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Mohammed AA, Mohammed SA, Gebreamlak AL, Leul MM. Management of neglected and fragmented DJ stent with severe encrustation and stone: A case report. Int J Surg Case Rep 2024; 117:109442. [PMID: 38479128 PMCID: PMC10945198 DOI: 10.1016/j.ijscr.2024.109442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 02/19/2024] [Accepted: 02/21/2024] [Indexed: 03/21/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE DJ stents are widely used in urological procedures and interventions. One of the main problems associated with DJ stent is encrustation and stone formation. The main risk factor for Forgotten, encrusted and calcified (FECal) stent is duration of the stent placement. In addition to high index of suspicion, Imaging like U/S and CT scan are important diagnostic modality. Multiple endourologic and open procedure may be needed for management of fecal stent. CASE PRESENTATION This case report is to discuss a 23 years old female patient with a neglected stent after right pyelolithotomy was done 6 years back. The presence of the stent was identified incidentally after she visited local health facility for recurrent LUTS. The CT scan shows fragmented and encrusted stent with in the bladder and pelvis, stones in stent coils and isolated lower pole stone. She was managed by a procedure of cystolithotomy and right PCNL in separate sessions. CLINICAL DISCUSSION Common complication of DJ stent placement especially if left for long duration is encrustation, stent migration, fragmentation and stone formation. Patient or relatives unawareness about the stent placement is the most important cause for neglecting stent. Multiple Endourologic procedures may be needed for the management of FECal stent. However some resource limited settings do combination of endourologic and open surgery. CONCLUSION Minimizing the duration of the stent especially for patient with risk factors is advised to decrease encrustation. Since management of FECal stent is challenging both for patient and urologists, prevention is the way to tackle it. Multiple procedures may be required to manage FECal stent.
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Yoshida T, Takemoto K, Sakata Y, Matsuzaki T, Koito Y, Yamashita S, Hara I, Kinoshita H, Matsuda T. A randomized clinical trial evaluating the short-term results of ureteral stent encrustation in urolithiasis patients undergoing ureteroscopy: micro-computed tomography evaluation. Sci Rep 2021; 11:10337. [PMID: 33990648 PMCID: PMC8121799 DOI: 10.1038/s41598-021-89808-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 05/04/2021] [Indexed: 01/21/2023] Open
Abstract
Although many ureteral stents are commercially available, the actuality of encrustation is yet to be elucidated in humans. This study compared the Tria Ureteral Stent with PercuShield and the Polaris Ultra Ureteral Stent with HydroPlus Coating for short-term encrustation formation. Eighty-four patients, who required ureteral stent placement after ureteroscopy, were randomized into two stent groups. After stent removal on postoperative day 14, the encrustation volume on the stent surface was measured by micro-computed tomography. The primary outcome was the inner luminal encrustation volume. Secondary outcomes were encrustation volume on the outer or total surfaces and occurrence of adverse events. Clinical factors related to encrustation were also assessed as a post-hoc analysis. Finally, of the 82 patients analyzed, 75 (91.5%) had encrustation in the inner lumen of the stent. The difference in median inner encrustation volume between the Tria and Polaris Ultra stents was comparable (0.56 vs. 0.37 mm3, P = 0.183). There was no difference observed in the encrustation volume on the outer/total surfaces and stent-related adverse events. In both ureteral stents, the shaft body showed significant inner luminal encrustation compared to the proximal or distal loop (all, P < 0.05). Dyslipidemia (P = 0.027), elevated urine pH (P = 0.046), and crystalluria (P = 0.010) were associated with encrustation formation. The Tria and Polaris Ultra stents had similar efficacy for preventing encrustation in the short-term. Further studies are required to compare their long-term patency.
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Affiliation(s)
- Takashi Yoshida
- Department of Urology and Andrology, Kansai Medical University, 2-5-1, Shin-machi, Hirakata, 573-1152, Japan.
- Department of Urology and Andrology, Kori Hospital, Kansai Medical University, Osaka, Japan.
| | - Kuniko Takemoto
- Department of Physics, Kansai Medical University, Osaka, Japan
| | - Yoshiko Sakata
- Central Research of Laboratory, Kansai Medical University, Osaka, Japan
| | - Tomoaki Matsuzaki
- Department of Urology and Andrology, Kansai Medical University, 2-5-1, Shin-machi, Hirakata, 573-1152, Japan
| | - Yuya Koito
- Department of Urology and Andrology, Kori Hospital, Kansai Medical University, Osaka, Japan
| | | | - Isao Hara
- Department of Urology, Wakayama Medical University, Wakayama, Japan
| | - Hidefumi Kinoshita
- Department of Urology and Andrology, Kansai Medical University, 2-5-1, Shin-machi, Hirakata, 573-1152, Japan
| | - Tadashi Matsuda
- Department of Urology and Andrology, Kansai Medical University, 2-5-1, Shin-machi, Hirakata, 573-1152, Japan
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The Efficacy and Safety of Ureteric Stent Removal with Strings versus No Strings: Which Is Better? BIOMED RESEARCH INTERNATIONAL 2020; 2020:4081409. [PMID: 33123574 PMCID: PMC7584935 DOI: 10.1155/2020/4081409] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 09/30/2020] [Indexed: 11/17/2022]
Abstract
Objective To evaluate the current evidence on the effectiveness and safety of ureteric stent removal using strings compared to conventional methods. Materials and Methods The electronic databases PubMed, Embase, China National Knowledge Infrastructure (CNKI), and the Cochrane Library were systematically searched up to March 2020. Two reviewers searched the literature, independently extracted the data, and evaluated the quality of the studies according to the inclusion and exclusion criteria. The data analysis was performed with the software program Review Manager 5.3. Results Eleven studies with a total of 1809 patients were included in the analysis based on the inclusion criteria. Our meta-analysis showed that visual analogue scale (VAS) scores were significantly lower in the string group than in the conventional group (weighted mean difference (WMD) -2.63; 95% confidence interval (CI) -3.68, -1.58; P < 0.00001). In terms of stent dwell time, the string group had an advantage (WMD -9.53; 95% CI -14.20, -4.86; P < 0.0001). In addition, no significant differences in the occurrence of urinary tract infection (UTI) (odds ratio (OR) 1.03; 95% CI 0.62, 1.72; P = 0.92), emergency room visits (OR 0.99; 95% CI 0.59, 1.67; P = 0.97), or other complications (P > 0.05) were observed between the two groups. Conclusion Our findings suggest that an extraction string is an effective and safe method for the removal of ureteric stents. This method gives patients the benefits of reduced pain and shortened stent dwell time without increasing the risk of UTI. Nevertheless, these findings should be further confirmed through large-volume, well-designed prospective randomized controlled trials (RCTs).
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Ramachandra M, Mosayyebi A, Carugo D, Somani BK. Strategies to Improve Patient Outcomes and QOL: Current Complications of the Design and Placements of Ureteric Stents. Res Rep Urol 2020; 12:303-314. [PMID: 32802807 PMCID: PMC7403435 DOI: 10.2147/rru.s233981] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 07/19/2020] [Indexed: 12/13/2022] Open
Abstract
Ureteric stents have played a vital role in relieving urinary obstruction in many urological conditions. Although they are extremely successful, stents have been associated with complications and reduced patients' health-related quality of life (HRQoL). There are many factors that may affect the quality and longevity of stents. In this review, we have highlighted the journey and innovation of ureteric stents through the modern day. A literature review was conducted to identify relevant articles over the last 20 years. There is a plethora of evidence with various indications for the use of ureteral stents and how they affect QoL. There is still ongoing research to develop the ideal stent with reduced encrustation, one that resists infection and is also comfortable for the patients. Stents made from metal alloys, polymers and biodegradable materials have unique properties in their own right but also have certain deficiencies. These have been discussed along with an overview of newly developed stents. Certain pharmacological adjuncts have also been highlighted that may be useful to improve patient's tolerance to stents. In summary, this paper describes the features of the different types of stents and the problems that are frequently encountered, including effect on patients' HRQoL and financial burden to healthcare providers.
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Affiliation(s)
- Meghana Ramachandra
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK
| | - Ali Mosayyebi
- Mechanical Engineering Department, Faculty of Engineering and the Environment, University of Southampton, Southampton, UK
- Institute for Life Sciences (IfLS), University of Southampton, UK
| | - Dario Carugo
- Mechanical Engineering Department, Faculty of Engineering and the Environment, University of Southampton, Southampton, UK
- Institute for Life Sciences (IfLS), University of Southampton, UK
| | - Bhaskar K Somani
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK
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Yoshida T, Matsuda T. Editorial Comment to Transient stent placement versus tubeless procedure after ureteroscopy retrograde surgery stone extraction (Fast Track Stent study 2): A randomized prospective evaluation. Int J Urol 2020; 27:754. [PMID: 32671864 DOI: 10.1111/iju.14309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Takashi Yoshida
- Department of Urology and Andrology, Kansai Medical University Hospital, Hirakata, Osaka, Japan
| | - Tadashi Matsuda
- Department of Urology and Andrology, Kansai Medical University Hospital, Hirakata, Osaka, Japan
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6
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Bates AS, Jameson M, Nkwam NM, Khan MA. Symptom and cost evaluation of ureteric stent extraction using strings versus flexible cystoscopy at a single high-volume centre. JOURNAL OF CLINICAL UROLOGY 2020. [DOI: 10.1177/2051415819876806] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background: This study evaluated ureteric stent symptoms using a modified ureteric stent symptom questionnaire (USSQ) for patients undergoing stent removal by either flexible cystoscopy, or manual, healthcare worker lead string extraction. Methods: Patients completed a stent symptom questionnaire derived from the USSQ. Mean data were compared between groups using paired Student’s t-tests. Data are presented as mean ± SD with associated p-values. A departmental cost analysis was undertaken. Results: Ninety patients completed questionnaires, 30 undergoing flexible cystoscopy and 60 string extraction. Six stents with strings were removed early (days 1–5, 6.67%, four female and two male). There were no adverse events recorded for this group. Men undergoing string extraction had significantly less pain (2.47 ± 1.88) compared to men undergoing flexible cystoscopic removal (5.67 ± 2.27, p < 0.001). There was no significant difference in pain scores for women undergoing string and flexible cystoscopic stent removal (3.56 ± 2.56 versus 3.66 ± 3.14, p > 0.90). The mean duration of stents left in situ was significantly less in the string group (10.1 ± 5.3 versus 26.5 ± 14.1 days, p < 0.001). Urinary tract infection rates did not differ between the string and the cystoscopy groups (3.7% ± 0.19 versus 2.78% ± 0.46, p > 0.90). The haematuria rates were 32.14% ± 0.47 and 66.67% ± 0.5, respectively ( p < 0.001). In our study, 60 flexible cystoscopies were avoided, saving over £67,000 at the institution within our study period. Conclusions: In our small study, stents removed with strings reduced pain scores in men, the duration of an indwelling ureteric stent, and cost to the health service. Level of evidence: 2b
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Affiliation(s)
| | | | | | - Masood Ahmed Khan
- Department of Urology, University Hospitals of Leicester NHS Trust, UK
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Sun X, Dong L, Chen T, Huang Z, Zhang X, Wu J, Lin C, Cui Y. Pooled analysis of efficacy and safety of ureteral stent removal using an extraction string. Medicine (Baltimore) 2019; 98:e17169. [PMID: 31517870 PMCID: PMC6750345 DOI: 10.1097/md.0000000000017169] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE We conducted a Pooled analysis to investigate the efficacy and safety of ureteral stent removal using an extraction string. METHODS A systematic review was performed by using the Preferred Reporting Items for Systematic Reviews and Pooled analyses. The sources including EMBASE, MEDLINE, and the Cochrane Controlled Trials Register were retrieved to gather randomized controlled trials of ureteral stent removal using an extraction string. The reference of included literature was also searched. RESULTS Four randomized controlled trials containing a amount of 471 patients were involved in the analysis. We found that the ureteral stent removal using an extraction string group had a greater decrease of visual analog scale (VAS) (Mean difference (MD) -1.40, 95% confidence interval (CI) -1.99 to -0.81, P < .00001) compared with the no string group. The string group did not show a significant differences in Ureteric Stent Symptom Questionnaire (USSQ) (P = .15), general health (P = .77), stent dwell time (P = .06), and urinary tract infection (UTI) (P = .59) with exception of stent dislodgement (Odds Ratio (OR) 10.36, 95% CI 2.40 to 44.77, P = .002) compared with the no string group. CONCLUSIONS Ureteral stent removal by string significantly provides less pain than those by cystoscope for patients without increasing stent-related urinary symptoms or UTI. However, this must be balanced against a risk of stent dislodgement and, hence, may not be a good option in all patients.
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Affiliation(s)
- Xujie Sun
- Department of Urology, Qingdao Chengyang People's Hospital, Qingdao
| | - Liying Dong
- Department of Urology, Yantai Yuhuangding Hospital Affiliated to Qingdao University, Yantai
| | - Tao Chen
- Jimo District Wenquan Hospital, Qingdao
| | - Zhongyi Huang
- Department of bid and tender office, Weihai municipal Hospital, Weihai, Shandong
| | - Xuebao Zhang
- Department of Urology, Yantai Yuhuangding Hospital Affiliated to Qingdao University, Yantai
| | - Jitao Wu
- Department of Urology, Yantai Yuhuangding Hospital Affiliated to Qingdao University, Yantai
| | - Chunhua Lin
- Department of Urology, Yantai Yuhuangding Hospital Affiliated to Qingdao University, Yantai
| | - Yuanshan Cui
- Department of Urology, Yantai Yuhuangding Hospital Affiliated to Qingdao University, Yantai
- Department of Urology, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
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8
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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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Ordonez M, Hwang EC, Borofsky M, Bakker CJ, Gandhi S, Dahm P. Ureteral stent versus no ureteral stent for ureteroscopy in the management of renal and ureteral calculi. Cochrane Database Syst Rev 2019; 2:CD012703. [PMID: 30726554 PMCID: PMC6365118 DOI: 10.1002/14651858.cd012703.pub2] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Ureteroscopy combined with laser stone fragmentation and basketing is a common approach for managing renal and ureteral stones. This procedure is associated with some degree of ureteral trauma. Ureteral trauma may lead to swelling, ureteral obstruction, and flank pain and may require subsequent interventions such as hospital admission or secondary ureteral stent placement. To prevent such issues, urologists often place temporary ureteral stents prophylactically, but the value of doing so remains unclear. OBJECTIVES To assess the effects of postoperative ureteral stent placement after uncomplicated ureteroscopy. SEARCH METHODS We performed a comprehensive search using multiple databases (the Cochrane Library, MEDLINE, Embase, Scopus, Google Scholar, and Web of Science), trials registries, other sources of grey literature, and conference proceedings, up to 01 February 2019. We applied no restrictions on publication language or status. SELECTION CRITERIA We included trials in which researchers randomised participants undergoing uncomplicated ureteroscopy to placement of a ureteral stent versus no ureteral stent. DATA COLLECTION AND ANALYSIS Two review authors independently classified studies and abstracted data from the included studies. We performed statistical analyses using a random-effects model. We rated the certainty of evidence (CoE) according to the GRADE approach. MAIN RESULTS Primary outcomesStenting may slightly reduce the number of unplanned return visits (16 trials with 1970 participants; very low CoE), but we are very uncertain of this finding.Pain on the day of surgery as measured on a visual analogue scale (scale 0 to 10; higher values reflect more pain) is probably similar (mean difference (MD) 0.32 higher, 95% confidence interval (CI) 0.13 lower to 0.78 higher; 4 trials with 346 participants; moderate CoE). Pain on postoperative days 1 to 3 may show little to no difference (standardised mean difference (SMD) 0.25 higher, 95% CI 0.32 lower to 0.82 higher; 8 trials with 683 participants; low CoE). On postoperative days 4 to 30, stented participants may experience more pain (8 trials with 903 participants; very low CoE), but we are very uncertain of this finding.Stenting may result in little to no difference in the need for secondary interventions (risk ratio (RR) 1.15, 95% CI 0.39 to 3.33; 10 studies with 1435 participants; low CoE); this corresponds to three more interventions per 1000 participants (95% CI 13 fewer to 48 more).Secondary outcomesStenting may reduce the need for narcotics (7 trials with 830 participants; very low CoE), but we are very uncertain of this finding.Rates of urinary tract infection (UTI) up to 90 days are probably not substantially different (RR 0.94, 95% CI 0.59 to 1.51; 10 trials with 1207 participants; moderate CoE); this corresponds to three fewer infections per 1000 participants (95% CI 23 fewer to 29 more).Ureteral stricture rates up to 90 days may be slightly reduced (14 trials with 1625 participants; very low CoE), but we are very uncertain of this finding.Rates of hospital admission may be slightly reduced (RR 0.70, 95% CI 0.32 to 1.55; 13 studies with 1647 participants; low CoE). This corresponds to 15 fewer admissions per 1000 participants (95% CI 33 fewer to 27 more). AUTHORS' CONCLUSIONS Findings of this review illustrate the trade-offs of risks and benefits faced by urologists and their patients when it comes to decision-making about stent placement after uncomplicated ureteroscopy for stone disease. We noted that both desirable and undesirable effects were small in absolute terms, with findings based mostly on low and very low CoE. The main issues reducing our confidence in research findings were study limitations (mostly risk of performance and detection bias) and imprecision. We were unable to conduct any of the preplanned subgroup analyses, in particular those based on stone size, stone location, and use of ureteral dilation, which may be important effect modifiers. Given the importance of this question, higher-quality and sufficiently large trials are needed to better inform decision-making.
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Affiliation(s)
- Maria Ordonez
- University of MinnesotaDepartment of Urology420 Delaware Street SE, MMC 394MinneapolisMinnesotaUSA
| | - Eu Chang Hwang
- Chonnam National University Medical School, Chonnam National University Hwasun HospitalDepartment of UrologyHwasunKorea, South
| | - Michael Borofsky
- University of MinnesotaDepartment of Urology420 Delaware Street SE, MMC 394MinneapolisMinnesotaUSA
| | - Caitlin J Bakker
- University of MinnesotaHealth Sciences Libraries303 Diehl Hall, 505 Essex Street SEMinneapolisMinnesotaUSA55455
| | | | - Philipp Dahm
- Minneapolis VA Health Care SystemUrology SectionOne Veterans DriveMail Code 112DMinneapolisMinnesotaUSA55417
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10
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Inoue T, Okada S, Hamamoto S, Yoshida T, Murota T, Matsuda T. Impact of ureteric stent removal by string on patient's quality of life and on complications at post-ureteroscopy for urolithiasis: a controlled trial. BJU Int 2018; 124:314-320. [DOI: 10.1111/bju.14622] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Takaaki Inoue
- Department of Urology and Andrology; Kansai Medical University; Osaka Japan
| | - Shinsuke Okada
- Department of Urology; Gyotoku General Hospital; Chiba Japan
| | - Shuzo Hamamoto
- Department of Nephro-Urology; Nagoya City University Graduate School of Medical Sciences; Aichi Japan
| | - Takashi Yoshida
- Department of Urology and Andrology; Kansai Medical University; Osaka Japan
| | - Takashi Murota
- Department of Urology; General Medical Centre; Kansai Medical University; Osaka Japan
| | - Tadashi Matsuda
- Department of Urology and Andrology; Kansai Medical University; Osaka Japan
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11
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Doersch KM, Elmekresh A, Machen GL, El Tayeb MM. The use of a string with a stent for self-removal following ureteroscopy: A safe practice to remain. Arab J Urol 2018; 16:435-440. [PMID: 30534444 PMCID: PMC6277270 DOI: 10.1016/j.aju.2018.04.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 04/28/2018] [Indexed: 11/26/2022] Open
Abstract
Abstract objectives To examine the safety and effectiveness of the use of a stent with a string attached after ureteroscopy (URS) for self-removal of the stent by the patient. Patients and methods After Institutional Review Board approval, a retrospective chart review was performed concerning patients who underwent URS and received an indwelling stent with or without a string attached to the stent (94 vs 349, respectively). Amongst the string group patients received a single- or a double-arm-stringed stent (31 vs 63, respectively). Statistical analyses included chi-squared and Student’s t-tests. Results The string group consisted of 94 procedures, in which 59.6% of the patients were male with a mean (SD) age of 50.0 (16.5) years. In the no-string group, 51.3% of the 349 procedures were performed in males and the mean (SD) age was 54.9 (18.1) years. Complication rates were 12.8% in the string group and 14.0% in the no-string group (P = 0.867). In the string group, 17.0% of the patients returned to the Emergency Department, whilst 15.8% of the no-string patients returned (P = 0.753). The complication rate in the single- and double-arm groups were 12.9% and 12.7%, respectively (P > 0.910). Self-removal of stents was successful in 94.7% of patients (89/94). Conclusions The use of a stent with a string after URS appears safe and effective. Few patients had difficulty removing their stents and complication rates were similar in the groups with and without a string attached to their stents. Single- and double-arm-stringed stents have similar complication rates.
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Affiliation(s)
- Karen M Doersch
- MD/PhD Program, Texas A&M Health Sciences Center, Temple, TX, USA
| | - Amr Elmekresh
- Department of Surgery, Division of Urology, Baylor Scott and White Health, Temple, TX, USA
| | - G Luke Machen
- Department of Surgery, Division of Urology, Baylor Scott and White Health, Temple, TX, USA
| | - Marawan M El Tayeb
- Department of Surgery, Division of Urology, Baylor Scott and White Health, Temple, TX, USA
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12
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Bach P, Reicherz A, Teichman J, Dahlkamp L, von Landenberg N, Palisaar RJ, Noldus J, von Bodman C. Short-term external ureter stenting shows significant benefit in comparison to routine double-J stent placement after ureterorenoscopic stone extraction: A prospective randomized trial - the Fast track stent study (FaST). Int J Urol 2018; 25:717-722. [DOI: 10.1111/iju.13711] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 04/05/2018] [Indexed: 12/23/2022]
Affiliation(s)
- Peter Bach
- Department of Urology; Marien Hospital Herne; Ruhr-University Bochum; Herne Germany
| | - Alina Reicherz
- Department of Urology; Marien Hospital Herne; Ruhr-University Bochum; Herne Germany
| | - Joel Teichman
- Department of Urology; University of British Columbia; Vancouver BC Canada
| | - Lisa Dahlkamp
- Department of Urology; Marien Hospital Herne; Ruhr-University Bochum; Herne Germany
| | | | - Rein-Jueri Palisaar
- Department of Urology; Marien Hospital Herne; Ruhr-University Bochum; Herne Germany
| | - Joachim Noldus
- Department of Urology; Marien Hospital Herne; Ruhr-University Bochum; Herne Germany
| | - Christian von Bodman
- Department of Urology; Marien Hospital Herne; Ruhr-University Bochum; Herne Germany
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13
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Abstract
Purpose of Review There are three technological parameters that play a key role on the performance of an ideal stent. These are its material, design and surface coating. This article highlights some fundamental developments that took place in these three areas of stent’s technology, in order to contribute to the identification of an ideal stent. Recent Findings In addition to technological developments concerning stent’s material, design and surface coating, the flow dynamic performance of stents has recently attracted increasing attention. Notably, it has been postulated that the local flow field in a stent is correlated with the deposition of crystals and microorganisms. These findings could potentially revolutionise future stent’s designs, and complement developments made on materials and coatings. Summary The most relevant changes in materials, designs and surface coatings of ureteric stents are reviewed in this article. These are described in the context of a specific cause of stent’s failure they aim to address, with a particular focus on encrustation and biofilm formation.
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Affiliation(s)
- Ali Mosayyebi
- Bioengineering Science Research Group, Faculty of Engineering and the Environment, University of Southampton, Southampton, UK. .,Institute for Life Sciences (IfLS), University of Southampton, Southampton, UK.
| | - Costantino Manes
- Department of Environment, Land and Infrastructure Engineering, Politecnico di Torino, Turin, Italy
| | - Dario Carugo
- Bioengineering Science Research Group, Faculty of Engineering and the Environment, University of Southampton, Southampton, UK.,Institute for Life Sciences (IfLS), University of Southampton, Southampton, UK
| | - Bhaskar K Somani
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK
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14
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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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15
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Fröhlich M, Fehr J, Sulser T, Eberli D, Mortezavi A. Extraction Strings for Ureteric Stents: Is There an Increased Risk for Urinary Tract Infections? Surg Infect (Larchmt) 2017; 18:936-940. [PMID: 28976816 DOI: 10.1089/sur.2017.165] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND To evaluate urinary tract infections associated with placement of ureteric stents, we performed a retrospective study and compared rates between patients with and patients without an extraction string attached to the ureteric stent. Indwelling ureteric stents are routinely removed by cystoscopy. If an extraction string has been connected to the stent at the time of placement, however, the removal can be performed without an invasive procedure. Concerns exist regarding the risk for an unintentional dislocation, increased stent-related discomfort, or an increase of the post-operative urinary tract infection rate. METHODS All elective transurethral ureteric stent placements performed between November 2011 and December 2012 in our department were included for this investigation. Urinary tract infection was defined according to the Centers for Disease Control and Prevention (CDC)/National Healthcare Safety Network (NHSN) surveillance definition of health-care-associated infections. Patients with an existing urinary tract infection at the time of admission were excluded from the analysis. RESULTS A total of 342 patients receiving ureteric stents were evaluated regarding post-operative urinary tract infections. Of these patients, 127 (37.1%) had an extraction string and 215 (62.9%) a stent without a string. The total urinary tract infection rate was 6.4% with no significant difference between the two groups (7.9% vs. 5.6%, p = 0.49). CONCLUSION In the present study, we did not observe an increased rate of post-operative urinary tract infections in patients with an extraction string attached to the ureteral stent. Extraction string is a good option for patients to avoid cystoscopic stent removal.
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Affiliation(s)
- Maryna Fröhlich
- 1 Department of Urology, University Hospital Zurich, University of Zurich , Zurich, Switzerland
| | - Jan Fehr
- 2 Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich , Zurich, Switzerland
| | - Tullio Sulser
- 1 Department of Urology, University Hospital Zurich, University of Zurich , Zurich, Switzerland
| | - Daniel Eberli
- 1 Department of Urology, University Hospital Zurich, University of Zurich , Zurich, Switzerland
| | - Ashkan Mortezavi
- 1 Department of Urology, University Hospital Zurich, University of Zurich , Zurich, Switzerland
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16
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Ordonez M, Borofsky M, Bakker CJ, Dahm P. Ureteral stent versus no ureteral stent for ureteroscopy in the management of renal and ureteral calculi. Hippokratia 2017. [DOI: 10.1002/14651858.cd012703] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Maria Ordonez
- University of Minnesota; Department of Urology; 420 Delaware Street SE, MMC 394 Minneapolis Minnesota USA
| | - Michael Borofsky
- University of Minnesota; Department of Urology; 420 Delaware Street SE, MMC 394 Minneapolis Minnesota USA
| | - Caitlin J Bakker
- University of Minnesota; Health Sciences Libraries; 303 Diehl Hall, 505 Essex Street SE Minneapolis Minnesota USA 55455
| | - Philipp Dahm
- Minneapolis VA Health Care System; Urology Section; One Veterans Drive Mail Code 112D Minneapolis Minnesota USA 55417
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17
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Okullo A, Yuminaga Y, Ziaziaris W, Ende D, Lau H, Brooks A, Patel MI, Bariol S. Comparison of cost of care for tethered versus non-tethered ureteric stents in the management of uncomplicated upper urinary tract stones. ANZ J Surg 2017; 87:505-508. [PMID: 28370915 DOI: 10.1111/ans.13945] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 01/13/2017] [Accepted: 01/24/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Many surgeons use a stent after ureteroscopic lithotripsy (URSL). For short-term stenting purposes, a surgeon has the choice of either a tethered or a non-tethered stent. Stents may be associated with complications that entail an additional cost to their use. There is a paucity of data on the direct healthcare cost of using stent type after either primary or secondary URSL. METHODS We retrospectively reviewed medical records for patients who underwent URSL for uncomplicated urolithiasis between January 2013 and December 2013 at two tertiary referral hospitals. Costs data was sourced from the costing department with complete data available for 134 patients. The overall medical care cost was estimated by computing the cost of surgery, stent-related emergency department presentations, re-admissions and stent removal. RESULTS A total of 113 patients had tethered stents and 21 had non-tethered stents, with similar age and gender composition between the two groups and complications rates. The mean cost of URSL and stent placement was A$3071.7 ± A$906.8 versus A$3423.8 ± A$808.4 (P = 0.049), mean cost of managing complications was A$309.4 ± A$1744.8 versus A$31.3 ± A$98.9 (P = 0.096), mean cost of out-patient clinic stent removal was A$222.5 ± A$60 versus A$1013.6 ± A$75.4 (P < 0.001) for endoscopic stent removal, overall mean cost of care was A$3603.6 ± A$1896.7 versus A$4468.1 ± A$820.8 (P = 0.042) for tethered and non-tethered stents, respectively. CONCLUSION It is cheaper to use a tethered ureteric stent compared with non-tethered stents for short-term stenting after uncomplicated URSL, with a mean cost saving of A$864.5.
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Affiliation(s)
- Alfin Okullo
- Urology Department, Westmead Hospital, Sydney, New South Wales, Australia.,Discipline of Surgery, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Yuigi Yuminaga
- Urology Department, Westmead Hospital, Sydney, New South Wales, Australia
| | - William Ziaziaris
- Discipline of Surgery, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - David Ende
- Urology Department, Westmead Hospital, Sydney, New South Wales, Australia
| | - Howard Lau
- Urology Department, Westmead Hospital, Sydney, New South Wales, Australia.,School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
| | - Andrew Brooks
- Urology Department, Westmead Hospital, Sydney, New South Wales, Australia.,Discipline of Surgery, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Manish I Patel
- Urology Department, Westmead Hospital, Sydney, New South Wales, Australia.,Discipline of Surgery, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Simon Bariol
- Urology Department, Westmead Hospital, Sydney, New South Wales, Australia.,Discipline of Surgery, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
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18
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Seklehner S, Sievert KD, Lee R, Engelhardt PF, Riedl C, Kunit T. A cost analysis of stenting in uncomplicated semirigid ureteroscopic stone removal. Int Urol Nephrol 2017; 49:753-761. [PMID: 28197765 DOI: 10.1007/s11255-017-1538-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 02/04/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate the outcome and the costs of stenting in uncomplicated semirigid ureteroscopic stone removal. MATERIALS AND METHODS A decision tree model was created to evaluate the economic impact of routine stenting versus non-stenting strategies in uncomplicated ureteroscopy (URS). Probabilities of complications were extracted from twelve randomized controlled trials. Stone removal costs, costs for complication management, and total costs were calculated using Treeage Pro (TreeAge Pro Healthcare version 2015, Software, Inc, Williamstown Massachusetts, USA). RESULTS Stone removal costs were higher in stented URS (€1512.25 vs. €1681.21, respectively). Complication management costs were higher in non-stented procedures. Both for complications treated conservatively (€189.43 vs. €109.67) and surgically (€49.26 vs. €24.83). When stone removal costs, costs for stent removal, and costs for complication management were considered, uncomplicated URS with stent placement yielded an overall cost per patient of €1889.15 compared to €1750.94 without stent placement. The incremental costs of stented URS were €138.25 per procedure. CONCLUSION Semirigid URS with stent placement leads to higher direct procedural costs. Costs for managing URS-related complications are higher in non-stented procedures. Overall, a standard strategy of deferring routine stenting uncomplicated ureteroscopic stone removal is more cost efficient.
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Affiliation(s)
- Stephan Seklehner
- Department of Urology, Landesklinikum Baden-Mödling, Waltersdorfer Straße 75, 2500, Baden, Austria.
- Department of Urology, Paracelsus Medical University Salzburg, Strubergasse 21, 5020, Salzburg, Austria.
| | - Karl-Dietrich Sievert
- Department of Urology, Paracelsus Medical University Salzburg, Strubergasse 21, 5020, Salzburg, Austria
| | - Richard Lee
- Department of Urology, Weill Medical College of Cornell University, New York, NY, USA
| | - Paul F Engelhardt
- Department of Urology, Landesklinikum Baden-Mödling, Waltersdorfer Straße 75, 2500, Baden, Austria
- Department of Urology, Paracelsus Medical University Salzburg, Strubergasse 21, 5020, Salzburg, Austria
| | - Claus Riedl
- Department of Urology, Landesklinikum Baden-Mödling, Waltersdorfer Straße 75, 2500, Baden, Austria
| | - Thomas Kunit
- Department of Urology, Paracelsus Medical University Salzburg, Strubergasse 21, 5020, Salzburg, Austria
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19
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Freifeld Y, Goldin D, Khalili L, Friedman B, Boyarsky L, Klein I, Gazy F, Stein A, Dekel Y. Does the use of ureteral stents with extraction strings increase urinary infection rates? Int Urol Nephrol 2017; 49:763-767. [PMID: 28185106 DOI: 10.1007/s11255-017-1533-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 01/27/2017] [Indexed: 11/24/2022]
Abstract
PURPOSE To assess the effect of ureteral stents with extraction string on the rate of postoperative UTI after ureteroscopies. METHODS Retrospective analysis of patient records who underwent ureteroscopy from January 2011 to August 2014 was performed. Patients were grouped into three groups according to postoperative stent status: non-stented or ureteral catheter for up to 24 h (NS), ureteral stent without extraction string (US) and ureteral stent with an extraction string (US-E). RESULTS There were 144, 133 and 282 cases in the NS, US and US-E groups, respectively. Overall infection rate was 4.7%; NS-2.1%, US-3.0% and US-E-6.7% (p = 0.057). Four percentage of men and 6.6% of women had postoperative UTI (p = 0.22). Within the group of men infection rates were 0, 2.4 and 6.4% for the NS, US and US-E groups, respectively (p = 0.01). For women, UTI rates were 7.5, 4.0 and 8.5% in the NS, US and US-E groups, respectively (p = 0.6). Infection rates were 20 and 3.9% (p = 0.001) for patients with extraction strings for >8 and <8 days. In multivariate analysis the presence of an extraction string was found to be a risk factor for infection OR 7.7 (1.01-58.9, 95% CI, p = 0.049) along with renal stone location OR 5.09 (2.1-12.05, 95% CI, p < 0.001). CONCLUSIONS No statistically significant difference was found between overall infections rates for patients with and without extraction strings, and such difference was found within the male group, suggesting extraction strings in men may increase the risk of infection.
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Affiliation(s)
- Yuval Freifeld
- Department of Urology, Lady Davis Carmel Medical Center, Haifa, Israel.
| | - Demitry Goldin
- Department of Urology, Lady Davis Carmel Medical Center, Haifa, Israel
| | - Luai Khalili
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Boris Friedman
- Department of Urology, Lady Davis Carmel Medical Center, Haifa, Israel
| | - Leonid Boyarsky
- Department of Urology, Lady Davis Carmel Medical Center, Haifa, Israel
| | - Ilan Klein
- Department of Urology, Lady Davis Carmel Medical Center, Haifa, Israel
| | - Faris Gazy
- Department of Urology, Lady Davis Carmel Medical Center, Haifa, Israel
| | - Avi Stein
- Department of Urology, Lady Davis Carmel Medical Center, Haifa, Israel
| | - Yoram Dekel
- Department of Urology, Lady Davis Carmel Medical Center, Haifa, Israel
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20
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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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21
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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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22
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Oliver R, Wells H, Traxer O, Knoll T, Aboumarzouk O, Biyani CS, Somani BK. Ureteric stents on extraction strings: a systematic review of literature. Urolithiasis 2016; 46:129-136. [PMID: 27324264 PMCID: PMC5852195 DOI: 10.1007/s00240-016-0898-1] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 06/09/2016] [Indexed: 11/24/2022]
Abstract
Short-term ureteric stents are commonly placed after ureteroscopy. The removal usually entails having a cystoscopy, but recently, endourologists have been using stents with extraction strings attached to them for ease of removal. We wanted to conduct a systematic review of literature looking at the outcomes of ureteric stents with extraction strings attached to them. Our objective was to investigate the use, morbidity, tolerability, complications, associated cost, and patient preference of stents with extraction strings attached to them. All studies in English language (between 1990 and 2015) where stents on extraction strings were either self-removed by patients or removed by physician were included. A total of eight studies (1279 patients) were included, of which 483 (38 %) patients had extraction strings for removal. There seemed to be no overall difference in pain scores or urinary symptoms between patients with and without extraction strings, but nearly 10 % of patients suffered stent dislodgement in the group with extraction strings attached. Overall stent dwell time was lower in patients who had their stents removed via extraction strings, and majority of them were able to remove their stents at home. Our study suggests that stents with extraction strings are easy for patient self-removal and can reduce the stent dwell time for patients, thus reducing the duration of morbidity and physical and financial burden to patients. However, this must be balanced against a risk of stent dislodgement and, hence, may not be a good option in all patients.
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Affiliation(s)
- Rachel Oliver
- Department of Urology, University Hospital of Southampton NHS Foundation Trust, Southampton, SO16 6YD, UK
| | - Hannah Wells
- Department of Urology, University Hospital of Southampton NHS Foundation Trust, Southampton, SO16 6YD, UK
| | - Olivier Traxer
- Department of Urology, Tenon Hospital, University Pierre and Marie Curie, Paris, France
| | - Thomas Knoll
- Department of Urology, Klinikum Sindelfingen-Böblingen, Sindelfingen, Germany
| | - Omar Aboumarzouk
- Urology Fellow, Bristol Urological Institute, Bristol, UK
- EAU Young Academic Urologists Group, Arnhem, The Netherlands
| | | | - Bhaskar K Somani
- Department of Urology, University Hospital of Southampton NHS Foundation Trust, Southampton, SO16 6YD, UK.
- EAU Young Academic Urologists Group, Arnhem, The Netherlands.
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Ureteroscopie Retrograde: Expérience de l’Hôpital Général Grand Yoff de Dakar. AFRICAN JOURNAL OF UROLOGY 2016. [DOI: 10.1016/j.afju.2016.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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24
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Althaus AB, Li K, Pattison E, Eisner B, Pais V, Steinberg P. Rate of dislodgment of ureteral stents when using an extraction string after endoscopic urological surgery. J Urol 2014; 193:2011-4. [PMID: 25541339 DOI: 10.1016/j.juro.2014.12.087] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2014] [Indexed: 11/26/2022]
Abstract
PURPOSE Ureteral stents are manufactured with an extraction string tethered to the distal end, which facilitates removal after urological surgery. However, the string may allow for stent dislodgment. We report the stent dislodgment rate in a multi-institutional series. MATERIALS AND METHODS We retrospectively reviewed the records of ureteroscopy cases at 3 academic endourology practices. Demographic and operative data were obtained as well as string use and stent dislodgment data. Categorical variables were assessed with the Fisher exact test and the Student t-test was used to assess continuous variables. RESULTS Of the 512 cases a string was used in 98 (19.1%) comprising 41 females (41.8%) and 57 males (58.2%). The stent was dislodged in 10 women and 3 men. No dislodgment occurred when a string was not used. When stratified by gender, 5.3% of men and 24.4% of women with a string experienced stent dislodgment (p = 0.013). Women were more than fourfold more likely to experience stent dislodgment than men (RR 4.6, 95% CI 1.36-15.8, p = 0.01). CONCLUSIONS Almost 15% of patients in whom a stent is placed with a string sustain stent dislodgment and most of these patients will be women. We recommend considering the risks of dislodgment in each patient who undergoes ureteroscopy with stent placement and considering string removal if the surgeon believes that dislodgment could result in adverse events such as severe colic or obstruction.
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Affiliation(s)
- Adam B Althaus
- Brigham and Women's Hospital, Boston, Massachusetts; Beth Israel Deaconess Medical Center, Boston, Massachusetts.
| | - Kai Li
- Massachusetts General Hospital, Boston, Massachusetts
| | - Erik Pattison
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Brian Eisner
- Massachusetts General Hospital, Boston, Massachusetts
| | - Vernon Pais
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
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Ureteral stenting after uncomplicated ureteroscopy for distal ureteral stones: a randomized, controlled trial. Minim Invasive Surg 2014; 2014:892890. [PMID: 25431663 PMCID: PMC4241699 DOI: 10.1155/2014/892890] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2014] [Accepted: 10/10/2014] [Indexed: 12/02/2022] Open
Abstract
Objectives. We compared outcome and complications after uncomplicated ureteroscopic treatment of distal ureteral calculi with or without the use of ureteral stents. Materials and Methods. 117 patients, prospectively divided into three groups to receive a double j stent (group 1, 42 patients), ureteral stent (group 2, 37 patients), or no stent (group 3, 38 patients), underwent ureteroscopic treatment of distal ureteral calculi. Stone characteristics, operative time, postoperative pain, lower urinary tract symptoms (LUTS), analgesia need, rehospitalization, stone-free rate, and late postoperative complications were all studied. Results. There were no significant differences in preoperative data. There was no significant difference between the three groups regarding hematuria, fever, flank pain, urinary tract infection, and rehospitalisation. At 48 hours and 1 week, frequency/urgency and dysuria were significantly less in the nonstented group. When comparing group 1 and group 3, patients with double j stents had statistically significantly more bladder pain (P = 0.003), frequency/urgency (P = 0.002), dysuria (P = 0.001), and need of analgesics (P = 0.001). All patients who underwent imaging postoperatively were without evidence of obstruction or ureteral stricture. Conclusions. Uncomplicated ureteroscopy for distal ureteral calculi without intraoperative ureteral dilation can safely be performed without placement of a ureteral stent.
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Barnes KT, Bing MT, Tracy CR. Do ureteric stent extraction strings affect stent-related quality of life or complications after ureteroscopy for urolithiasis: a prospective randomised control trial. BJU Int 2014; 113:605-9. [PMID: 24765679 DOI: 10.1111/bju.12541] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine whether ureteric stent extraction strings affect stent-related quality of life (QoL) or increase complications after ureteroscopy (URS) for stone disease. PATIENTS AND METHODS In all, 68 patients undergoing URS (October 2011 to May 2013) for stone disease were randomised to receive a ureteric stent with or without an extraction string. Patients completed the Ureteric Stent Symptom Questionnaire (USSQ) on postoperative days 1 and 6, and 6 weeks after stent removal. Pain was assessed at stent removal. Adverse events, including early stent removal, stent migration, retained stent, urinary tract infection (UTI), emergency room (ER) visits and postoperative phone calls were monitored. RESULTS There was no difference in stent-related QoL as measured by the USSQ between those with and without a stent extraction string, pain at stent removal between those who pulled their stent independently vs those who underwent cystoscopy for stent removal, or in the rate of UTIs, ER visits or phone calls between groups. Five patients (four female, one male) removed their stent early by inadvertently pulling the string; none required replacement. Patients without a string had a significantly longer period with the postoperative ureteric stent (10.6 vs 6.3 days, P < 0.001). One patient without a stent string retained her ureteric stent for 6 months, which was removed by cystoscopy without incident. CONCLUSION Ureteric stent extraction strings may offer several advantages without increasing stent-related urinary symptoms, complications, or postoperative morbidity.
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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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Abstract
Ureteral stones are normally clinically symptomatic as colic or flank pain. The investigation of acute flank pain by diagnostic imaging targets on the confirmation of the suspected ureteral stone and the exclusion of other diseases. Furthermore, imaging using unenhanced computed tomography (NCCT) or excretory urography (IVU) serves as a basis for treatment planning. Depending on the size and location of ureteral stones a spontaneous stone passage, medical expulsive therapy (MET), extracorporeal shock wave lithotripsy (SWL), ureterorenoscopy (URS) or initially just simple stenting can be considered. The aim of this review is to provide the reader with the necessary decision criteria for optimal care of patients in the daily routine.
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Affiliation(s)
- M Straub
- Klinikum rechts der Isar, Urologische Klinik und Poliklinik, Technische Universität München, Ismaninger Str. 22, 81675 München, Deutschland.
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Picozzi SCM, Ricci C, Stubinski R, Casellato S, Ratti D, Macchi A, Bozzini G, Carmignani L. Is stone diameter a variable in the decision process of employing a ureteral stent in patients undergoing uncomplicated ureterorenoscopy and associated intracorporeal lithotripsy? World J Urol 2013; 31:1617-25. [PMID: 23462959 DOI: 10.1007/s00345-013-1046-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Accepted: 02/18/2013] [Indexed: 10/27/2022] Open
Abstract
INTRODUCTION A number of randomized trials and meta-analysis in patients who underwent ureteroscopic stone removal investigated the effects of placing a ureteral stent at the end of the procedure on complication rates. However, none of these investigates the stone diameter and its possible influence on complication rates and, as such, if it should be considered a possible variable in the decision process of placing or not a ureteral stent. MATERIALS AND METHODS A bibliographic search covering the period from January 1990 to March 2012 was conducted in PubMed, MEDLINE and EMBASE. This analysis is based on the fifteen remaining studies which fulfilled the predefined inclusion criteria. All statistical evaluations were performed using SAS version 9.2. and by RevMan 5.0. RESULTS A total of 1,416 patients were included. All the studies were published after 2000. Mean stone diameter ranged between 5.3 and 13.3 mm in the non-stented group and between 6.26 and 13.28 mm in the stented group. Meta-analysis showed that stone diameter was not statistically different for stented or non-stented subgroups, whereas surgical operative time was shorter for the non-stented subgroup. The effect of stone diameter, irrespectively if patients were operated with or without stents were grouped or considered separately, did not influence complications of fever, haematuria, unplanned medical visits after surgery and urinary tract infections. CONCLUSIONS Stone diameter is not a variable in the pre- or intraoperative decision process of placing or not placing a ureteral stent in patients undergoing uncomplicated ureterorenoscopy with intracorporeal lithotripsy.
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Affiliation(s)
- Stefano C M Picozzi
- Urology Department, IRCCS Policlinico San Donato, University of Milan, Via Morandi 30, 20097, San Donato Milanese, Milan, Italy,
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Bockholt NA, Wild TT, Gupta A, Tracy CR. Ureteric stent placement with extraction string: no strings attached? BJU Int 2012; 110:E1069-73. [PMID: 22578135 DOI: 10.1111/j.1464-410x.2012.11219.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
UNLABELLED Study Type--Therapy (case series) Level of Evidence 4 What's known on the subject? and What does the study add? Of patients treated with an indwelling ureteric stent 80-90% experience lower urinary tract symptoms that are a hindrance to health-related quality of life. The prevalence of the extraction/retrieval string after ureteroscopy for stone disease and stent placement varies significantly between surgeons and published series, but the benefits of eliminating the need for a secondary procedure such as cystoscopy and stent removal, as well as the decrease in cost to the patient are well established. Published reports have not addressed the prevalence of post-procedure related events (PREs) in patients who have received an indwelling ureteric stent with the extraction/retrieval string still intact after ureteroscopy for stone disease. By analysing PREs (Emergency Room visits, unscheduled clinic visits, and telephone calls) related to their stent or procedure for patients with and without an extraction/retrieval string, the feasibility of the extraction string can be validated and the misconceptions about their use can be alleviated. OBJECTIVE • To review a retrospective ureteric stent cohort with and without extraction string to compare post-procedure related events (PRE), as ureteric stent placement after endoscopic management of urolithiasis is common, but data regarding the potential benefits or disadvantages of ureteric stent placement with extraction string are sparse. PATIENTS AND METHODS • Between June 2009 and June 2010, 293 patients underwent ureteroscopy with or without lithotripsy for stone disease. • In all, 181 patients had a unilateral procedure and underwent stent placement postoperatively. • Records were retrospectively reviewed for operative data and PRE occurring within the first 6 weeks after surgery, defined as unscheduled clinic or Emergency Room visits, or adverse event telephone calls. RESULTS • Of 181 patients who underwent ureteric stent placement, 43 (23.8%) included an extraction string. • In all, 34.3% of all patients had a PRE, including 37.2% and 33.3% of patients with and without extraction string, respectively (P = 0.64). • PRE occurred in men with or without an extraction string (27.8 vs 32.4%, respectively; P = 0.71) and women with or without an extraction string (44.0 vs 34.3%, respectively, P = 0.39). • PRE occurred with relatively equal frequency between men and women (P = 0.28). • Only two women (4.7%) reported removing their stent prematurely, on postoperative days 2 and 6. CONCLUSIONS • Ureteric stent placement with extraction string after ureteroscopy for stone disease does not seem to result in more PRE, regardless of gender. • Prospective randomised trials are needed to determine the benefits and disadvantages of ureteric stents with extraction string.
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Affiliation(s)
- Nathan A Bockholt
- Department of Urology, University of Iowa, Iowa City, IA 52242-1089, USA
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Reply by Authors. J Urol 2012. [DOI: 10.1016/j.juro.2011.12.154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Fuchs GJ, Koopman SG. Ureteroscopy for Ureteric Stones. Urolithiasis 2012. [DOI: 10.1007/978-1-4471-4387-1_57] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Tang L, Gao X, Xu B, Hou J, Zhang Z, Xu C, Wang L, Sun Y. Placement of Ureteral Stent After Uncomplicated Ureteroscopy: Do We Really Need It? Urology 2011; 78:1248-56. [DOI: 10.1016/j.urology.2011.05.004] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2011] [Revised: 04/15/2011] [Accepted: 05/05/2011] [Indexed: 11/28/2022]
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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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Başeskioğlu B, Sofikerim M, Demirtaş A, Yenilmez A, Kaya C, Can C. Is ureteral stenting really necessary after ureteroscopic lithotripsy with balloon dilatation of ureteral orifice? A multi-institutional randomized controlled study. World J Urol 2011; 29:731-6. [PMID: 21590466 DOI: 10.1007/s00345-011-0697-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2011] [Accepted: 05/04/2011] [Indexed: 10/18/2022] Open
Abstract
PURPOSE Our aim was to evaluate the role of balloon dilatation of the ureteral orifice on the decision to stent after ureteroscopy. MATERIALS AND METHODS We prospectively enrolled 505 patients from two clinics, undergoing ureteroscopy (URS) for urolithiasis. Patients having balloon dilatation of the ureteral orifice and uncomplicated ureteroscopy were randomized to be either stented (n = 144) or nonstented (n = 142). Ureteroscopy was done with a 9.8 rigid ureteroscope. For dilatation of ureteral orifice, 18Fr-4 cm balloons were used (Uromax™, Boston Scientific, USA). Holmium laser or pneumatic devices were used for lithotripsy. In the second postoperative week, patients were asked to assess: pain, dysuria, and urgency using a 10-cm visual analog score (VAS) and unplanned visits. In each visit, urinalysis, urine culture, plain X-ray, and ultrasound examinations were performed. Six months after URS, follow-up IVU was performed to evaluate ureteral narrowing. Results for the separate clinics were not revealed until the end of study. RESULTS There were no significant differences between the two groups regarding gender, age, preoperative serum creatinine levels, stone size, stone side and location, lithotripsy type, pain, infectious complications, unplanned visits, and ureteral narrowing. However, irritative symptoms were more common in the stented group. Success rates of 97.8 and 97.2% were similar in the unstented and stented groups. CONCLUSION In uncomplicated URS, balloon dilatation of the ureteral orifice should not significantly affect the decision for or against stent placement. Avoiding stents lowers costs and gives fewer irritative symptoms.
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Meta-analysis of postoperatively stenting or not in patients underwent ureteroscopic lithotripsy. ACTA ACUST UNITED AC 2011; 40:67-77. [PMID: 21573923 DOI: 10.1007/s00240-011-0385-7] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2011] [Accepted: 04/26/2011] [Indexed: 02/05/2023]
Abstract
The aim of this study was to evaluate the necessity for stenting after ureteroscopic lithotripsy. We performed a systematic research of Medline, Embase, Cochrane central registration for RCTs concerning the comparison between stented and non-stented post-ureteroscopic procedures for stone removal and reference lists of the included study were also screened. 15 trials were included and data related was extracted and analyzed in meta way. No difference was detected in stone free rate and stricture formation between the two groups (P = 0.69; P = 0.67). Participants with stents had higher risk of being infected than those without, RR = 1.72, but with no difference. Stent related lower urinary symptoms were more frequently experienced by stented patients, dysuria (RR = 5.24, P = 0.003); hematuria (RR = 7.28, P = 0.001); loin voiding pain (RR = 5.24, P = 0.003). Postoperative pain score were also higher in patients with stent in the early period after surgery with mean difference 0.95 (P = 0.002). With additional time needed for the placement of stent, the operative time in stented patients were 3.36 min longer than those without stenting (P = 0.02). The additional cost for longer operative room stay, together with the sent and cystoscopic stent removed conditionally, and made the cost for stented patients much higher. No difference were detected in length of hospital stay between both groups (P = 0.22), the stented patients were even of lower rate pay unplanned hospital visit (RR = 0.81, P = 0.55). Stenting did not improve the outcome of patients who underwent ureteroscopic lithotripsy, but associated with increased complication rate. Routinely stenting after ureteroscopic procedure for stone removal was not necessary; however, it still should be reserved conditionally.
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Cevik I, Dillioglugil O, Akdas A, Siegel Y. Is stent placement necessary after uncomplicated ureteroscopy for removal of impacted ureteral stones? J Endourol 2010; 24:1263-7. [PMID: 20615145 DOI: 10.1089/end.2009.0153] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND PURPOSE Ureteral stent placement after ureteroscopic lithotripsy has some advantages and disadvantages. In this randomized study, the necessity of ureteral stent placement after uncomplicated ureteroscopy for impacted ureteral stones was assessed. MATERIALS AND METHODS Between 2005 and 2007, 60 evaluable patients were equally randomized to groups with and without stents. Patients underwent ureteroscopic pneumatic lithotripsy for ureteral stones. The operation was completed with or without stent placement according to the randomization order. Excretory urography was performed 3 months after the procedure. All stents were cystoscopically removed at the third postoperative week. Sociodemographic and clinical variables (age, sex, stone location, stone size, operative time, hospital stay, narcotic and nonnarcotic analgesic use), and postoperative complications (fever, pain delaying discharge, emergency department visit, urinary retention, stent-related irritative symptoms) were evaluated. RESULTS Mean stone size was not significantly different in both groups. Mean operative time was significantly longer in the stent group: 30.5 +/- 9.6 vs 43.7 +/- 11.6 minutes. On the operation day and until postoperative day (POD) 5, narcotic (P = 0.004) and nonnarcotic analgesic (P = not significant) use was more frequent in the no-stent group. At POD 5 and later, although narcotic and nonnarcotic analgesic use were frequently necessary in the stent group, both were almost unnecessary in the no-stent patients. Stent-related irritative symptoms were overwhelmingly higher (10% vs 93%) in the stent group. Discharge was delayed (23% vs 10%) and unplanned emergency department visits (20% vs 10%) were exercised almost two times more commonly in the no-stent group. Stone-free rates were identical (n = 29/30; 97%) in both groups. CONCLUSION Routine placement of a ureteral stent is not mandatory in patients without complications after ureteroscopic lithotripsy for impacted ureteral stones. Stent placement can be argued and agreed with the patients preoperatively in the light of the data presented above.
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The influence of ureteral stent on renal pelvic pressure in vivo. ACTA ACUST UNITED AC 2009; 37:221-5. [DOI: 10.1007/s00240-009-0199-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2009] [Accepted: 05/21/2009] [Indexed: 11/26/2022]
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Wang CJ, Huang SW, Chang CH. Indications of stented uncomplicated ureteroscopic lithotripsy: a prospective randomized controlled study. ACTA ACUST UNITED AC 2009; 37:83-8. [PMID: 19183976 DOI: 10.1007/s00240-009-0175-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2008] [Accepted: 01/09/2009] [Indexed: 10/21/2022]
Abstract
The purpose of our trial was to evaluate whether stents could be eliminated after uncomplicated ureteroscopic lithotripsy for ureteral stones and the indications of ureteral stent placement. A total of 228 patients underwent uncomplicated ureteroscopic intracorporeal lithotripsy. After the procedures, patients without marked ureteral edema, polypoid change or stent placement were treated as a control group. The other patients were randomized to two groups. Patients were followed on the first postoperative day, 6 and 12 weeks, postoperatively. In stented cases the stent was removed after 1 week. Outcome measures included visual analog scale assessment, postoperative analgesic requirements, complications and the stone-free rate. On the first postoperative day the symptoms of flank pain, dysuria and frequency were significantly greater in the stented group (P < 0.0001). The overall perioperative complication rate, including fever, pyuria, flank and loin pain, was 3.3% (3/90) in group 1, 16.9% (12/71) in group 2, and 41.8% (28/67) in group 3. We believe that in selected patients undergoing ureteroscopy for ureteral stone, stents can be safely omitted. Patients without stents have significantly less stent-related symptoms and are not at higher risk of complications with smooth ureteral mucosa. When there is ureteral edema or polypoid change with pyuria, ureteral stents should be indwelled to avoid severe postoperative complications.
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Affiliation(s)
- Chung-Jing Wang
- Division of Urology, Department of Surgery, Saint Martin De Porres Hospital, Chiayi, Taiwan, ROC.
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Augustovski F, Iglesias C, Manca A, Drummond M, Rubinstein A, Martí SG. Barriers to generalizability of health economic evaluations in Latin America and the Caribbean region. PHARMACOECONOMICS 2009; 27:919-929. [PMID: 19888792 DOI: 10.2165/11313670-000000000-00000] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Use and acceptance of health economic evaluations (HEEs) has been much greater in developed than in developing nations. Nevertheless, while developing countries lag behind in the development of HEE methods, they could benefit from the progress made in other countries and concentrate on ways in which existing methods can be used or would need to be modified to fulfill their specific needs. HEEs, as context-specific tools, are not easily generalizable from setting to setting. Existing studies regarding generalizability and transferability of HEEs have primarily been conducted in developed countries. Therefore, a legitimate question for policy makers in Latin America and the Caribbean region (LAC) is to what extent HEEs conducted in industrialized economies and in LAC are generalizable to LAC (trans-regional) and to other LAC countries (intra-regional), respectively. We conducted a systematic review, searching the NHS Economic Evaluation Database (NHS EED), Office of Health Economics Health Economic Evaluation Database (HEED), LILACS (Latin America health bibliographic database) and NEVALAT (Latin American Network on HEE) to identify HEEs published between 1980 and 2004. We included individual patient- and model-based HEEs (cost-effectiveness, cost-utility, cost-benefit and cost-consequences analyses) that involved at least one LAC country. Data were extracted by three independent reviewers using a checklist validated by regional and international experts. From 521 studies retrieved, 72 were full HEEs (39% randomized controlled trials [RCTs], 32% models, 17% non-randomized studies and 12% mixed trial-modeling approach). Over one-third of identified studies did not specifically report the type of HEE. Cost-effectiveness and cost-consequence analyses accounted for almost 80% of the studies. The three Latin American countries with the highest participation in HEE studies were Brazil, Argentina and Mexico. While we found relatively good standards of reporting the study's question, population, interventions, comparators and conclusions, the overall reporting was poor, and evidence of unfamiliarity with international guidelines was evident (i.e. absence of incremental analysis, of discounting long-term costs and effects). Analysis or description of place-to-place variability was infrequent. Of the 49 trial-based analyses, 43% were single centre, 33% multinational and 18% multicentre national. Main reporting problems included issues related to sample representativeness, data collection and data analysis. Of the 32 model-based studies (most commonly using epidemiological models), main problems included the inadequacy of search strategy, range selection for sensitivity analysis and theoretical justifications. There are a number of issues associated with the reporting and methodology used in multinational and local HEE studies relevant for LAC that preclude the assessment of their generalizability and potential transferability. Although the quality of reporting and methodology used in model-based HEEs was somewhat higher than those from trial-based HEEs, economic evaluation methodology was usually weak and less developed than the analysis of clinical data. Improving these aspects in LAC HEE studies is paramount to maximizing their potential benefits such as increasing the generalizability/transferability of their results.
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Affiliation(s)
- Federico Augustovski
- Instituto de Efectividad Clínica y Sanitaria-Servicio de Medicina Familiar y Comunitaria, Hospital Italiano, Buenos Aires, Argentina
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Sur RL, Haleblian GE, Cantor DA, Springhart WP, Albala DM, Preminger GM. Efficacy of intravesical ropivacaine injection on urinary symptoms following ureteral stenting: a randomized, controlled study. J Endourol 2008; 22:473-8. [PMID: 18290733 DOI: 10.1089/end.2007.9847] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE Previous studies suggest that intravesical administration of nonsteroidal anti-inflammatory drugs may reduce the troublesome voiding symptoms and pain related to ureteral stenting. The objective of this study was to investigate the effectiveness of a long-acting local anesthetic, ropivacaine, injected submucosally into the bladder to control ureteral stent-associated symptoms. MATERIALS AND METHODS A randomized, single-blinded, study approved by our Institutional Review Board of adult patients scheduled for ureteroscopic stone surgery and possible stent placement was conducted. Patients were randomized to either the treatment cohort, who received five injections of 2 mL 0.5% ropivacaine around the ureteral orifice or to the control cohort, who received five injections of 2 mL of 0.9% normal saline in identical locations. Pain scale questionnaires were provided to each subject preoperatively and at postoperative hours 2, 4, 8, 24, and 48 as well as on the day of stent removal. Student's t test and Wilcoxon signed rank sum tests were used for Gaussian and nonparametric data, respectively. RESULTS Twenty-two patients were randomized evenly into the two cohorts. The ropivacaine group consisted of 11 patients (eight men and three women) with a mean age of 56.2 years (standard deviation [SD] = 12, range 27-69), and the saline group consisted of eleven patients (six men and five women) with a mean age of 47.8 years (SD = 6.6, range 37-58). Intraoperative parameters appeared similar between the two cohorts. Intraoperative and postoperative narcotic usage was not different between the two groups, except at postoperative hour 2 when it favored the ropivacaine cohort (P = 0.05). Trends favoring ropivacaine in flank pain, bladder pain, genitalia pain, and hematuria domains were seen as long as 8 hours and up to the day of stent removal. Trends of less magnitude and duration were seen in the dysuria domain. No differences were seen in the frequency and urgency domains. CONCLUSIONS Our preliminary investigation with intravesical injection of ropivacaine before ureteroscopic surgery demonstrated trends toward decreased pain and voiding symptoms in this small-sample study. Inclusion of a larger sample should definitively address the effectiveness of intravesical ropivacaine and its impact on stent-related symptoms.
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Affiliation(s)
- Roger L Sur
- Comprehensive Kidney Stone Center, Duke University Medical Center, Durham, North Carolina, USA
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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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Ibrahim HM, Al-Kandari AM, Shaaban HS, Elshebini YH, Shokeir AA. Role of ureteral stenting after uncomplicated ureteroscopy for distal ureteral stones: a randomized, controlled trial. J Urol 2008; 180:961-5. [PMID: 18639269 DOI: 10.1016/j.juro.2008.05.030] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2008] [Indexed: 10/21/2022]
Abstract
PURPOSE We determined the differences in outcome between ureteral stenting and nonstenting following uncomplicated ureteroscopy for distal ureteral stones. MATERIALS AND METHODS A total of 220 patients treated with successful ureteroscopy for distal ureteral stones were randomized to 2 equal groups according to postoperative placement of a ureteral stent (Cook Ireland, National Technological Park, Ireland), including group 1--without a stent and group 2--with a stent. Outcome measures were flank pain and dysuria at 48 hours and 1 week, early postoperative complications, analgesia need, rehospitalization, return to normal physical activity, stone-free rate, stone recurrence and late postoperative complications. Patients were followed a mean +/- SD of 25 +/- 9 months (range 12 to 49). RESULTS Early postoperative complications, including low grade fever, hematuria and urinary tract infection, were observed in 22 patients (20%) in group 1 and 19 (19%) in group 2, a difference of no significant value. Mean initial hospitalization and time to return to normal physical activity were not different between the 2 groups. At 48 hours and 1 week there was no significant difference in flank pain between the 2 groups, while dysuria was significantly less in the nonstented group. The amount of analgesics required in the recovery room was not different but after discharge from the hospital stented patients used a larger amount of analgesia while the stent was still in the ureter. The stone-free rate at 4 weeks was 100% in each group. Late postoperative sequelae, including stone recurrence and ureteral narrowing, were reported in 6 patients (5.5%) in group 1 and 4 (3.6%) in group 2, a difference of no significant value. CONCLUSIONS Uncomplicated ureteroscopy for treatment of distal ureteral stones is safe without stent placement. Patients without stents have significantly fewer irritative bladder symptoms and are not at risk of increased complications.
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Affiliation(s)
- Hamdy M Ibrahim
- Al-Adan Urology Unit, Ministry of Health, Kuwait City, Kuwait
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Makarov DV, Trock BJ, Allaf ME, Matlaga BR. The Effect of Ureteral Stent Placement on Post-ureteroscopy Complications: A Meta-analysis. Urology 2008; 71:796-800. [DOI: 10.1016/j.urology.2007.10.073] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2007] [Revised: 09/19/2007] [Accepted: 10/25/2007] [Indexed: 11/29/2022]
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Is routine ureteral stenting necessary after uncomplicated ureteroscopic lithotripsy for lower ureteral stones larger than 1 cm? ACTA ACUST UNITED AC 2008; 36:115-9. [PMID: 18385992 DOI: 10.1007/s00240-008-0135-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2007] [Accepted: 03/11/2008] [Indexed: 10/22/2022]
Abstract
We evaluated the need for routine ureteral stenting after uncomplicated ureteroscopic lithotripsy (URSL) without dilation for lower ureteral stones larger than 1 cm. A total of 43 patients underwent URSL for lower ureteral stones larger than 10 mm. They were randomized into a stented (21) or an unstented (22) group. URSL was performed by using a semirigid ureteroscope and pneumatic lithotripter without ureteral dilation. Additional forceps application (AFA) was used to remove fragments > or =4 mm. Patients in each group were assessed for stone-free rate, stone size, operative time, AFA, hospitalization time, postoperative pain, irritative voiding symptoms, hematuria, re-hospitalization and stricture formation. The stone-free rate was 100% in each group. There were no statistical differences in the two groups regarding stone size, operative time, AFA, postoperative pain, hematuria and hospitalization time. However, irritative voiding symptoms of the stented group were significantly higher than those in the unstented group (P < 0.05). One patient (4.5%) in the unstented group required re-hospitalization for severe flank pain with fever (>38 degrees C) compared to one patient (4.7%) in the stented group for proximal stent migration (P > 0.05). Stricture formation was not demonstrated in either group at 3 months follow-up excretory urography (EXU). Our results demonstrate that ureteral stenting after uncomplicated URSL without dilation for lower ureteral stones larger than 1 cm does not appear to be necessary if AFA is used to remove fragments > or =4 mm, thereby reducing morbidity of patients and risk of re-hospitalization.
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Auge BK, Sarvis JA, L'esperance JO, Preminger GM. Practice patterns of ureteral stenting after routine ureteroscopic stone surgery: a survey of practicing urologists. J Endourol 2008; 21:1287-91. [PMID: 18042016 DOI: 10.1089/end.2007.0038] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Controversy exists regarding the need for ureteral stent insertion after routine ureteroscopic stone surgery. We designed a questionnaire to assess and better understand the practice patterns of urologists for stent applications. MATERIALS AND METHODS A 26-question survey was distributed to 570 community and academic urologists. The answers were anonymously tabulated to determine the practice patterns for stent placement. RESULTS Of the 173 respondents, 97.7% performed ureteroscopic surgery, with the majority (77%) performing 1 to 10 procedures per month. Sixty-eight percent of urologists considered more than 70% of their ureteroscopic procedures "routine." Only 21% of urologists dilated the ureteral orifice more than 90% of the time. Those who dilated the ureteral orifice used a balloon (43%), ureteral access sheath (13.5%), or both (21%). The use of an access sheath did not change stenting practices for 75% of urologists. Patterns vary with regard to length of indwelling time, with 85% of urologists maintaining the stent for fewer than 7 days. Most urologists use either cystoscopy (42%) or pull-suture in clinic (37%) to remove stents. Patient tolerance is the most significant problem with stents reported by 97.6% of urologists. The respondents were divided into three experience-based groups: group 1, <2 years of experience; group 2, 2 to 10 years; and group 3, >10 years. Using Fisher's exact test, there were no statistically significant differences between the groups. CONCLUSION A wide variability exists among urologists in the practice patterns of stent insertion after routine ureteroscopic surgery. Most consider their procedures routine and are more likely to place stents after ureteral dilation despite growing evidence to the contrary. Knowledge of the varied practices may aid less experienced urologists in their decision to insert a stent after ureteroscopy.
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Affiliation(s)
- Brian K Auge
- Department of Urology, Naval Medical Center San Diego, San Diego, California 92134, USA.
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Haleblian G, Kijvikai K, de la Rosette J, Preminger G. Ureteral Stenting and Urinary Stone Management: A Systematic Review. J Urol 2008; 179:424-30. [PMID: 18076928 DOI: 10.1016/j.juro.2007.09.026] [Citation(s) in RCA: 140] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2007] [Indexed: 10/22/2022]
Affiliation(s)
- George Haleblian
- Comprehensive Kidney Stone Center, Division of Urologic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Kittinut Kijvikai
- Department of Urology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
- Department of Urology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Jean de la Rosette
- Department of Urology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Glenn Preminger
- Comprehensive Kidney Stone Center, Division of Urologic Surgery, Duke University Medical Center, Durham, North Carolina
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Preminger GM, Tiselius HG, Assimos DG, Alken P, Buck C, Gallucci M, Knoll T, Lingeman JE, Nakada SY, Pearle MS, Sarica K, Türk C, Wolf JS. 2007 guideline for the management of ureteral calculi. J Urol 2008; 178:2418-34. [PMID: 17993340 DOI: 10.1016/j.juro.2007.09.107] [Citation(s) in RCA: 501] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2007] [Indexed: 12/28/2022]
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Rapoport D, Perks AE, Teichman JM. Ureteral Access Sheath Use and Stenting in Ureteroscopy: Effect on Unplanned Emergency Room Visits and Cost. J Endourol 2007; 21:993-7. [DOI: 10.1089/end.2006.0236] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Daniel Rapoport
- Division of Urology, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alexandra E. Perks
- Division of Urology, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Joel M.H. Teichman
- Division of Urology, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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