The Spanish Linguistic Validation of the Ureteral Stent Symptom Questionnaire

Stent Syndrome: Does the Diameter Matter? Results of a Randomized Trial

Introduction: Double-J (DJ) ureteral stents are used for multiple purposes in urology. Even though they temporize the subsequent treatment of lithiasis, they may cause different symptoms that impact quality of life (QoL). Purpose: In this randomized trial, we assessed whether the diameter of ureteral stents has an impact on catheter-associated symptoms, and their impact on QoL. Methods: A total of 194 consecutive patients undergoing DJ insertion between December 2018 and December 2022 were prospectively enrolled and divided into three categories: 4.7F (Group 1, n = 71), 6F (Group 2, n = 65), and 7F (Group 3, n = 58). Within 1 week after the DJ placement, patients completed the validated Spanish version of the Ureteral Stent Symptoms Questionnaire. Continuous variables were compared using analysis of variance and Student's t-tests. For categorical data, the chi-square test was used. Results: In the domain of "work" and "additional problems," there were significant differences. In the "Work" domain, Group 1 presented the lower symptoms. In the domain "additional problems," patients in Group 1 were prescribed fewer antibiotics owing to low urinary tract symptoms. In question U4 about urinary incontinence, patients in Groups 2 and 3 developed these symptoms more than patients in Group 1. In the "sexual activity" domain, specifically in question S3 (the patient has ever suffered any type of pain during sexual activity?), patients with 4.7F presented lower scores than patients with larger catheters. Conclusion: DJ-related symptoms affect QoL in most cases. Smaller catheters produced significantly less urinary incontinence, faster work reincorporation, fewer symptoms related to sexual activity, and fewer catheter-related symptoms than 7F catheters. In contrast, Group 3 presented fewer outpatient visits because of symptoms related to the DJ.

Long-term maintenance treatment of recurrent ureteropelvic junction obstruction with covered metallic ureteral stent

Whether or not the covered metallic ureteral stent can be used as maintenance treatment for recurrent ureteropelvic junction obstruction (UPJO) after pyeloplasty is unknown. Therefore, this study aims to analyze its feasibility. We retrospectively analyzed the records of 20 patients with recurrent UPJO who were treated with the covered metallic ureteral stents from March 2019 to June 2021 at our institution. Then, we assessed their renal function, stent patency and stent-related quality of life by the blood creatinine, renal ultrasound (or computed tomography), and the Chinese version of the ureteral symptom score questionnaire (USSQ). The last follow-up mean blood creatinine dropped from 0.98 ± 0.22 to 0.91 ± 0.21 mg/dL (P = .04), and the median renal pelvic width was reduced from 3.25 (3.10) to 2.00 (1.67) cm (P = .03) compared with the preoperative conditions. Meanwhile, the last follow-up mean USSQ total score of the covered metallic ureteral stent among the 16 patients with preoperative indwelling double-J ureteral stent was 78.56 ± 14.75, significantly lower than the preoperative USSQ total score, which was 102.25 ± 5.57 (P < .001). During the median duration of follow-up of 27.00 (18.00) months, 85% (17/20) of patients maintained unobstructed drainage from the renal pelvis to the ureter. Stent-related complications occurred in 7 patients, 3 of which failed because of complications, including stent migration (1 patient), stent encrustation (1 patient), and stent-related infection (1 patient). The covered metallic ureteral stent is feasible for the long-term maintenance treatment of recurrent UPJO after pyeloplasty.

Translation and Validation of the Ureteral Stent Symptoms Questionnaire in Urdu

Introduction

In endourology, ureteric stenting is a common procedure, and stent placement is not without adverse health consequences. A ureteric stent symptoms questionnaire (USSQ) was devised to objectively evaluate the symptoms related to it. The original questionnaire is in English and translated into various languages worldwide. We translated the questionnaire into Urdu and validated it in an Urdu-speaking population with a stent in situ.

Materials and methods

The English version of USSQ was translated and back-translated by experts in both languages. Content validity was checked by sending Urdu version to five experts, and their scores were used to calculate the content validity index. The final version was filled by patients with stents on three different occasions, two with stents in situ at one and two weeks post stent placement, and a third time two weeks after stent removal. Discriminant validity was checked by filling of USSQ by 64 healthy individuals. Statistical analysis was done with mean and standard deviation, Cronbach’s alpha, Spearman’s coefficient, and paired sample t-test.

Results

A total of 64 patients filled the complete questionnaire at all times with mean age of 35.31 ± 8.853. All subdomains of USSQ have significant drop in scores with stent in situ in comparison to post stent removal. Reliability was checked by Cronbach’s alpha in all subdomains (71.5-91.1) and test-retest reliability by Spearman’s coefficient (80.5-94.7). Symptoms change in stent in situ with post stent removal checked with paired sample t-test with a p-value of <0.005 in all domains, except body pain. Discriminant validity was checked with healthy controls, and a p-value of <0.005 was found in all subdomains of USSQ, except pain. 

Conclusion

The Urdu version of the USSQ is a reliable and valid instrument that can be used in clinical practice and future research in an Urdu-speaking population.

Validating 7-items Overactive Bladder Symptom Score (OABSS) through Arabic linguistic version

The scoring of the 7-item Overactive Bladder Symptom Score (OABSS) questionnaire is unusual because its scale varies with the same maximum and minimum scoring values and quantifies all aspects of OAB. The questionnaire also contains a graded response for urgency. The current study is mainly concerned with the development and validation of the OABSS questionnaire for Jordanian patients. The process of translating the English OABSS questionnaire into the Arabic language involved forward and backward translations. Afterward, a prospective study was conducted to validate the Arabic version of the OABSS questionnaire by examining 235 patients from the outpatient clinics of Karak Governorate Teaching Hospital. The Arabic OABSS questionnaire was completed by all the enrolled patients before and after three months of treatment with solifenacin 5 mg taken once daily. The study included 235 regular patients (152 females and 83 males) diagnosed with OAB in accordance with the definition of the International Continence Society (ICS). The results showed major and significant differences on all seven domains of the questions on the OABSS questionnaire before and after receiving treatment (p < 0.05). Confirmatory Factor Analysis was used to measure the reliability and the questionnaire was found to be highly reliable for the construct variables. The findings derived from the current study would be beneficial for local urologists and researchers, as the Arabic version of the OABSS questionnaire was proven to be a reliable instrument for use in the assessment of OAB. Future studies are needed to compare different translated questionnaires relating to OAB.Trial registration number: NCT04309890.

Ureteral stents in urolithiasis

Ever since the ureteral stent design was fitted with a curl on both sides to prevent it from migrating up or down the ureter some 40 years ago, its use has gained tremendous momentum, aiding in the rise and evolution of endourology and has confidently kept its place in modern time urology. Over the past four decades, several designs, coating and biomaterials have been developed, trying to reduce infection, encrustation and other stent related symptoms. As the ideal stent has not yet been discovered, different ways of helping patients with their complaints have been researched. This review will cover these aspects of stent use in urolithiasis.

Impact of loop-tail ureteral stents on ureteral stent-related symptoms immediately after ureteroscopic lithotripsy: Comparison with pigtail ureteral stents

Purpose

To evaluate urination-related quality of life (QoL) in patients with an indwelling ureteral stent immediately after ureteroscopic lithotripsy (URSL) for upper urinary calculi. We compared the effects of loop-tail and pigtail ureteral stents on urination-related QoL.

Materials and Methods

Of 135 patients who underwent URSL between May 2014 and March 2015 at our hospital, we retrospectively analyzed the records of 70 patients (42 men, 28 women; median age, 63 years) in whom the stent tail was positioned inside the bladder without crossing the midline and who completed the core lower urinary tract symptoms score (CLSS) questionnaire pre- and postoperatively.

Results

There were significant differences in incomplete emptying (p=0.048) and bladder pain (p=0.041) between patients with loop-tail versus pigtail ureteral stents after URSL. In the multivariate analysis, stent type had a stronger association with incomplete emptying (p=0.022) and bladder pain (p=0.018) than age, sex, body mass index, stent side, operation time, diameter of ureteral access sheath, and stent type.

Conclusions

Patients with loop-tail ureteral stents had better urination-related QoL in the immediate post-URSL stage than patients with pigtail stents.

The German linguistic validation of the Ureteral Stent Symptoms Questionnaire (USSQ)

PURPOSE

We developed and validated the German version of the Ureteral Stent Symptoms Questionnaire (USSQ) for male and female patients with indwelling ureteral stents.

METHODS

The German version of the USSQ was developed following a well-established multistep process. A total of 101 patients with indwelling ureteral stents completed the German USSQ as well as the validated questionnaires International Prostate Symptom Score (IPSS) or International Consultation on Incontinence Questionnaire (ICIQ) and the Short Form Health Survey (SF-36). Patients completed questionnaires at 1 and 2-4 weeks after stent insertion and 4 weeks after stent removal. Statistical analyses were performed to assess the psychometric properties of the questionnaire.

RESULTS

The German version of the USSQ showed good internal consistency (Cronbach's α = .72-.88) and test-retest reliability [intraclass correlation coefficient (ICC) = .81-.92]. Inter-domain associations within the USSQ showed substantial correlations between different USSQ domains, indicating a high conceptual relationship of the domains. Except from urinary symptoms and general quality of life, German USSQ showed good convergent validity with the corresponding validated questionnaires. All USSQ domains showed significant sensitivity to change (p ≤ .001).

CONCLUSION

The new German version of the USSQ proved to be a reliable and robust instrument for the evaluation of ureteral stent-associated morbidity for both male and female patients. It is expected to be a valid outcome measure in the future stent research.

Influence of patient education on morbidity caused by ureteral stents

OBJECTIVES

To investigate the influence of patient education on symptoms and problems caused by ureteral stents.

METHODS

The German version of the Ureteral Stent Symptom Questionnaire was completed by 74 patients with unilateral inserted indwelling stents. Additionally, six self-developed questions regarding type and quality of patient education on pain, urinary symptoms, hematuria, activities permitted, stent function and overall patient education were answered. Correlations between questionnaires, subscores and single items, and the influence on economic aspects were analyzed.

RESULTS

Adjusting for age, sex, intravesical stent length, stent indwelling time, use of analgesics and an alpha-blocker, the correlation between the Ureteral Stent Symptom Questionnaire and self-developed questions was -0.40 (95% CI -0.58, -0.19, P < 0.001). The following subscores and items showed a statistically significant correlation with quality of patient education after correction for multiple testing: Ureteral Stent Symptom Questionnaire total score, urinary symptoms subscore, U6, U10, G3, G4 and GQ. No relevant influence of patient education on economic aspects was found.

CONCLUSION

High-quality patient education on ureteral stent-related symptoms is highly advisable, as it has the potential to reduce these symptoms. However, the influence of information on the incidence and extent of potential problems seems to be limited. A much better approach would be to develop better designed devices and more convenient stent-free procedures.

Validation of the Arabic linguistic version of the Ureteral Stent Symptoms Questionnaire

Objective

To validate the Arabic version of the Ureteral Stent Symptoms Questionnaire (USSQ).

Patients and methods

The English version of the USSQ was translated into Arabic using a multi-step process by three urologists and two independent translators. The Arabic version was validated by asking 37 patients with temporary unilateral ureteric stents to complete the questionnaire at 2 weeks after stent insertion. The second group included 53 healthy individuals who agreed to complete the Arabic version of the questionnaire. The reliability of the Arabic version was evaluated for internal consistency using Cronbach’s α test. Domain structures were examined by interdomain (section) associations using Spearman’s correlation coefficient (r). The discrimination validity was evaluated by comparing the scores of patients with those of healthy individuals, using the Mann–Whitney test.

Results

Internal consistency was high for the sexual index and intermediate for urinary, pain and general health indices. There were good correlations of urinary symptoms with body pain (r = 0.596) and general health (r = 0.690). There was also a good correlation between body pain and general health (r = 0.681). For discrimination validity, there were significant changes in all domain scores when comparing patients with ureteric stents and healthy individuals (P < 0.001).

Conclusion

The Arabic version of the USSQ is a reliable and valid instrument that can be used to evaluate symptoms and health-related quality of life in Arabic patients with ureteric stents.