[Pigtail suture stent: decisive progress towards double-pigtail stent tolerance and unexpected properties of the suture in the ureter]

Comparation of intraureteral stent and conventional stent at different stages: a systematic review with meta-analysis

INTRODUCTION

Stent related symptom (SRS) is the most common adverse effect of ureteral stenting. In recent years, many efforts have been made to develope modified ureteral stents to ameliorate SRS. It has been reported that intraureteral stents have the potential to improve the tail end adverse effect of the bladder and alleviate SRS. However, there still lack of evidence for the efficacy and the safety of clinically applying intraureteral stents. The aim of this work is to investigate the efficacy and safety of intraureteral stents.

EVIDENCE ACQUISITION

A systematic review was performed by using the PubMed, Web of Science, Medline, Embase, and Cochrane library. The studies published before February 2023 were included. The study selection was following the guideline from Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA). The searching strategy was: "Pigtail suture stent" OR "Intra-ureteric stent" OR "Suture Stent" OR "Intraureteral stent" AND "Ureteroscopy" OR "Urinary calculi" OR "Stent-related symptoms" OR "Lower urinary tract symptoms". The data from randomized clinical trials which meet the selection criteria were extracted. Revman 5.4 was employed to proceed the meta-analysis.

EVIDENCE SYNTHESIS

A total of six randomized clinical trials of intraureteral stents were included in this systematic review and meta-analysis. According to the different investigation time, the results could be divided into four stages: early-stage, middle-stage, late-stage, and long-term evaluation. Urinary symptoms, pain score, and general health were significantly improved in intraureteral stents group at middle stage. For late-stage, intraureteral stent achieved better outcomes in urinary symptoms index, VAS score, quality of life, general health, and pain score. However, for early-stage and long-term evaluation, there was no significant difference between two groups.

CONCLUSIONS

This systematic review and meta-analysis reveal that regardless of the stage of treatment, the efficacy and safety of intraureteral stent are no worse than that of conventional stent. During 7-14 days postoperation, which is the most commonly time for clinically using ureteral stent, most of the outcomes of intraureteral stent are better than those of conventional stent. Hence, it is confirmed that intraureteral stent is worth for more clinical study and application.

In Vivo Evaluation of a Novel Pigtail Suture Stent

OBJECTIVE

To compare pressure, dilation, and histology in a porcine model after stenting with a pigtail suture stent (PSS)-where the ureteral and bladder component consists of a suture and a double J (DJ) stent.

METHODS

Twelve pigs were studied with a PSS (4.8F/MiniJFil®) and DJ stent (4.8F/RocaJJ Soft) inserted in both sides, except in one where the DJ was not placed to serve as control. Intrapelvic pressure (IPP) and ureteral pressures were recorded. Five pigs were stented for 7 days, and the next 7 for 13-15 days, where a retrograde study was performed after stent removal. Ureteral histology in 4 and 3 pigs stented for 7- and 13-15 days, respectively, were assessed in a blinded manner.

RESULTS

In total, 11 renal units were stented with PSS and DJ, respectively. There was a rise in IPP and ureteral pressure after stenting. There were no significant differences in post-stenting pressures between DJ and PSS systems. Ureteral dilation occurred in 100% of DJ and 83% of PSS units. PSS suture migration occurred in 3 of 11. Gross edema at the ureteral orifice was greater with the DJ compared to the PSS (82% vs 18%; p = .003). Histology demonstrated greater inflammation at the ureteral orifice in the DJ group (2.3 vs 1; p = .016) when stented for 13-15 days.

CONCLUSION

There was no difference in IPP after stenting with a PSS compared to a DJ stent. When stented for 13-15 days, the PSS resulted in ureteral dilation, but with less edema and inflammation at the ureteral orifice.

Histological Inflammation in Human Ureter either Healthy or Fitted with Double-Pigtail Stent or a Thin 0.3 F Suture Thread: A Preliminary Study

Background

Ureteral stent intolerance reduces patients' quality of life. It has been suggested that changes in the shape of stents could decrease discomfort. In previous studies, the innovative pigtail-suture stent (i.e., JFil® or MiniJFil®) with a thin 0.3 F suture thread significantly decreased stent-related symptoms. Fortuitously, a dilation of the ureter containing the sutures was discovered. In addition, no inflammation was seen on the ureter wall around the suture in endoscopy. In this preliminary study, we assessed ureteral inflammation in the human ureter when it was healthy or when fitted with a double-pigtail stent or a thread.

Materials and Methods

After consent and inclusion of patients in the protocol, fifteen segments of ureters were collected during cystectomy procedures for bladder tumors. Ureteral inflammation was assessed on the histological section stained with hematoxylin-eosin. Histological grading (cumulative range of 0 to 6) assessing inflammation was performed on the ureter section for mucosa inflammation and inflammation in the muscle layer.

Results

A marked ureteral inflammatory reaction was observed in all cases of ureters fitted with a double-pigtail stent with a mean inflammation score of 4.8 ± 0.4. The ureter fitted with the thin suture thread showed inflammation in only one case with a mean inflammation score of 1.8 ± 1.3 (p=0.001).

Conclusion

Although the study was limited by the small number of patients, it confirmed that the double-pigtail stent induced ureteral inflammation in all cases and the thin 0.3 F suture thread caused less ureteral inflammation than the double-pigtail stent. The concept of material reduction within the urinary tract seems necessary in order to decrease mucosal irritation. The JFil® or the MiniJFil® thread could meet this requirement.

MiniJFil®: A New Safe and Effective Stent for Well-Tolerated Repeated Extracorporeal Shockwave Lithotripsy or Ureteroscopy for Medium-to-Large Kidney Stones?

Background

Percutaneous nephrolithotomy (PCNL) is recommended for treating staghorn stones or stones measuring > 20 mm. Extracorporeal shockwave lithotripsy (ESWL) or flexible ureteroscopy (URS) may be used as a complement. However, PCNL can cause trauma to the kidney parenchyma, and patients may find a noninvasive procedure, such as ESWL, to be more attractive.

Objectives

The aim of this study was to evaluate the clinical efficiency of MiniJFil® stenting associated with ESWL or second-line URS for the treatment of medium-to-large kidney stones. The MiniJFil® is a stent reduced to a suture of 0.3F attached to a renal pigtail. The entire ureter is occupied only by the suture of the stent.

Methods

We retrospectively analyzed the data of 28 patients. Twenty-four patients had kidney stones measuring > 15 mm (group 1) and four patients had staghorn stones (group 2). All of the patients were fitted with MiniJFil® 2 - 3 weeks before any treatment. ESWL was always our first-line therapy. Stone-free (SF) status was defined as no evidence of stones.

Results

In group 1, the mean largest and cumulative stone diameters, respectively, were 18.7 ± 5.7 mm and 45.0 ± 12.0 mm. In group 2, the mean volume was 6,288.4 ± 2,733.0 mm³. The overall SF was 96.4% (100% for group 1 and 75% for group 2). The mean number of sessions of ESWL and URS, respectively, was 1.4 ± 0.7 and 0.8 ± 0.9 in group 1 and 4.0 ± 2.0 and 1.5 ± 1.3 in group 2. The mean times to achieve these rates were 3.2 ± 1.7 months and 5.6 ± 2.3 months for groups 1 and 2, respectively. One patient in group 2 was treated with only three sessions of ESWL. Renal colic was observed in only five patients (17.9%).

Conclusions

MiniJFil® stenting is safe and may be an alternative for the treatment of kidney stones during minimally invasive procedures.

Changing the double-pigtail stent by a new suture stent to improve patient's quality of life: a prospective study

PURPOSE

Double-pigtail stent intolerance reduces patient's quality of life. By decreasing the amount of material within the bladder, it should be possible to attenuate stent's symptoms. We evaluated the tolerance of a new stent with a dedicated questionnaire.

METHODS

The major innovation of the pigtail suture stent (PSS) is in the replacement of the lower part of the double-pigtail stent with a 0.3F suture. A total of 79 consecutive patients agreed to be fitted with a PSS. The double-pigtail stents of 24 patients complaining strongly of symptoms were replaced with PSS (group 1), and 55 other patients were fitted directly with the PSS after an ureteral endoscopic intervention (group 2). The questionnaire was prospectively administered to patients at baseline and Day 15 post-placement.

RESULTS

All questionnaires were returned. In group 1, the replacement of the double-pigtail stent with a PSS significantly decreased urinary symptom scores (35.2 ± 7.5 vs. 23.6 ± 5.4; p = 2 × 10(-6)) and pain scores (11.0 ± 3.9 vs. 4.9 ± 3.1; p = 1 × 10(-7)). In group 1, the baseline scores were not significantly different from those of control group with double-pigtail stent. In group 2, the urinary scores with PSS were significantly different from those of baseline without stent. The scores of the two groups fitted with a PSS were not significantly different at Day 15 post-placement. Unexpectedly, following PSS implantation, we observe a clear dilation of the ureter without inflammation around the suture.

CONCLUSIONS

The PSS significantly decreases stent's symptoms and constitutes a medical advance in the domain of ureteral stent tolerance.