30747279 DOI: 10.1007/s00345-019-02660-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 01/30/2019] [Indexed: 11/29/2022] Open
Abstract
PURPOSE Stent omission after routine ureteroscopy (rtURS) is accepted by current guidelines and may result in decreased patient morbidity and treatment costs. In a value-based healthcare model, the added morbidity and cost of routine stent placement may be scrutinized. Furthermore, data are limited on urologist cost knowledge and it is effect on ureteral stent placement. As such, we seek to describe ureteral stenting practices and urologist cost knowledge amongst US and non-US-based urologists. METHODS The ureteroscopic practice patterns and cost awareness of members of the Endourological Society were surveyed using an international email listserv. Respondents were grouped by practice location (US vs non-US). Logistic regression was used to evaluate the associations of surgeon practice location with stenting practices. RESULTS 233 completed responses were received with a response rate of 13.5%. Results revealed that 55% and 71% of respondents reported ureteral stent insertion after rtURS more than 75% of the time for ureteral and renal stones, respectively. Reporting stent insertion following more than 75% of rtURS was more common among US participants for both ureteral and renal stones. Overall, reported cost knowledge was high, but lower among US participants. On multivariable analysis, US respondents were more likely to place ureteral stents after rtURS for ureteral stones more than 75% of the time when compared to those abroad (OR 3.43 p < 0.01). CONCLUSION Ureteral stenting after rtURS is over utilized in the US compared to other countries. While this phenomenon is multifactorial in nature, cost knowledge may be under recognized as a determinant of ureteral stent placement following rtURS.
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Affiliation(s)
- Jorge F Pereira
- Columbia University Division of Urology, Mount Sinai Medical Center, 4302 Alton Road, Suite 540, Miami Beach, FL, 33140, USA.
| | - Paul Bower
- Warren Alpert Medical School of Brown University, Providence, RI, USA.,Division of Urology, Rhode Island Hospital, The Miriam Hospital, Providence, RI, USA
| | - Eric Jung
- Warren Alpert Medical School of Brown University, Providence, RI, USA.,Division of Urology, Rhode Island Hospital, The Miriam Hospital, Providence, RI, USA
| | - Egor Parkhomenko
- Department of Urology, University of California, Irvine, Orange, CA, USA
| | - Timothy Tran
- Warren Alpert Medical School of Brown University, Providence, RI, USA.,Division of Urology, Rhode Island Hospital, The Miriam Hospital, Providence, RI, USA
| | - Simone Thavaseelan
- Warren Alpert Medical School of Brown University, Providence, RI, USA.,Division of Urology, Rhode Island Hospital, The Miriam Hospital, Providence, RI, USA
| | - Gyan Pareek
- Warren Alpert Medical School of Brown University, Providence, RI, USA.,Division of Urology, Rhode Island Hospital, The Miriam Hospital, Providence, RI, USA.,Minimally Invasive Urology Institute, The Miriam Hospital, Providence, RI, USA
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How bothersome double-J ureteral stents are after semirigid and flexible ureteroscopy: a prospective single-institution observational study. World J Urol 2018; 37:201-207. [PMID: 29923014 DOI: 10.1007/s00345-018-2376-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Accepted: 06/12/2018] [Indexed: 12/23/2022] Open
Abstract
PURPOSE To evaluate in details the actual extent of double-J stent-related symptoms after semirigid (URS) and flexible (RIRS) ureteroscopy using a validated questionnaire. METHODS We asked to complete the Ureteric Stent Symptoms Questionnaire (USSQ) to all stone patients undergoing URS or RIRS with stent placement from 2010 to 2015. Stent-related symptoms' prevalence, severity, and impact on daily life were analyzed using descriptive statistics and five-order Likert scales. Subgroups analyses were performed. RESULTS 232 patients completed the USSQ. Stents had a deep impact on urinary symptoms (daily frequency ≥ 1 per hour 59.1%, ≥ 1 nocturnal micturition 90.1%, urgency 86.6%, burning 82.3%) that represented a problem for 88.4% of patients. 83.2% complained of pain, mostly in the kidney (67.9%) or in the bladder area (31.3%), particularly during physical activity (72.9%) and micturition (77.0%). Pain interfered with everyday life in 92.2%. General health, working, and sexual activity were also affected. 62.0% of patients would be dissatisfied (51.6% unhappy or terrible) if further ureteral stenting was proposed in future. Younger patients and females were more affected. Limitations include observational design and lack of baseline evaluation. CONCLUSIONS Ureteral stents are responsible for significant urinary symptoms and pain after semirigid and flexible ureteroscopy. They also considerably affect general health, working and sexual activity. Urologists should consider it carefully before stenting, inform patients about stent-related symptoms, and minimize stent indwelling time.
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Unplanned Emergency Department Visits and Hospital Admissions Following Ureteroscopy: Do Ureteral Stents Make a Difference? Urology 2018; 117:44-49. [PMID: 29601836 DOI: 10.1016/j.urology.2018.03.019] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 03/10/2018] [Accepted: 03/15/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate unplanned medical visits within the early postoperative period after ureteroscopy in patients with and without ureteral stent placement. MATERIALS AND METHODS We identified all ureteroscopic procedures for urinary stone disease in the California Office of Statewide Health Planning and Development database from 2010 to 2012. The primary outcome was any emergency department visit or inpatient hospital admission in the first 7 days following ureteroscopy. Patients were subcategorized by type of ureteroscopy (ie, laser lithotripsy vs basket retrieval) and were analyzed for significant differences between stented and unstented patients. Multivariable logistic regression was performed to determine if ureteral stent placement was independently associated with unplanned visits. RESULTS Our analytic cohort included 16,060 patients undergoing 17,716 ureteroscopy procedures. A ureteral stent was placed in 86.2% of patients undergoing laser lithotripsy and in 70.5% of patients receiving basket retrieval. In the 7 days following ureteroscopy, 6.6% of patients were seen in the emergency department and 2.2% of patients were admitted to a hospital. In a fully adjusted model, the utilization of a ureteral stent was not associated with emergency department visits or inpatient admissions. CONCLUSION Ureteral stent placement during ureteroscopy is not associated with an increased odds of emergency department visits and inpatient admissions in the early postoperative period.
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Doizi S, Traxer O. Flexible ureteroscopy: technique, tips and tricks. Urolithiasis 2017; 46:47-58. [PMID: 29222575 DOI: 10.1007/s00240-017-1030-x] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Accepted: 11/20/2017] [Indexed: 12/11/2022]
Abstract
During the last decades, the surgical management of kidney stones benefited of many technological advances and one of them is the development of flexible ureteroscopy (fURS). This tool, ancillary equipment such as graspers and baskets, and lithotripsy technique with Holmium:YAG laser underwent many improvements leading to a widening of its indications with diagnostic and therapeutic management of upper urinary tract pathologies such as urolithiasis and urothelial tumors. The objective of this review is to describe the surgical technique for fURS as well as tips and tricks for the treatment of renal stones.
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Affiliation(s)
- Steeve Doizi
- Department of Urology, Tenon Hospital, Assistance-Publique Hôpitaux de Paris, 4 rue de la Chine, 75020, Paris, France.,Pierre et Marie Curie University, Paris, France.,Groupe de Recherche Clinique sur la Lithiase Urinaire, Tenon Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Olivier Traxer
- Department of Urology, Tenon Hospital, Assistance-Publique Hôpitaux de Paris, 4 rue de la Chine, 75020, Paris, France. .,Pierre et Marie Curie University, Paris, France. .,Groupe de Recherche Clinique sur la Lithiase Urinaire, Tenon Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.
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Wang H, Man L, Li G, Huang G, Liu N, Wang J. Meta-Analysis of Stenting versus Non-Stenting for the Treatment of Ureteral Stones. PLoS One 2017; 12:e0167670. [PMID: 28068364 PMCID: PMC5221881 DOI: 10.1371/journal.pone.0167670] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 11/20/2016] [Indexed: 12/23/2022] Open
Abstract
Background and aim Ureteroscopic lithotripsy (URL) and extracorporeal shock wave lithotripsy (ESWL) are two widely used methods for the treatment of ureteral stones. The need for ureteral stenting during these procedures is controversial. In this meta-analysis, we evaluated the benefits and disadvantages of ureteral stents for the treatment of ureteral stones. Methods Databases including PubMed, Embase and Cochrane library were selected for systematic review of randomized controlled trials (RCTs) comparing outcomes with or without stenting during URL and ESWL. Meta-analysis was performed using RevMan 5.3 and STATA 13.0 software. Results We identified 22 RCTs comparing stenting and non-stenting. The stented group was associated with longer operation time (WMD: 4.93; 95% CI: 2.07 to 7.84; p < 0.001), lower stone-free rate (OR: 0.55; 95% CI: 0.34 to 0.89; p = 0.01). In terms of complications, the incidence of hematuria (OR: 3.68; 95% CI: 1.86 to 7.29; p < 0.001), irritative urinary symptoms (OR: 4.40; 95% CI: 2.19 to 9.10; p < 0.001), urinary infection (OR: 2.23; 95% CI: 1.57 to 3.19; p < 0.001), and dysuria (OR: 3.90; 95% CI: 2.51 to 6.07; p < 0.001) were significantly higher in the stented group. No significant differences in visual analogue score (VAS), stricture formation, fever, or hospital stay were found between stenting and non-stenting groups. The risk of unplanned readmissions (OR: 0.63; 95% CI: 0.41 to 0.97; p = 0.04) was higher in the non-stented group. Conclusions Our analysis showed that stenting failed to improve the stone-free rate, and instead, it resulted in additional complications. However, ureteral stents are valuable in preventing unplanned re-hospitalization. Additional randomized controlled trials are still required to corroborate our findings.
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Affiliation(s)
- Hai Wang
- Department of Urology, Beijing Jishuitan Hospital, Beijing, China
- * E-mail:
| | - Libo Man
- Department of Urology, Beijing Jishuitan Hospital, Beijing, China
| | - Guizhong Li
- Department of Urology, Beijing Jishuitan Hospital, Beijing, China
| | - Guanglin Huang
- Department of Urology, Beijing Jishuitan Hospital, Beijing, China
| | - Ning Liu
- Department of Urology, Beijing Jishuitan Hospital, Beijing, China
| | - Jianwei Wang
- Department of Urology, Beijing Jishuitan Hospital, Beijing, China
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Dellis AE, Papatsoris AG, Keeley FX, Bamias A, Deliveliotis C, Skolarikos AA. Tamsulosin, Solifenacin, and Their Combination for the Treatment of Stent-Related Symptoms: A Randomized Controlled Study. J Endourol 2017; 31:100-109. [DOI: 10.1089/end.2016.0663] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Athanasios E. Dellis
- Second Department of Surgery, School of Medicine, Aretaieion Hospital, National and Kapodistrian University of Athens, Maroussi, Greece
| | - Athanasios G. Papatsoris
- Second Department of Urology, School of Medicine, Sismanogleion Hospital, National and Kapodistrian University of Athens, Maroussi, Greece
| | - Francis X. Keeley
- Southmead Hospital, Bristol Urological Institute, Bristol, United Kingdom
| | - Aristotelis Bamias
- Department of Therapeutics, School of Medicine, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Charalambos Deliveliotis
- Second Department of Urology, School of Medicine, Sismanogleion Hospital, National and Kapodistrian University of Athens, Maroussi, Greece
| | - Andreas A. Skolarikos
- Second Department of Urology, School of Medicine, Sismanogleion Hospital, National and Kapodistrian University of Athens, Maroussi, Greece
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First clinical evaluation of a new single-use flexible cystoscope dedicated to double-J stent removal (Isiris™): a European prospective multicenter study. World J Urol 2016; 35:1269-1275. [DOI: 10.1007/s00345-016-1986-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 12/02/2016] [Indexed: 10/20/2022] Open
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Zhang P, Hu WL, Cheng B, Cheng L, Zeng YJ, Wang G. α 1-blockers for the reduction of ureteric stent-related symptoms: A systematic review and meta-analysis. Exp Ther Med 2015; 11:660-668. [PMID: 26893663 DOI: 10.3892/etm.2015.2942] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 10/21/2015] [Indexed: 11/06/2022] Open
Abstract
The present meta-analysis aimed to evaluate the current evidence for the use of α1-blockers in relieving ureteric stent-related symptoms (USS). Electronic databases, including PubMed, Embase and Cochrane Library, were searched and two independent reviewers identified relevant parallel randomized controlled trials (RCTs), assessed trial quality and extracted data. Review Manager (version 5.2) was used to conduct a meta-analysis of the data. Significant advantages were demonstrated in the treatment group based on International Prostate Symptom Score (IPSS), voiding symptom sub-scores [mean difference (MD), -2.66; 95% confidence interval (CI), (-4.36, -0.96)], Ureteral Stent Symptom Questionnaire (USSQ) urinary symptoms score (MD, -5.84; 95%CI, -9.35 to -2.33), IPSS quality of life score (MD, -1.46; 95%CI, -2.64 to -0.28) USSQ quality of life score (MD, -0.69; 95%CI, -1.10 to -0.28), USSQ pain score (MD, -3.97; 95%CI, -5.52 to -2.42), Visual Analog Pain Scale (MD, -1.53; 95%CI, -2.25 to -0.80) and USSQ general health score (MD, -1.82; 95%CI, -2.47 to -1.18). No significant differences were detected from the following results: IPSS storage symptom sub-score (MD, -0.93; 95%CI, -2.28 to 0.43), USSQ sexual matters score (MD, -0.10; 95%CI, -0.79 to 0.59), USSQ work performance score (MD, 1.64; 95%CI, -2.18 to 5.47) and USSQ additional problems score (MD, -2.02; 95%CI, -4.55 to 0.52). However, significant between-trial heterogeneity was detected following statistical analysis and there were insufficient data to trace its source. The existing RCT data supported the hypothesis that α1-blockers beneficially influence pain, urinary symptoms and the quality of life of patients with an indwelling ureteral stent.
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Affiliation(s)
- Peng Zhang
- Department of Urology, Zhongnan Hospital, Wuhan University, Wuhan, Hubei 430071, P.R. China
| | - Wan-Li Hu
- Department of Urology, Zhongnan Hospital, Wuhan University, Wuhan, Hubei 430071, P.R. China
| | - Bei Cheng
- Department of Anatomy and Embryology, School of Basic Medical Sciences, Wuhan University, Wuhan, Hubei 430071, P.R. China
| | - Long Cheng
- Department of Urology, Zhongnan Hospital, Wuhan University, Wuhan, Hubei 430071, P.R. China
| | - Yang-Jun Zeng
- Department of Urology, Zhongnan Hospital, Wuhan University, Wuhan, Hubei 430071, P.R. China
| | - Gang Wang
- Department of Urology, Zhongnan Hospital, Wuhan University, Wuhan, Hubei 430071, P.R. China
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Kim DJ, Son JH, Jang SH, Lee JW, Cho DS, Lim CH. Rethinking of ureteral stent removal using an extraction string; what patients feel and what is patients' preference? : a randomized controlled study. BMC Urol 2015; 15:121. [PMID: 26653027 PMCID: PMC4675013 DOI: 10.1186/s12894-015-0114-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 11/30/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ureteral stent removal using an extraction string is advantageous because it can obviate an invasive cystoscopy, but there is a paucity of data on how patients feel about it, and how bothersome or beneficial it is. We performed this study to evaluate patients' preference for stent removal using an extraction string and which parameters could affect it. METHODS In total, 114 consecutive patients undergoing ureteral stent insertion after ureteroscopic stone removal (URS) for unilateral recurrent ureter stones were enrolled. Patients were randomized to a string group or a no string group. Stent removal was performed on the first visit within 7 days postoperatively. All patients were asked to complete the ureteral stent symptom questionnaire, to rate the degree of pain during stent removal using a visual analog scale (VAS) and to answer to questions regarding their preference. RESULTS No significant differences were found in domain total scores including urinary symptoms (p = 0.17), pain (p = 0.62), general health (p = 0.37), work performance (p = 0.41). However, regarding separate questions for 'dysuria' and 'difficulties with heavy physical activity', there were significant intergroup differences (p = 0.03 and p = 0.04, respectively). Particular, a significantly higher proportion of patients in the string group checked 'stoppage of sexual intercourse due to stent-related problems' than in the no string group (p = 0.03). VAS score on stent removal was significantly higher in the no string group than the string group (p = 0.005). Among the patients who remember the experience of an indwelling ureteral stent in the past, 85% (17/20) of the no string group answered 'No' to the question of 'difference between the methods used in this time and in the past'. On the contrary, 84.2% (16/19) answered 'Yes' to the same question in the string group. And, all 16 patients of the string group who noted differences between the methods preferred ureteral stent removal using an extraction string to the past method. CONCLUSIONS Despite of minor increased morbidity related to the extraction string, patients preferred ureteral stent removal using the extraction string after URS. The patients with the extraction string felt less pain on stent removal than flexible cystoscopic stent removal. TRIAL REGISTRATION KCT0001700 . The trial was registered in the Clinical Research Information Service (CRiS), Republic of Korea; registration date: 18/11/2015.
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Affiliation(s)
- Dae Ji Kim
- Department of Urology, Bundang Jesaeng Hospital, 180 Seohyeon-rho Bundang-gu, Seongnam, 463-774, Republic of Korea.
| | - Jeong Hwan Son
- Department of Urology, Bundang Jesaeng Hospital, 180 Seohyeon-rho Bundang-gu, Seongnam, 463-774, Republic of Korea.
| | - Seok Heun Jang
- Department of Urology, Bundang Jesaeng Hospital, 180 Seohyeon-rho Bundang-gu, Seongnam, 463-774, Republic of Korea.
| | - Jae Won Lee
- Department of Urology, Bundang Jesaeng Hospital, 180 Seohyeon-rho Bundang-gu, Seongnam, 463-774, Republic of Korea.
| | - Dae Sung Cho
- Department of Urology, Bundang Jesaeng Hospital, 180 Seohyeon-rho Bundang-gu, Seongnam, 463-774, Republic of Korea.
| | - Chae Hong Lim
- Department of Urology, Bundang Jesaeng Hospital, 180 Seohyeon-rho Bundang-gu, Seongnam, 463-774, Republic of Korea.
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13
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Loh-Doyle JC, Low RK, Monga M, Nguyen MM. Patient experiences and preferences with ureteral stent removal. J Endourol 2015; 29:35-40. [PMID: 25019375 DOI: 10.1089/end.2014.0402] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
PURPOSE Ureteral stent removal is a source of patient morbidity. We surveyed 599 patients to evaluate their experiences and identify the preferred method of stent removal. MATERIALS AND METHODS Visitors to a kidney stone website were invited to participate. Respondents were asked how their ureteral stent was removed? Pain during and after the procedure, patient experiences, and preferences regarding stent removal were queried. Chi-square and ANOVA tests were used to identify significant differences among removal methods. RESULTS Five hundred seventy-one respondents were included in the study. The majority of stents (44%) were removed by office cystoscopy while 39% had their stents removed by string. Mean pain during stent removal was 4.8 out of 10 with 57% reporting moderate-to-severe pain levels of 4 or more. Removal by office cystoscopy resulted in the highest experienced pain (5.3). Thirty-two percent reported delayed severe pain after stent removal, including 9% who returned for emergency care. Removal by string resulted in more emergency room visits when compared to cystoscopy. Willingness to undergo the same removal technique was lowest for those who underwent office cystoscopy and highest for operating room cystoscopy. Being informed of why a stent was placed and the removal process was of high priority for respondents. CONCLUSIONS The majority of patients report moderate-to-severe pain with stent removal and a third report delayed significant pain after stent removal. Variations exist in the patient experience with stent removal based on the method used. More research is needed to identify effective ways to prevent or manage stent-removal-related adverse events.
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Affiliation(s)
- Jeffrey C Loh-Doyle
- 1 USC Institute of Urology, Keck School of Medicine of USC , Los Angeles, California
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Dellis AE, Keeley FX, Manolas V, Skolarikos AA. Reply. Urology 2014. [DOI: 10.1016/j.urology.2013.08.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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15
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Matani YS, Al-Ghazo MA, Al-azab RS, Bani-hani O, Rabadi DK. Emergency double-J stent insertion following uncomplicated Ureteroscopy: risk-factor analysis and recommendations. Int Braz J Urol 2013; 39:203-8. [PMID: 23683666 DOI: 10.1590/s1677-5538.ibju.2013.02.08] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2012] [Accepted: 01/15/2013] [Indexed: 11/22/2022] Open
Abstract
PURPOSE Emergency double-J (DJ) stenting following ″uncomplicated″ ureteroscopic (UURS) stone treatment is both morbid and costly. Our study aims at identifying those patients who are more likely to require such an extra procedure. Handling of this complication will also be highlighted. MATERIALS AND METHODS 319 cases of UURS cases were selected out of 903 patients, who were admitted for URS stone treatment at King Abdullah University Hospital during the period from May, 2003 to December, 2010. Thirty-eight of them (11.9%) had emergency post-URS DJ stenting within 24 hours of discharge. The medical records of all UURS cases were retrospectively reviewed. Comparison in demographic and stone-related variables was made using 2-paired t-test with P < 0.05. Operative findings of 38 stented patients were outlined. RESULTS Significant risk factors for emergency stenting were noted in males with larger (> 1.5 cm) and proximal stones (38 stented vs. 281 unstented). Operative risk factors among the 38 patients were: initial procedure time > 45 minutes (42.1%), ureteral wall edema (21.1%), repeated access for stones > 1.5 cm (21.1%), impacted stone (10.5%) and ignored or missed stones/fragments (4.6%). CONCLUSIONS The need for emergency DJ stenting following UURS stone treatment is not uncommon. The routine insertion is impractical and weakly-supported. With risk-factor stratification, selective and individualized DJ stenting policy is recommended.
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Affiliation(s)
- Yousef S Matani
- Department of General Surgery and Urology and Department of Anaesthesia Jordan University of Science and Technology, Faculty of Medicine, King Abdullah University Hospital, Irbid, Jordan.
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Schoenthaler M, Wilhelm K, Kuehhas FE, Farin E, Bach C, Buchholz N, Miernik A. Postureteroscopic lesion scale: a new management modified organ injury scale--evaluation in 435 ureteroscopic patients. J Endourol 2012; 26:1425-30. [PMID: 22698147 DOI: 10.1089/end.2012.0227] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND PURPOSE Objective parameters for the classification of ureteral injuries and resulting indications for ureteral stent placement after ureteroscopy are lacking. We hereby present a new classification system including proof of interrater reliability and validation of recommendations for postoperative ureteral stent placement. PATIENTS AND METHODS The Postureteroscopic Lesion Scale (PULS) was applied in 435 patients undergoing ureteroscopy. Interrater reliability between three surgeons (junior resident, senior resident, and specialist) was evaluated in 112 patients. Postoperative ureteral stent placement was performed according to PULS. For follow-up with ultrasonography, we assumed hydronephrosis to be an indirect sign for significant postoperative ureteral obstruction. RESULTS No ureteral lesion was seen in 46.2% of patients (grade 0). A grade 1, 2, or 3 lesion was seen in 30.8%, 19.1%, and 3.9% of patients, respectively. No grade 4 or 5 lesions were observed in our series. Interrater reliability was high (Kendall W=0.91; mean Spearman Rho=0.86). This was particularly true between senior resident and specialist (Rho=0.95), compared with junior resident and senior resident or specialist (Rho=0.83, Rho=0.79, respectively). All patients with documented lesions had a Double-J stent placed. Indwelling time varied according to PULS. Results of a postoperative ultrasonographic follow-up could be obtained in 95.6% of cases. No patient showed clinical or sonographic signs of upper urinary tract obstruction. CONCLUSIONS According to these preliminary data for the clinical application of PULS, interrater reliability is high. Standardized empiric recommendations for the use and duration of postoperative stent placement after ureteroscopy might be useful in guiding urologists in this conversely discussed issue, ultimately preventing ureteral strictures as a late complication of ureteroscopy. These will have to be confirmed, however, by controlled trials in the future.
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Affiliation(s)
- Martin Schoenthaler
- Department of Urology, University Medical Centre Freiburg, Freiburg, Germany.
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Nazim SM, Ather MH. Alpha-blockers impact stent-related symptoms: a randomized, double-blind, placebo-controlled trial. J Endourol 2012; 26:1237-41. [PMID: 22563773 DOI: 10.1089/end.2012.0036] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND PURPOSE Ureteral stents are indispensable tools in endourology, although they often are associated with bothersome lower urinary tract symptoms. This study was conducted to evaluate the effect of alfuzosin on urinary symptoms, quality of life, and pain in patients after Double-J ureteral stent placement in a randomized, placebo-controlled trial. PATIENTS AND METHODS This study was conducted from July 2008 to May 2009. A total of 130 patients underwent placement of a Double-J stent after retrograde semirigid ureteroscopy for ureteral stones. They were randomized in two groups. Group 1 (n=65) received alfuzosin 10 mg once daily and group 2 (n=65) received placebo for 1 week. Both groups also received standardized analgesia. The stent symptoms were measured and recorded 1 week after the procedure. Statistical analyses were performed using the chi-square test and Student t test with P<0.05 considered significant. RESULTS The demographic profile including patient and stone-related parameters were comparable. Group 1 had significantly less urinary symptoms (P<0.05). The quality-of-life assessment was better in the alfuzosin arm than in the placebo arm (P<0.001). The mean pain score was 1.15 in group 1 and 3.89 in the placebo group (P<0.001). None of the patients in either of the arms withdrew from treatment; there were minimal adverse effects in the treatment arm. The limitation of the current work includes relatively smaller sample size and use of single type of stent. CONCLUSIONS Alfuzosin 10 mg once daily in patients with a Double-J stent significantly decreases the bothersome urinary symptoms, besides decreasing significantly the pain associated with the stent.
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Affiliation(s)
- Syed M Nazim
- Section of Urology, Department of Surgery, Aga Khan University, Karachi, Pakistan
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Pengfei S, Yutao L, Jie Y, Wuran W, Yi D, Hao Z, Jia W. The results of ureteral stenting after ureteroscopic lithotripsy for ureteral calculi: a systematic review and meta-analysis. J Urol 2011; 186:1904-9. [PMID: 21944085 DOI: 10.1016/j.juro.2011.06.066] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2011] [Indexed: 02/05/2023]
Abstract
PURPOSE We evaluated the necessity and adverse effects of routine ureteral stent placement after ureteroscopic lithotripsy for ureteral stones. MATERIALS AND METHODS A systematic search of PubMed®, Embase® and the Cochrane Library was performed to identify all randomized controlled trials. All relevant studies were on the outcomes and complications of ureteroscopic lithotripsy in the management of ureteral stones with or without a Double-J stent. The outcomes and complications included stone-free rate, operative time, lower urinary tract symptoms, hematuria, fever, urinary tract infection, pain and analgesia, unplanned medical visits and late postoperative complications. The Cochrane Collaboration Review Manager software (RevMan 5.0.2) was used for statistical analysis. RESULTS A total of 16 randomized controlled trials were enrolled for analysis and involved 1,573 patients. Of these patients 797 were in the nonstented group and 776 in the stented group. There was a statistically significant difference in mean operative time between the 2 groups. The incidence of lower urinary tract symptoms and pain was significantly higher in the stented group than in the nonstented group. Significant differences between the groups were not found in fever, urinary tract infection, need for analgesia, unplanned readmission and late postoperative complications. CONCLUSIONS This systematic review reveals the obvious disadvantages of ureteral stents after ureteroscopic lithotripsy in lower urinary tract symptoms and pain. Stents do not improve stone-free rate, fever, incidence of urinary tract infection, unplanned medical visits, requirement for analgesia and late postoperative complications. Ureteral stenting after uncomplicated ureteroscopic lithotripsy could be unnecessary.
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Affiliation(s)
- Shen Pengfei
- Department of Urology, West China Hospital, Sichuan University, Chengdu, China
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Gunlusoy B, Degirmenci T, Arslan M, Kozacýoglu Z, Minareci S, Ayder AR. Is Ureteral Catheterization Necessary after Ureteroscopic Lithotripsy for Uncomplicated Upper Ureteral Stones? J Endourol 2008; 22:1645-8. [DOI: 10.1089/end.2008.0098] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Bulent Gunlusoy
- Department of Urology, Izmir Teaching and Research Hospital, Izmir, Turkey
| | - Tansu Degirmenci
- Department of Urology, Izmir Teaching and Research Hospital, Izmir, Turkey
| | - Murat Arslan
- Department of Urology, Izmir Teaching and Research Hospital, Izmir, Turkey
| | - Zafer Kozacýoglu
- Department of Urology, Izmir Teaching and Research Hospital, Izmir, Turkey
| | - Suleyman Minareci
- Department of Urology, Izmir Teaching and Research Hospital, Izmir, Turkey
| | - Ali Ryza Ayder
- Department of Urology, Izmir Teaching and Research Hospital, Izmir, Turkey
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