Validation of the Spanish version of Ureteral Stent Symptom Questionnaire: prevalence of symptoms in a tertiary care center in Mexico

Linguistic and cultural validation of Ureteral Stent Symptom Questionnaire in Hindi

Introduction:

In the year 2003, Joshi et al. developed a validated outcome assessment tool to measure the ureteral stent-related symptoms. The original English language Ureteral Stent Symptom Questionnaire (USSQ) has been validated in various languages worldwide. Our objective was to develop the USSQ in Hindi, a commonlyused language in India, by validating it in patients undergoing ureteroscopic lithotripsy.

Materials and Methods:

A final Hindi version of the USSQ was derived from the original English version to apply to the study population by translation, back translation, and face-to-face interviews. The Hindi and English versions were completed by 70 patients undergoing ureteroscopic lithotripsy with stent in situ, on postoperative days 7 and 8, and 4 weeks after stent removal. Similarly, discriminant validity was checked among 50 healthy individuals. A detailed statistical analysis was used to correlate results (Cronbach's α coefficient, Spearman's correlation, and Mann–Whitney U-test).

Results:

A total of 70 patients were enrolled in the study and 61 completed the final assessment. The median age was 35 years (range: 18–60 years). The USSQ domain scores with the stent in situ were higher than poststent status. The test–retest reliability checked by Cronbach's α coefficient (>0.44) and Spearman's correlation coefficient (>0.44) were acceptable to good. We found high discriminant validity of the questionnaire between patients with stent and the healthy controls (P < 0.05).

Conclusion:

Our results demonstrate satisfactory validity for the Hindi version of the USSQ for the assessment of quality of life in patients with stent. This is ready for application in the clinical studies and the future stent-related research in Hindi language.

A ureteral stent crossing the bladder midline leads to worse urinary symptoms

Introduction

To investigate the correlation between the position of a ureteral stent and stent-related symptoms, excluding the influence of ureteroscopic maneuvers.

Material and methods

From January 2016 to December 2016, we analyzed 130 patients who placed a ureteral stent before ureteroscopic lithotripsy (URSL). A total of 108 patients were enrolled, including 77 (71.3%) men and 31 (28.7%) women, and the mean age was 58.9 ±14.3 years. On the day before URSL, plain radiography (kidney, ureter, bladder X-ray [KUB]) was used to confirm the stone location and ureteral stent position. According to KUB, we defined the crossing midline group as when the distal loop of the ureteral stent was crossing the bladder midline, and the not crossing midline group as when the distal loop of the ureteral stent was not crossing the bladder midline. We assessed urinary symptoms of the two groups using the overactive bladder symptom score (OABSS) on the day before URSL.

Results

The crossing midline group had a worse total OABSS (p <0.001) and worse scores for each item of daytime frequency (p = 0.047), nocturia (p <0.001), urgency (p = 0.002), and urgency incontinence (p = 0.045) than did the not crossing group. In multivariate analysis, stent position had the strongest association with the total OABSS (p = 0.002) among the other factors of age, sex, body mass index, stent side, stent diameter, stent length and stent indwelling time.

Conclusions

This study shows that a ureteral stent crossing the bladder midline leads to worse urinary symptoms. Choosing the appropriate stent length for each patient is important for improving stent-related symptoms.

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.

Efficacy of Tamsulosin, Oxybutynin, and their combination in the control of double-j stent-related lower urinary tract symptoms

Introduction and objective

Indwelling double J ureteral stents are used routinely in the resolution of ureteral obstruction caused by different etiologies. Evaluation of urinary symptoms related to double-J stent, indicate that these affect 73-90% of patients. We conducted a prospective, randomized study, to evaluate the efficacy of tamsulosin, oxybutinin and combination therapy in improving the urinary symptoms.

Methods

Patients who underwent ureteral stent placement after ureterolithotripsy (total 51), were randomized into three groups: Group I: Tamsulosin 0.4 mg. once per day(17 patients), Group II: Oxybutinin 5 mg. once per day (17 patients), Group III: Tamsulosin+ oxybutynin once per day (17 patients). All the groups received the drugs for three weeks and completed a Spanish validated Ureteral Stent Symptom Questionnaire (USSQ) at day 7 and 21.

Results

Repeated measures ANOVA showed mean urinary symptom index score was 22.3 vs. 15.5 in group three (p<0.001) at day 7 and 21 respectively. The mean work performance index was 6.6 vs 8.1 (p=0.049) favoring tamsulosin group, the mean sexual score was 0.5 vs 1.5 (p=0.03). Among additional problems the mean was 7.2 vs 6.2 (p=0.03). No significant difference was noted among pain and general health index. No side effects were reported.

Conclusions

Combination therapy with tamsulosin and oxybutynin improved irritative symptoms and work performance as well as sexual matters. Combination therapy should be considered for patients who complained of stent related symptoms.

Use of cystourethroscopy to remove an indwelling double-J ureteral stent 6 years following simultaneous radical sigmoid colon cancer and partial bladder resection: A case report

Ureteral stents are widely used to ensure good urinary drainage and to relieve obstruction, pain and infection during urologic procedures. However, long-term indwelling ureteral stents can cause various complications, such as encrustation, hematuria and infection. Here, the case of an 88-year-old man who had undergone simultaneous radical resection of sigmoid colon cancer and partial resection of the bladder 6 years prior is presented. The patient complained of urinary frequency and urgency, dysuria and intermittent fever. A kidney ureter bladder X-ray examination revealed the presence of an entire coiled double-J stent with calculi from the kidney to the bladder. A computed tomography scan revealed mild hydronephrosis of the left kidney and one J end of the stent in the bladder. The stent was removed successfully by cystourethroscopy and holmium laser lithotripsy. This report describes the clinical experience of the removal of a long-term stent by endoscopic manipulation.

Validação do instrumento Ureteral Stent Symptom Questionnaire para uso no Brasil

Resumo Objetivo Traduzir para a língua portuguesa do Brasil o instrumento intitulado Ureteral Stent Symptom Questionnaire, desenvolvido no idioma inglês no Reino Unido, adaptá-lo e validá-lo à realidade brasileira através da análise das características demográficas, confiabilidade de instrumento, correlação inter-itens e exploração quanto à sensibilidade à mudança. Métodos Trata-se de um estudo metodológico realizado segundo critérios de validação de instrumentos preconizado pela literatura internacional, sendo: tradução inicial, síntese da tradução, comitê de juízes especialistas, retradução (backtranslation) e pré-teste da versão final. Resultados A versão em português possui moderada à alta consistência interna em todos os domínios. A análise de correlação inter-itens revelou que os maiores coeficientes são observados entre os domínios dor e sintomas urinários. Conclusão Nossos resultados mostram que a versão do USSQ-Brasil é um instrumento válido e confiável para medir a repercussão dos vários sintomas relacionados ao stent ureteral em pacientes brasileiros.