1
|
Heidenberg DJ, Nauheim J, Grant C, Mi L, Van Der Walt C, Mufarrij P. Timing of Ureteral Stent Removal After Ureteroscopy on Stent-Related Symptoms: A Validated Questionnaire Comparison of 3 and 7 Days Stent Duration. J Endourol 2024; 38:82-87. [PMID: 37885220 DOI: 10.1089/end.2023.0189] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023] Open
Abstract
Objectives: To determine whether urinary symptoms are significantly improved with a shorter duration of stent placement without an increase in complications. Methods: A total of 100 patients were prospectively randomized to two groups, either a 3-day (n = 59, Group 1) or 7-day (n = 41, Group 2) stent placement group depending on date of operation. Patients submitted Ureteral Stent Symptom Questionnaires both while stents were in situ and 2 to 3 days after removal. Results: Group 2 reported greater urinary symptoms (p < 0.001) and pain (p < 0.001) with stents in situ compared with Group 1. Urinary symptoms (p < 0.001), pain (p = 0.003), and general health (p = 0.02) were more severe in Group 2 after stent removal as well. The analysis also revealed that urinary symptoms, pain, and general health improved after stent removal compared with stent in situ (p < 0.001). There were no significant differences in work-related functioning between two groups. There was one complication in Group 1 requiring bilateral stent replacement. There were no significant differences in emergency department visits, unplanned clinic visits, or hospitalizations between Groups 1 and 2. Conclusions: Patients with stent removal at 3-day group had better reported urinary, pain, and general health score compared with 7-day group. Patients after stent removal had improved urinary symptoms, pain symptom, and general health compared with ureteral stent in situ. There was no statistically significant difference in complications between the groups.
Collapse
Affiliation(s)
- Daniel J Heidenberg
- Department of Urology, Mayo Clinic, Phoenix, Arizona, USA
- Department of Urology, George Washington University Hospital, Washington, District of Columbia, USA
| | - Jennifer Nauheim
- Department of Urology, Montefiore Medical Center, Bronx, New York, USA
| | - Campbell Grant
- Department of Pediatric Urology, University of Kentucky, Lexington, Kentucky, USA
| | - Lanyu Mi
- Department of Urology, Mayo Clinic, Phoenix, Arizona, USA
| | | | - Patrick Mufarrij
- Department of Urology, George Washington University Hospital, Washington, District of Columbia, USA
| |
Collapse
|
2
|
Khoo TX, Wang S, Chambers B, McMillan A, Yates G. Modified endoluminal ureteral stenting for the management of proximal ureteral obstruction in two cats. JFMS Open Rep 2023; 9:20551169231210449. [PMID: 38115862 PMCID: PMC10729628 DOI: 10.1177/20551169231210449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023] Open
Abstract
Case series summary Two cases of placement of modified endoluminal ureteral stents are described, for revision of a subcutaneous ureteral bypass (SUB) and for primary treatment of obstructive ureterolithiasis. Modified endoluminal stents were inserted through the ureterotomy, anchored in the renal pelvis with a single pigtail and shortened to a length sufficient to span the proximal ureter and ureterotomy site. Relevance and novel information The advantages of this approach as a surgical option for feline obstructive ureterolithiasis are demonstrated, including the avoidance of disruption, or bypass, of the ureterovesicular junction, minimisation of implanted foreign material and avoidance of intravesicular stent mass, maintenance of the physiological route of urine flow, including preservation of active distal ureteral function, and limitation of the potential complications of ureterotomy. The clinical efficacy of this adaptation of the previously published endoluminal stenting technique is demonstrated with its applicability de novo and in the revision of other stenting procedures.
Collapse
Affiliation(s)
- Teng-Xiang Khoo
- Centre for Animal Referral and Emergency, Collingwood, VIC, Australia
| | - Shaojing Wang
- Centre for Animal Referral and Emergency, Collingwood, VIC, Australia
| | - Brenton Chambers
- Centre for Animal Referral and Emergency, Collingwood, VIC, Australia
| | - Angus McMillan
- Centre for Animal Referral and Emergency, Collingwood, VIC, Australia
| | - Guy Yates
- Centre for Animal Referral and Emergency, Collingwood, VIC, Australia
| |
Collapse
|
3
|
Outcomes and Complications from a Randomized Controlled Study Comparing Conventional Stent Placement Versus No Stent Placement after Ureteroscopy for Distal Ureteric Calculus < 1 cm. J Clin Med 2022; 11:jcm11237023. [PMID: 36498598 PMCID: PMC9740435 DOI: 10.3390/jcm11237023] [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: 11/04/2022] [Revised: 11/21/2022] [Accepted: 11/23/2022] [Indexed: 11/29/2022] Open
Abstract
Ureteric stent insertion following ureteroscopic lithotripsy (URSL) is a common and widely accepted procedure. However, there is no agreement on whether a ureteric stent should be placed following an uncomplicated URSL. Furthermore, the definition of uncomplicated URSL remains debatable. To compare the efficacy, safety, and morbidity of no stent placement with the conventional stent placement after uncomplicated retrograde semirigid URS for a distal ureteric calculus of size ≤1 cm, we compared the corresponding complication rates, emergency visits, secondary interventions, and pain at follow-up. Following an uncomplicated ureteroscopic lithotripsy, 104 patients were randomized into the conventional stented group (CSG) and nonstented group (NSG). Lower urinary tract symptoms and sexual function were evaluated using validated questionnaires (IPSS + IIEF-5 + MSHQ-EjD/FSFI) preoperatively and at 4 weeks during follow-up. Pain scores at follow-up were recorded using a visual analogue scale (VAS). Patients who visited the emergency room or needed secondary interventions before the recommended follow-up time were noted. The Generalized Estimating Equations method was used to explore the difference in change in the domains of IPSS, IIEF-5, MSHQ-EjD, and FSFI between the two groups over time. A significant difference was noted in the following IPSS domains: Frequency, Urgency, Nocturia, Storage Symptoms, Total IPSS Score (p ≤ 0.001), and QoL (p = 0.002); IIEF-5 domains: Overall Score (p = 0.004); MSHQ-EjD domains: Ejaculation Bother/Satisfaction (p ≤ 0.001); and FSFI domains: Lubrication (p ≤ 0.001), Satisfaction (p = 0.006), and Overall Score (p = 0.004). There was no significant difference between the various groups in terms of distribution of emergency visits, readmission and secondary interventions, pain at follow-up (VAS), and need for long-term analgesia. Nonplacement of stents after uncomplicated URS decreases stent-related symptoms and preserves QoL without placing the patient under increased postoperative risk.
Collapse
|
4
|
Ho CH, Liu SP, Wang CW, Liao PW. Complete intraureteral stent placement reduces stent-related symptoms: Systemic review and meta-analysis. J Formos Med Assoc 2022; 121:2308-2316. [PMID: 35864025 DOI: 10.1016/j.jfma.2022.06.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 06/21/2022] [Accepted: 06/30/2022] [Indexed: 12/19/2022] Open
Abstract
PURPOSE The distal coil of a double-J ureteral stent is considered the major cause of stent-related symptoms. We noticed that some recent studies investigated whether complete intraureteral stent placement (CIU-SP) reduced these symptoms. The current systemic review and meta-analysis aimed to evaluate the safety and the effectiveness of CIU-SP, as compared to conventional stent placement (C-SP). METHODS We retrieved relevant trials published before December 2021 from three databases, including PubMED, Embase, and Web of Science. The following medical subject heading were used ((complete intraureteral stent) OR (suture stent)) AND (symptom OR pain) AND (randomized OR randomised). The above search was limited to English language publication. RESULTS We identified six prospective randomized trials, all of which investigated a short-term (1-2 weeks) stent placement following uncomplicated ureteroscopic lithotripsy. The meta-analysis revealed that CIU-SP significantly reduced stent-related symptoms: CIU-SP had lower USSQ (Ureteral Stent Symptom Questionnaire) Urinary Symptom Index score (MD -5.13; 95%CI [-5.82,-4.44]; P < 0.00001), lower USSQ Pain Index score (MD -4.21; 95%CI [-5.25,-3.17]; P < 0.00001), and lower VAS pain scale (MD -1.93; 95%CI [-2.17,-1.69]; p < 0.00001). Besides, patients with CIU-SP were less likely to have pain (RR 0.78; 95%CI [0.67,0.91]; p = 0.001). There was no significant difference regarding the USSQ General Health and Work Performance. Both CIU-SP and C-SP had similarly few complications of Clavien-Dindo grade ≥2. CONCLUSION This meta-analysis reveals that CIU-SP significantly decreases stent-related urinary symptoms and pain. Based on the current evidence, CIU-SP is ready to be applied in clinical practice, at least in those requiring short-term stent placement following uncomplicated ureteroscopic lithotripsy.
Collapse
Affiliation(s)
- Chen-Hsun Ho
- Division of Urology, Department of Surgery, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan; School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan.
| | - Shih-Ping Liu
- Department of Urology, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - Chi-Wei Wang
- Division of Urology, Department of Surgery, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Pin-Wen Liao
- School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan; Department of Neurology, Cathay General Hospital, Taipei, Taiwan.
| |
Collapse
|
5
|
Villares da Costa LA, da Costa LGV, Lopes Neto AC, Casulli BM, Arnoni LRR, Glina S. Can ureteral stents with a different format reduce patients' symptomatology? A single-blinded, randomized, controlled study comparing smooth-walled and grooved ureteral stents. Actas Urol Esp 2022; 46:504-512. [PMID: 36109314 DOI: 10.1016/j.acuroe.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 12/19/2021] [Indexed: 12/13/2022]
Abstract
INTRODUCTION The true benefits of perioperative JJ stent placement are being widely studied due to its known side effects. However, no consensus has been reached in the literature regarding the best type of stent. This prospective, randomized, single-blinded study therefore aimed to compare the symptomatology associated with two JJ stent designs: smooth-walled and grooved. MATERIALS AND METHODS The study prospectively recruited 42 patients who underwent JJ stent placement between July 2019 and August 2020. The patients were randomly divided into two groups according to the JJ stent design used: the smooth-walled stent (control) and grooved stent (intervention) groups. After surgery, all patients completed the Portuguese-validated Ureteral Stent Symptom Questionnaire at three timepoints (days 7 and 30 post-surgical procedure, and day 30 post-stent removal). RESULTS No significant differences in gender, age, median body mass index, laterality, type of surgical procedure (flexible, semi-rigid or mixed ureteroscopy) were found. Smooth-walled JJ stents were associated with a higher incidence of flank pain (52.38% vs. 10%, P = .006) and suprapubic pain (57.14% vs. 30%, P = .04) on the 7th post-procedure day. Linear mixed regression showed significantly lower flank (P < .001) and suprapubic pain (P < .01), and significantly better sexual performance in the intervention group (P = .03). CONCLUSIONS Ureteral stent with a grooved format are associated with a lower incidence of flank and suprapubic pain and had less impact on the sexual performance of patients.
Collapse
Affiliation(s)
| | - L G V da Costa
- Department of Anesthesiology, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - A C Lopes Neto
- Department of Urology, Faculdade de Medicina do ABC, São Paulo, Brazil
| | - B M Casulli
- Department of General Surgery, Hospital do Servidor Público Estadual, São Paulo, Brazil
| | - L R R Arnoni
- Department of General Surgery, Hospital do Servidor Público Estadual, São Paulo, Brazil
| | - S Glina
- Department of Urology, Faculdade de Medicina do ABC, São Paulo, Brazil
| |
Collapse
|
6
|
Villares da Costa L, V. da Costa L, Lopes Neto A, Casulli B, Arnoni L, Glina S. ¿Puede el diseño del catéter ureteral reducir la sintomatología de los pacientes? Estudio controlado, aleatorizado y simple ciego, que compara el catéter ureteral de superficie lisa con el catéter ureteral de diseño acanalado. Actas Urol Esp 2022. [DOI: 10.1016/j.acuro.2021.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
7
|
Salih EM, Koritenah AK, Yehya M, Mourad MM. The efficacy of alpha-1A blocker (tamsulosin), antimuscarinic (solifenacin) and their combination in the management of double-J stent-related lower urinary tract symptoms: a randomized controlled study. AFRICAN JOURNAL OF UROLOGY 2021. [DOI: 10.1186/s12301-021-00142-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
Abstract
Abstract
Background
The insertion of a double-J (DJ) stent is considered a routine and necessary urological procedure. It can cause lower urinary tract symptoms (LUTS). Pharmacologic management is one of many trials that were done to improve these symptoms, particularly the administration of alpha-1A blockers and antimuscarinics medications. This trial aimed to evaluate the efficacy of alpha-1A blocker (tamsulosin), antimuscarinic (solifenacin), and their combination in managing DJ stent-related LUTS.
Methods
This prospective, randomized, comparative, and nonblinded trial was conducted between November 2016 and October 2018. Eligible patients were between 18 and 50 years of both genders who underwent temporary retrograde unilateral Double-J stent fixation. Patients were randomized to four groups; group I was control (drug-free), group II received tamsulosin 0.4 mg, group III received solifenacin 5 mg, and group IV received the combination of tamsulosin and solifenacin. All patients completed the IPSS, QoL, and VAS questionnaires at both pre-insertion day of the stent and 2 weeks postoperatively; the data obtained were compared to all four groups.
Results
The study included 143 patients (78 males, 65 females). There was no statistically significant difference between the four groups regarding age, sex, side, and DJ placement indications. In comparison with the control group, there were statistically significant differences in all scores in favor of groups II, III, and IV. Compared to groups II and III, there were statistically significant differences in overall IPSS, QoL, and VAS scores in group IV. No significant differences were found between the tamsulosin and solifenacin groups.
Conclusion
The alpha-1A blocker (tamsulosin) or antimuscarinic (solifenacin) monotherapy effectively improves the DJ stent-related LUTS and the QoL of patients with no advantage with either drug. The combination therapy of both pharmacotherapies is significantly effective than drug monotherapy.
Collapse
|
8
|
Gao X, Song T, Peng L, Yuan C, Wang W, Chen J, Xiao K, Wei X. Self-expanding metal ureteral stent for ureteral stricture: Experience of a large-scale prospective study from a high-volume center - Cross-sectional study. Int J Surg 2021; 95:106161. [PMID: 34728417 DOI: 10.1016/j.ijsu.2021.106161] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 10/18/2021] [Accepted: 10/28/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND The management of ureteral stricture is still a challenge for urologists. The aim of this prospective study was to assess the safety and effectiveness of self-expanding metal ureteral stents (URS) in ureteral strictures. METHODS We performed URS placement procedures for ureteral stricture from Jan 2019 to July 2020, and prospectively collect various data before and after the operation. A paired T test was used to compare continuous variables before and after surgery, binary logistic regression analysis was used to identify the independent risk predictors of surgical failure. RESULTS A total of 147 patients with 157 renal units received successful placement of URS. The mean operative time was 70.0 min. After a median follow-up time of 15 months, 73.2% (115/157) of stents were kept in situ. The most common complication was hematuria (13, 8.8%), followed by urinary tract infection (11, 7.5%) and pain (8, 5.4%). The volume of hydronephrosis (67.9 ± 34.9 VS 34.9 ± 51.1 cm3, P = 0.0001), serum creatinine level (103.0 ± 54.5 VS 93.8 ± 45.1 μmol/L, P = 0.034) and blood urea nitrogen level (6.6 ± 6.7 VS 5.4 ± 2.4 mmol/L, P = 0.032) decreased significantly at last follow up when compared with baseline. Stricture of the distal ureter was an independent risk factor for stent failure (HR 1.77, 95% CI 1.15, 2.73, P = 0.009). CONCLUSIONS URS was found to be safe and effective for ureteral strictures with a limited complications and good long-term results. For those who are not suitable for surgical reconstruction, the URS is an alternative management.
Collapse
Affiliation(s)
- Xiaoshuai Gao
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | | | | | | | | | | | | | | |
Collapse
|
9
|
Chandna A, Kumar S, Parmar KM, Sharma AP, Devana SK, Mete UK, Singh SK. Comparison of stent related symptoms in patients taking mirabegron, solifenacin, or tamsulosin: A double blinded randomized clinical trial. Urologia 2021; 89:589-596. [PMID: 34596484 DOI: 10.1177/03915603211048153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The present study aims to assess the efficacy of mirabegron, a novel beta-3 agonist for ameliorating stent related symptoms (SRSs) as compared to tamsulosin and solifenacin. METHODS Total of 150 patients undergoing ureteral stent placement following ureteroscopic lithotripsy, percutaneous nephrolithotomy, or laparoscopic/robotic pyeloplasty were randomized in 1:1:1 fashion to receive mirabegron 50 mg (group A), solifenacin 5 mg (group B), and tamsulosin 0.4 mg (group C) OD respectively. Patients were followed at POD10 (I visit), 4 weeks (II visit) after surgery, and 2 weeks post-stent removal. Validated vernacular version of ureteric stent symptoms questionnaire (USSQ) was administered to the patients at each visit. RESULTS Out of 150 patients randomized, 123 patients (A; n = 41, B; n = 40, and C; n = 42) completed the study. The groups were comparable in terms of urinary index score of USSQ at I and II visits (p = 0.119 and 0.076, respectively). A lower proportion of patients in group B experiencing bodily pain at II visit (p = 0.039), however, pain scores were comparable. Significantly lower general health index scores were observed in group A at I visit and over 4 weeks (p = 0.007). No significant differences were observed in other domains of USSQ. Age, sex, and surgical procedure undertaken did not significantly impact the scores in various USSQ domains. CONCLUSION Mirabegron demonstrates comparable benefit in alleviating SRSs with better general health indices and may be an effective alternative for SRSs, especially when tamsulosin or solifenacin are contra-indicated or poorly tolerated.
Collapse
Affiliation(s)
- Abhishek Chandna
- Department of Urology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Santosh Kumar
- Department of Urology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Kalpesh M Parmar
- Department of Urology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Aditya P Sharma
- Department of Urology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Sudheer K Devana
- Department of Urology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Uttam K Mete
- Department of Urology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Shrawan K Singh
- Department of Urology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| |
Collapse
|
10
|
Tong E, Hunter K, Deegan J, Torreggiani WC. Safely increasing nephro-ureteric stent exchange intervals, resulting in significant cost savings for the interventional radiology suite, a 2-year experience in a tertiary referral centre. Ir J Med Sci 2021; 191:1349-1353. [PMID: 34091859 PMCID: PMC9135782 DOI: 10.1007/s11845-021-02657-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 05/19/2021] [Indexed: 11/25/2022]
Abstract
Aim To evaluate the nephro-ureteric stent (NUS) insertion and exchange practice in a tertiary referral cancer centre, and determine the safety and compliance with current guidelines. We also reviewed if increasing exchange time interval from 6 to 12 weeks was safe, and if this could be adopted into our local guidelines. Methods A retrospective review was performed covering 24 months from January 2017 to December 2018. All NUS insertions and exchanges performed in that period were analysed, including the number of exchanges the patient underwent, the time between subsequent exchanges, and the screening time. We also reviewed the indications for stent insertion, possible causes for failed stent exchange, and factors which led to significant delays in stent exchanges for some patients. A scatterplot of screening time versus time in situ was derived and correlation analysis performed using the Pearson coefficient. Results Thirty-two patients underwent de novo NUS insertion during the period, and 102 NUS exchanges were performed. The interval between stent exchanges ranged from 1 to 40 weeks, with a mean of 12.3 weeks (SD = 8.96 weeks). Screening time ranged from 33 s to 17 min, with a mean of 3 min 50 s (SD = 3 min 35 s). There were 100 successful exchanges, and two failed exchanges, accounting for 1.9% of total exchanges. In both failed cases, the reason for failed exchange was due to a prolonged period between exchanges (6 months in both cases). The reason for delay for stent exchange was due to non-attendance for scheduled appointments. There was a weakly positive correlation coefficient of 0.06 (screening time versus time period between insertions); however, this was not statistically significant (p = 0.81). Conclusion In this retrospective review, we have demonstrated that the recommended 6-week period between stent exchanges is unnecessary in the vast majority of cases, and that a longer interval between NUS exchanges, e.g. 8–12 weeks, is safe for the patient, and reduces screening time. This reduction in procedures also provides a significant potential saving to the radiology department in both monetary expense and limited angiography suite time.
Collapse
Affiliation(s)
- Emma Tong
- Department of Radiology, Tallaght University Hospital, Dublin, Ireland.
| | - Kate Hunter
- Department of Radiology, Tallaght University Hospital, Dublin, Ireland
| | - Joe Deegan
- Department of Medicine, Trinity College Dublin, Dublin, Ireland
| | | |
Collapse
|
11
|
Huang IS, Tsai CH, Chen WJ, Cheng WM, Chiang CY, Kao WT, Huang EH, Huang W. Measuring individual ureteral length using computed tomography urography to determine the appropriate lengths of ureteral stents. UROLOGICAL SCIENCE 2021. [DOI: 10.4103/uros.uros_68_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
12
|
Bostanci Y, Mercimek MN, Gulsen M, Ozden E, Yakupoglu YK, Sarikaya S. Clinical Effectiveness of Single Pigtail Suture Stent on Patient Comfort: A Double-Blind Prospective Randomized Trial. J Laparoendosc Adv Surg Tech A 2020; 30:1183-1188. [PMID: 32293992 DOI: 10.1089/lap.2020.0127] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background: A double-pigtail ureteral stent (DPUS) can cause untoward symptoms, such as urgency, frequency, urinary incontinence, hematuria, and body pain that are bothersome to patient's quality of life (QoL). By reducing the quantity of material in the bladder, it could be reasonable to decrease stent-related symptoms (SRSs). We aimed to evaluate the tolerability of single pigtail suture stent (SPSS) with a validated questionnaire after uncomplicated retrograde semirigid ureteroscopic lithotripsy (URSL). Materials and Methods: A total of 130 patients who underwent ureteral stent placement after URSL for unilateral symptomatic ureteral stones with <15 mm diameter were randomized prospectively into two groups. Polyurethane ureteral stent (6 Fr, 24 or 26 cm) was placed in all patients, which was removed postoperatively with a mean of 14 days. There were 65 patients in both groups. All subjects completed the ureteral stent symptoms questionnaire (USSQ), which explores the SRSs. The questionnaires were conducted on the day of stent removal (at week 2) with the stent in situ and 4 weeks after removal (at week 6, poststent). The severity of SRSs and QoL were compared between the two groups. Results: SPSS was associated with perfect effect on all domains of USSQ, except from sexual and general health index scores. Pain index scores, visual analog scores (VAS), and analgesic requirements in SPSS group were found significantly low compared with those in the DPUS group. The QoL scores were significantly better in patients indwelling SPSS. Conclusion: SPSS is a potentially beneficial option to minimize ureteral SRSs after uncomplicated URSL.
Collapse
Affiliation(s)
- Yakup Bostanci
- Department of Urology, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | | | - Murat Gulsen
- Department of Urology, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Ender Ozden
- Department of Urology, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | | | - Saban Sarikaya
- Department of Urology, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
| |
Collapse
|
13
|
Forzini T, Demouron M, Uhl M, Mesureur S, Renard C, Klein C, Haraux E. Computed tomograpy evaluation of ureteral length in children. J Pediatr Urol 2019; 15:555.e1-555.e5. [PMID: 31324475 DOI: 10.1016/j.jpurol.2019.06.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 06/15/2019] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Although ureteral length (UL) is highly variable in children, reliable data on this topic are scarce. During urinary tract surgery, the use of an inappropriately dimensioned ureteral stent is associated with adverse effects. This study aimed to evaluate UL as a function of the child's age, using contrast-enhanced computed tomography (CT) of the abdomen and pelvis, and to calculate a new equation for predicting UL (and thus the optimal length of ureteral stents) in children. MATERIAL AND METHODS A retrospective, single-centre study of children (younger than 16 years) who are free of abdominal mass syndrome and severe scoliosis was conducted. After three-dimensional reconstruction of the CT data, the ureter was measured between the ureteropelvic junction and ureterovesical junction by two observers. The lengths of the right and left ureters were analyzed by age, with at least 10 CT measurements per age class. RESULTS The mean ULs on the right and left were, respectively, 9.7 and 9.91 cm before the age of 1 year, 20.10 and 21.08 cm at the age of 7 and 26.55 and 27.46 cm at the age of 16. The interobserver reproducibility of UL determination was high (intraclass correlation coefficient [95% confidence interval]: 0.97 [0.94-0.99]). On the basis of these results, the length of the double-J catheter should be equal to the child's age +12 cm (Table 1). CONCLUSION Computed tomography measurement of the UL in healthy children is reproducible and reliable and enabled the estimation of the UL by age group. This knowledge should facilitate the choice of the stent used in ureteral surgery. To confirm the study results, the stent size suggested here should be evaluated in routine practice.
Collapse
Affiliation(s)
- T Forzini
- Department of Urology and Transplantation, Amiens University Hospital, Amiens, France
| | - M Demouron
- Department of Visceral Surgery, Amiens University Hospital, Amiens, France
| | - M Uhl
- Department of Urology and Transplantation, Amiens University Hospital, Amiens, France
| | - S Mesureur
- Department of Pediatric Surgery, Amiens University Hospital, Amiens, France
| | - C Renard
- Department of Radiology, Amiens University Hospital, Amiens, France
| | - C Klein
- Department of Pediatric Surgery, Amiens University Hospital, Amiens, France
| | - E Haraux
- Department of Pediatric Surgery, Amiens University Hospital, Amiens, France; PeriTox - UMI 01, UFR de Médecine, Jules Verne University of Picardy, Amiens, France.
| |
Collapse
|
14
|
Ramstedt M, Ribeiro IAC, Bujdakova H, Mergulhão FJM, Jordao L, Thomsen P, Alm M, Burmølle M, Vladkova T, Can F, Reches M, Riool M, Barros A, Reis RL, Meaurio E, Kikhney J, Moter A, Zaat SAJ, Sjollema J. Evaluating Efficacy of Antimicrobial and Antifouling Materials for Urinary Tract Medical Devices: Challenges and Recommendations. Macromol Biosci 2019; 19:e1800384. [PMID: 30884146 DOI: 10.1002/mabi.201800384] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 01/18/2019] [Indexed: 01/05/2023]
Abstract
In Europe, the mean incidence of urinary tract infections in intensive care units is 1.1 per 1000 patient-days. Of these cases, catheter-associated urinary tract infections (CAUTI) account for 98%. In total, CAUTI in hospitals is estimated to give additional health-care costs of £1-2.5 billion in the United Kingdom alone. This is in sharp contrast to the low cost of urinary catheters and emphasizes the need for innovative products that reduce the incidence rate of CAUTI. Ureteral stents and other urinary-tract devices suffer similar problems. Antimicrobial strategies are being developed, however, the evaluation of their efficacy is very challenging. This review aims to provide considerations and recommendations covering all relevant aspects of antimicrobial material testing, including surface characterization, biocompatibility, cytotoxicity, in vitro and in vivo tests, microbial strain selection, and hydrodynamic conditions, all in the perspective of complying to the complex pathology of device-associated urinary tract infection. The recommendations should be on the basis of standard assays to be developed which would enable comparisons of results obtained in different research labs both in industry and in academia, as well as provide industry and academia with tools to assess the antimicrobial properties for urinary tract devices in a reliable way.
Collapse
Affiliation(s)
| | - Isabel A C Ribeiro
- Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, Universidade de Lisboa, 1649-004, Lisbon, Portugal
| | - Helena Bujdakova
- Department of Microbiology and Virology, Faculty of Natural Sciences, Comenius University in Bratislava, 81499, Bratislava 1, Slovakia
| | - Filipe J M Mergulhão
- Laboratory for Process Engineering, Environment, Biotechnology and Energy (LEPABE), Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, 4200-465, Porto, Portugal
| | - Luisa Jordao
- Department of Environmental Health, Research and Development Unit, National Institute of Health Dr. Ricardo Jorge (INSA), Avenida Padre Cruz, 1649-016, Lisbon, Portugal
| | - Peter Thomsen
- BioModics ApS, Stengårds Alle 31A, DK-2800, Lyngby, Denmark
| | - Martin Alm
- BioModics ApS, Stengårds Alle 31A, DK-2800, Lyngby, Denmark
| | - Mette Burmølle
- Department of Biology, University of Copenhagen, 2100, Copenhagen, Denmark
| | - Todorka Vladkova
- Department of Polymers, University of Chemical Technology and Metallurgy (UCTM), 8 Kliment Ohridski Blvd, 1756, Sofia, Bulgaria
| | - Fusun Can
- Department of Medical Microbiology, School of Medicine, Koc University, 34450, Sariyer, Istanbul, Turkey
| | - Meital Reches
- Institute of Chemistry and the Center for Nanoscience and Nanotechnology, The Hebrew University of Jerusalem, Jerusalem, 91904, Israel
| | - Martijn Riool
- Department of Medical Microbiology, Amsterdam UMC, Amsterdam Infection and Immunity Institute, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Alexandre Barros
- 3B's Research Group, I3Bs Research Institute on Biomaterials, Biodegradables and Biomimetics, University of Minho, Guimarães, 4710-057, Braga, Portugal
| | - Rui L Reis
- 3B's Research Group, I3Bs Research Institute on Biomaterials, Biodegradables and Biomimetics, University of Minho, Guimarães, 4710-057, Braga, Portugal
| | - Emilio Meaurio
- Department of Mining-Metallurgy Engineering and Materials Science, POLYMAT, School of Engineering, University of the Basque Country, 48940 Leina, Bizkaia, Bilbao, Spain
| | - Judith Kikhney
- Biofilmcenter, Department of Microbiology, Infectious Diseases and Immunology, Charité University Medicine Berlin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Annette Moter
- Biofilmcenter, Department of Microbiology, Infectious Diseases and Immunology, Charité University Medicine Berlin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Sebastian A J Zaat
- Department of Medical Microbiology, Amsterdam UMC, Amsterdam Infection and Immunity Institute, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Jelmer Sjollema
- University of Groningen, University Medical Center Groningen, Department of Biomedical Engineering, Antonius Deusinglaan 1, 9713 AV, Groningen, The Netherlands
| |
Collapse
|
15
|
Kurata S, Tobu S, Udo K, Noguchi M. Outcomes of Ureteral Stent Placement for Hydronephrosis in Patients with Gynecological Malignancies. Curr Urol 2017; 10:126-131. [PMID: 28878594 DOI: 10.1159/000447165] [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: 04/25/2016] [Accepted: 09/28/2016] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE We examined the outcomes of patients undergoing ureteral stent placement for hydronephrosis that occurred during treatment for gynecological malignancies. MATERIALS AND METHODS From January 2004 to December 2009, we enrolled 33 patients with 45 ureters undergoing ureteral stent placement for hydronephrosis which occurred during treatment for gynecological malignancies. We examined the outcomes of the patients after stent placement. RESULTS The causes of hydronephrosis were obstruction of the urinary tract by a tumor (n = 22), obstruction due to lymph node swelling (n = 6), ureteral stenosis after radiation therapy (n = 4), and others (n = 1). The ureteral stent was inserted into both ureters in 12 cases, and into one ureter in 21 cases. Ureteral stents were replaced 1-26 times during the observation period (median 3 times). Eighteen (40%) ureteral stents were removed. The reasons for ureteral stent removal were hydronephrosis improvement (11 ureters, 24.4%), a change to nephrostomy (cystectomy: 1 ureter, progression of ureteral stenosis: 2 ureters), renal atrophy (3 ureters), and ureteral dilatation (1 ureter). All of the cases in which ureteral stent withdrawal due to hydronephrosis improvement were cases in which the ureter was compressed by a tumor and were lower ureteral obstructions. Twenty-one patients (64%) died due to cancer after stent placement. The periods from the first stent placement to death ranged from 1 to 58 months (median 18 months). CONCLUSION Ureteral stent placement was associated with a poor prognosis in patients with gynecological malignancies. There were a few cases in which stent withdrawal became possible due to the improvement of hydronephrosis. In such cases, the withdrawal rate varied according to the cause and obstructive level.
Collapse
Affiliation(s)
- Saya Kurata
- Department of Urology, Faculty of Medicine, Saga University, Saga, Japan
| | - Shohei Tobu
- Department of Urology, Faculty of Medicine, Saga University, Saga, Japan
| | - Kazuma Udo
- Department of Urology, Faculty of Medicine, Saga University, Saga, Japan
| | - Mitsuru Noguchi
- Department of Urology, Faculty of Medicine, Saga University, Saga, Japan
| |
Collapse
|
16
|
Bier S, Amend B, Wagner E, Rausch S, Mischinger J, Neumann E, Stühler V, Hennenlotter J, Todenhoefer T, Stenzl A, Bedke J, Kruck S. The thermoexpandable nitinol stent: a long-term alternative in patients without nephropathy or malignancy. Scand J Urol 2017. [PMID: 28644054 DOI: 10.1080/21681805.2017.1331262] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the long-term outcome of a thermoexpandable nickel-titanium nitinol ureteral stent (Memokath 051™) and to identify individual risk factors for failure. MATERIALS AND METHODS This retrospective single-centre study included 125 patients who underwent implantation of the self-expandable Memokath 051 stent. Complications, indwelling time and reason for explantation were recorded. Analyses were stratified by gender, age, body mass index, American Society of Anesthesiologists score, estimated glomerular filtration rate (eGFR), side, localization and cause of the stricture. RESULTS In total, 91 out of 125 patients (73%) were available for analysis. Median indwelling time was 355 days (range 7-2125 days). Most stents were removed because of dislocation (42%) or occlusion (40%). Stent removal was rarely performed because of infection (3%). Patients with sufficient renal function (eGFR ≥60 ml/min/1.73 m²) showed increased indwelling times compared with those with nephropathy (386 vs 317 days; p < 0.01). Patients with active malignant disease showed reduced patency time compared with strictures of benign origin (455 vs 190 days; p < 0.01). CONCLUSIONS This thermoexpandable nitinol stent offers safe mid-term treatment of ureteric strictures, especially in patients without active malignancy and with good renal function.
Collapse
Affiliation(s)
- Simone Bier
- a Department of Urology , Eberhard-Karls-University , Tuebingen , Germany
| | - Bastian Amend
- a Department of Urology , Eberhard-Karls-University , Tuebingen , Germany
| | - Elena Wagner
- a Department of Urology , Eberhard-Karls-University , Tuebingen , Germany
| | - Steffen Rausch
- a Department of Urology , Eberhard-Karls-University , Tuebingen , Germany
| | | | - Eva Neumann
- a Department of Urology , Eberhard-Karls-University , Tuebingen , Germany
| | - Viktoria Stühler
- a Department of Urology , Eberhard-Karls-University , Tuebingen , Germany
| | - Joerg Hennenlotter
- a Department of Urology , Eberhard-Karls-University , Tuebingen , Germany
| | - Tilman Todenhoefer
- a Department of Urology , Eberhard-Karls-University , Tuebingen , Germany
| | - Arnulf Stenzl
- a Department of Urology , Eberhard-Karls-University , Tuebingen , Germany
| | - Jens Bedke
- a Department of Urology , Eberhard-Karls-University , Tuebingen , Germany
| | - Stephan Kruck
- a Department of Urology , Eberhard-Karls-University , Tuebingen , Germany
| |
Collapse
|
17
|
Vachon C, Defarges A, Brisson B, Nykamp S, Weese JS, Denstedt J, Berent AC. Passive ureteral dilation and ureteroscopy after ureteral stent placement in five healthy Beagles. Am J Vet Res 2017; 78:381-392. [DOI: 10.2460/ajvr.78.3.381] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
18
|
Eryildirim B, Tuncer M, Sahin C, Yucetas U, Sarica K. Evaluation of sexual function in patients submitted to ureteroscopic procedures. Int Braz J Urol 2015; 41:791-5. [PMID: 26401873 PMCID: PMC4757009 DOI: 10.1590/s1677-5538.ibju.2014.0353] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 01/26/2015] [Indexed: 12/03/2022] Open
Abstract
Objective: We aimed to evaluate the possible effects of ureteroscopic procedures on the sexual function of both genders. Materials and Methods: A total of 102 sexually active cases (60 male, 42 female) undergoing ureteroscopic procedures were included in this study. Sexual function has been evaluated in detail by using International Index of Erectile Function (IIEF) in male and Female Sexual Function Index (FSFI) forms in female cases both before and 1-month after the procedures. Pre-and postoperative data were evaluated in a comparative manner. Results: The pre-and postoperative mean IIEF scores were 57.86±2.26 and 54.57±2.48 (p=0.19) in males and the mean FSFI scores were 13.58±1.46 and 14.46±1.52 (p=0.41), respectively in females. Evaluation of these values showed that regarding the effects of this procedure on male cases although the total scores for sexual function were not influenced it was observed a significant reduction in the intercourse satisfaction sub-domain (IIEF-IS) in males (p<0.05). In female cases however, unlike the male cases no statistically significant alterations with respect to these scores were noted (p=0.418). Conclusion: Ureteroscopic interventions could have some adverse effects on the sexual function particularly in male cases. However, it is clear that further prospective studies in both genders with large population of cases are certainly needed in order to outline this unresolved but important subject.
Collapse
Affiliation(s)
- Bilal Eryildirim
- Dr. Lütfi Kirdar Training and Research Hospital Urology Clinic, Istanbul, Turkey
| | - Murat Tuncer
- Dr. Lütfi Kirdar Training and Research Hospital Urology Clinic, Istanbul, Turkey
| | - Cahit Sahin
- Dr. Lütfi Kirdar Training and Research Hospital Urology Clinic, Istanbul, Turkey
| | - Ugur Yucetas
- Istanbul Training and Research Hospital Urology Clinic, Istanbul, Turkey
| | - Kemal Sarica
- Dr. Lütfi Kirdar Training and Research Hospital Urology Clinic, Istanbul, Turkey
| |
Collapse
|
19
|
Kim HW, Lee JH, Shin DG, Lee JZ. The effects of silodosin in the treatment of ureteral stent related symptoms. J INCL PHENOM MACRO 2015. [DOI: 10.1007/s10847-015-0494-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
20
|
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.
Collapse
|
21
|
Rhee J, Steele SS, Beiko D. Percutaneous antegrade nephroscopic holmium laser pyelotomy: Novel endourologic technique for removal of extruded ureteral stent. Can Urol Assoc J 2014; 7:E830-2. [PMID: 24475007 DOI: 10.5489/cuaj.1258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Ureteral stent malposition outside of the urinary tract is a very uncommon complication of retrograde or antegrade ureteral stent insertion. There are few reports of open, laparoscopic or endourologic approaches to remove malpositioned stents. We present a novel technique for the removal of an extruded retroperitoneal ureteral stent using percutaneous antegrade nephroscopic holmium laser pyelotomy. This previously undescribed procedure represents a new soft tissue application of the holmium laser.
Collapse
Affiliation(s)
- Jonathon Rhee
- Department of Urology, Queen's University, Kingston General Hospital, Kingston, ON
| | - Stephen S Steele
- Department of Urology, Queen's University, Kingston General Hospital, Kingston, ON
| | - Darren Beiko
- Department of Urology, Queen's University, Kingston General Hospital, Kingston, ON
| |
Collapse
|
22
|
Randomized controlled trial to compare the safety and efficacy of tamsulosin, solifenacin, and combination of both in treatment of double-j stent-related lower urinary symptoms. Adv Urol 2013; 2013:752382. [PMID: 24235970 PMCID: PMC3819880 DOI: 10.1155/2013/752382] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2013] [Accepted: 09/07/2013] [Indexed: 11/17/2022] Open
Abstract
Purpose. We evaluated the effectiveness and safety of tamsulosin, solifenacin, and combination of both in reducing double-J stent-related lower urinary symptoms. Materials and Methods. A total of 338 patients with double-J ureteral stenting were randomly divided, postoperatively, into 4 groups. In group I (n = 84), no treatment was given (control group), group II (n = 85) received tamsulosin 0.4 mg daily, group III (n = 84) received solifenacin 10 mg daily, and group IV (n = 85) received a combination of both medications. Before insertion and 2 weeks after, all patients completed the International Prostate Symptom Score (IPSS), quality of life component of the IPSS (IPSS/Qol), Overactive Bladder Questionnaire (OAB-q), and Visual Analogue Pain Scale (VAPS) questionnaire. Results. The demographics and preoperative questionnaires scores of all groups were comparable. There were statistically significant differences in all scores in favour of groups II, III, and IV as compared to control group (P value < 0.005). Group IV showed statistically significant differences in total IPSS, QoL score, and OAB-q score as compared to groups II and III (P value < 0.001). Conclusions. Combined therapy of tamsulosin and solifenacin significantly alleviated lower urinary symptoms associated with double-J stents as compared to either medication alone.
Collapse
|
23
|
Shrewsberry AB, Al-Qassab U, Goodman M, Petros JA, Sullivan JW, Ritenour CWM, Issa MM. A +20% adjustment in the computed tomography measured ureteral length is an accurate predictor of true ureteral length before ureteral stent placement. J Endourol 2013; 27:1041-5. [PMID: 23537290 DOI: 10.1089/end.2013.0041] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE The correct length of a ureteral stent is important in minimizing postplacement discomfort and stent migration. We describe and validate a method to accurately measure the ureteral length. MATERIALS AND METHODS The ureteral length in 48 patients undergoing ureteral stent placement for urolithiasis was measured by computed tomography (CT) (total thickness of axial slices between the ureteropelvic junction and ureterovesical junction) and adjusted up by 20%. The adjusted CT measurement of ureteral length was compared with direct intraoperative measurement using scatter plot and Pearson correlation coefficient. Correlation coefficients were also calculated between intraoperative ureteral length and various body habitus measurements such as the height, weight, and waist circumference. RESULTS Median patient age was 62 years. The median stone diameter was 7.5 mm (1-20). The ratio of left- to right-sided stones was 2:1. The stone location was in the proximal ureter in 45.8%, distal ureter in 37.5%, kidney in 10.4%, and midureter in 6.3%. Symptoms included adnominal/flank pain (93.8%) followed by nausea/vomiting (39.6%) and gross hematuria (16.7%). Median creatinine was 1.4 (0.8-3.6 mg/dl) and median WBC was 8.6 (2.8-17.6). The median ureteral length was 25.8 cm (19.2-29.4) on the CT scan and 25.5 cm (19.0-29.0) on the intraoperative measurement (p=0.57). The Pearson correlation coefficient between the two measurements was 0.979. In contrast, the height, weight, and waist circumference correlated poorly with intraoperative ureteral length measurements (r=0.34, 0.19, and 0.40, respectively). CONCLUSION CT-measured ureteral length adjusted up by 20% is a reliable method to accurately measure the true ureteral length. This method is superior to traditional indirect methods that rely on body habitus measurements.
Collapse
Affiliation(s)
- Adam B Shrewsberry
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia, USA
| | | | | | | | | | | | | |
Collapse
|
24
|
Yu SH, Ryu JG, Jeong SH, Hwang EC, Jang WS, Hwang IS, Yu HS, Kim SO, Jung SI, Kang TW, Kwon DD, Park K, Hwang JE, Kim GS. Predicting factors for stent failure-free survival in patients with a malignant ureteral obstruction managed with ureteral stents. Korean J Urol 2013; 54:316-21. [PMID: 23700497 PMCID: PMC3659225 DOI: 10.4111/kju.2013.54.5.316] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Accepted: 01/04/2013] [Indexed: 12/16/2022] Open
Abstract
Purpose To determine predictive factors for stent failure-free survival in patients treated with a retrograde ureteral stent for a malignant ureteral obstruction. Materials and Methods We retrospectively reviewed 71 patients who underwent insertion of a cystoscopic ureteral stent due to a malignant ureteral obstruction between May 2004 and June 2011. Performance status, type of cancer, hydronephrosis grade, location of the obstruction, presence of bladder invasion, C-reactive protein (CRP), serum albumin, and inflammation-based prognostic score (Glasgow prognostic score, GPS) were assessed using a Cox proportional regression hazard model as predicting factors for stent failure. Results A univariate analysis indicted that hypoalbuminemia (<3.5 g/dL; hazard ratio [HR], 2.43; 95% confidence interval [CI], 1.21 to 4.86; p=0.012), elevated CRP (≥1 mg/dL; HR, 4.79; 95% CI, 2.0 to 11.1; p=0.001), and presence of a distal ureter obstruction (HR, 3.27; 95% CI, 1.19 to 8.95; p=0.021) were associated with stent failure-free survival. A multivariate analysis revealed that the presence of a mid and lower ureteral obstruction (HR, 3.27; 95% CI, 1.19 to 8.95; p=0.007), GPS ≥1 (HR, 7.22; 95% CI, 2.89 to 18.0; p=0.001), and elevated serum creatinine before ureteral stent placement (>1.2 mg/dL; HR, 2.16; 95% CI, 1.02 to 4.57; p=0.044) were associated with stent failure-free survival. Conclusions A mid or lower ureteral obstruction, GPS ≥1, and serum creatinine before ureteral stent insertion >1.2 mg/dL were unfavorable predictors of stent failure-free survival. These factors may help urologists predict survival time.
Collapse
Affiliation(s)
- Seong Hyeon Yu
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Moskovitz B, Halachmi S, Nativ O. A new self-expanding, large-caliber ureteral stent: results of a multicenter experience. J Endourol 2013; 26:1523-7. [PMID: 22697886 DOI: 10.1089/end.2012.0279] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND PURPOSE Ureteral strictures (US) can be a recurrent chronic illness that leads to severe side effects and poor quality of life. Several options to treat US exist, including repeated dilations, stents, minimally invasive reconstructive surgeries, and urinary diversion or nephrectomy. Placement of an ureteral stent is a good minimally invasive option but has major limitations, such as stent migration, mucosal in-growth, incrustations, and stent obstruction. Our study aim was to evaluate the safety and the efficacy of a new self-expanding, large caliber ureteral stent (Allium(®)). PATIENTS AND METHODS During 2005 to 2011, 49 stents were inserted in 49 renal units (40 patients) for a mean indwelling time of 17 months (range 1-63 mos). RESULTS Migration was observed in seven (14.2%) patients, mandating stent removal. Only one stent was occluded. In eight renal units, the stents were removed as scheduled, and no reobstruction was detected during follow-up. Twenty-eight patients currently have a patent stent. CONCLUSIONS The Allium stent provides an attractive solution for long-term internal ureteral drainage. Its design allows good anchoring, prevents intraluminal ingrowth, and has the ability of rapid disintegration for extremely easy removal.
Collapse
Affiliation(s)
- Boaz Moskovitz
- Department of Urology, Bnai Zion Medical Center, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | | | | |
Collapse
|
26
|
Ključevšek D, Ključevšek T. Percutaneous insertion of double-J ureteral stent in children with ureteral obstruction: our experiences. J Pediatr Urol 2013; 9:188-92. [PMID: 22364714 DOI: 10.1016/j.jpurol.2012.01.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2011] [Accepted: 01/30/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Ureteral obstruction (UO) is usually treated by surgical or endoscopic approaches. We investigated whether percutaneous anterograde treatment with insertion of double-J ureteral stent (DJ) is a feasible alternative technique for the management of UO in selected cases, where traditional approaches are not possible or too risky. PATIENTS AND METHODS The DJ was percutaneously inserted into 10 children (mean age 9 years) who suffered from UO. Three children had already been treated surgically for complex urotract congenital anomalies; six children had restenosis/reocclusion or stenosis of ureteropelvic junction; and one girl suffered migration of an intraoperatively placed DJ with stenosis of the distal ureter. RESULTS Percutaneous insertion of the DJ was successful on the first attempt in 8 and on the second in 2 children. Adverse events after the procedure, all successfully treated, included one pyelonephritis and one migration of DJ, and 3 children had bacteriuria and 3 hematuria. Mean duration of insertion of the DJ was 6.4 months. After removal of the DJ, 7 children did not need any further interventions, but 2 children needed surgical correction and 1 reinsertion of the DJ. CONCLUSION In selected cases, percutanous insertion of a DJ should be considered as an alternative to surgery or endoscopic treatment in the management of children with UO.
Collapse
Affiliation(s)
- Damjana Ključevšek
- University Children's Hospital Ljubljana, Pediatric Radiology Unit, Bohoričeva 20, 1000 Ljubljana, Slovenia.
| | | |
Collapse
|
27
|
Kuyumcuoglu U, Eryildirim B, Tuncer M, Faydaci G, Tarhan F, Ozgül A. Effectiveness of medical treatment in overcoming the ureteral double-J stent related symptoms. Can Urol Assoc J 2011; 6:E234-7. [PMID: 21914427 DOI: 10.5489/cuaj.10143] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND We investigated whether the frequency of lower urinary tract symptoms (LUTS) increased in patients in whom double-J stents were applied. We also evaluated several medical therapy protocols to treat symptoms related with ureteral stents. MATERIALS AND METHODS A total of 108 patients, in whom unilateral double-j stent was applied during ureteral stone treatment, were included. Before the double-J stent was applied, all patients completed storage components of the "International Prostate Symptom Score" (IPSSs), quality of life components of the IPSS (IPSS-QOL) and "Overactive Bladder Questionnaire" (OABq) forms and scores were calculated. After the procedure, cases were randomized into 5 groups, an antiinflammatory was given to Group 1, spasmolytic to Group 2, anticholinergic to Group 3 and α-blocker to Group 4. No additional drug was given to Group 5 as this control group. During the fourth week of the procedure, IPSSs, IPSS-QOL and OABq forms were again completed and scores were compared with the previous ones. RESULTS When all the cases were evaluated, the IPSSs, IPSS-QOL and OABq scores of patients in whom the double-J stent was applied were statistically significantly higher the procedure. Compared to the control group, the cases where the double-J stent was applied showed a higher IPSSs, IPSS-QOL and OABq scores and none of the medical therapies could prevent this increase. INTERPRETATION The frequency of LUTS increased in cases where the ureteral stent was applied and discomfort continued as long as the stent stayed in the body.
Collapse
Affiliation(s)
- Ugur Kuyumcuoglu
- Dr. Lütfi Kirdar Training and Research Hospital 1. Urology Clinic, Istanbul, Turkey
| | | | | | | | | | | |
Collapse
|
28
|
Eryildirim B, Tuncer M, Kuyumcuoglu U, Faydaci G, Tarhan F, Ozgül A. Do ureteral catheterisation procedures affect sexual functions? A controlled prospective study. Andrologia 2011; 44 Suppl 1:419-23. [DOI: 10.1111/j.1439-0272.2011.01199.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
29
|
Lange D, Hoag NA, Poh BK, Chew BH. Drainage Characteristics of the 3F MicroStent Using a Novel Film Occlusion Anchoring Mechanism. J Endourol 2011; 25:1051-6. [DOI: 10.1089/end.2010.0722] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Dirk Lange
- Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nathan A. Hoag
- Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Beow Kiong Poh
- Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ben H. Chew
- Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
30
|
Soria F, Rioja LÁ, Morcillo E, Martin C, Pamplona M, Sánchez FM. New combined approach in metallic ureteral stenting to avoid urothelial hyperplasia: study in swine model. J Urol 2011; 185:1939-45. [PMID: 21421242 DOI: 10.1016/j.juro.2010.12.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2010] [Indexed: 11/25/2022]
Abstract
PURPOSE We assessed the therapeutic value of a new treatment option for ureteral strictures that may avoid urothelial hyperplasia, which is the main cause of metallic stent failure. MATERIALS AND METHODS We used 24 pigs in this study. An experimental model of ureteral stricture was induced in all animals. Obstruction was confirmed by ultrasound and retrograde ureteropyelogram 6 weeks after model creation. The pigs were then randomly allocated to 2 experimental groups. Therapy involved placement of a 6 × 30 mm metallic ureteral covered stent in the ureteral stricture in group 1 and subsequent endoureterotomy at the ureteral segments adjacent to the 2 ends of the stent in group 2. A double pigtail stent was then deployed for 3 weeks. Completion studies 6 months after therapy included retrograde ureteropyelogram, endoluminal ultrasound and ureteroscopy to assess urothelial hyperplasia formation. RESULTS At the end of the study evidence of urothelial hyperplasia was seen in 50% of the pigs in group 1 and in 29% in group 2. Four and 2 cases of cranial stent migration in groups 1 and 2, respectively, were seen at 6 months. Hyperplasia and renal involvement were statistically significantly different between the groups with more damage in group 1 than in group 2. CONCLUSIONS Hyperplasia was markedly reduced when ureteral peristalsis was inhibited by endoureterotomy at the area of interaction between the stent and the ureter.
Collapse
Affiliation(s)
- Federico Soria
- Endoscopy Department, Minimally Invasive Surgery Centre Jesús Usón, Cáceres, Spain.
| | | | | | | | | | | |
Collapse
|
31
|
Tanriverdi O, Yencilek F, Koyuncu H, Yencilek E, Sarica K. Emergent Stenting After Uncomplicated Ureteroscopy: Evaluation of 23 Patients. Urology 2011; 77:305-8. [DOI: 10.1016/j.urology.2010.07.472] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2010] [Revised: 06/29/2010] [Accepted: 07/19/2010] [Indexed: 10/18/2022]
|
32
|
Gupta M, Patel T, Xavier K, Maruffo F, Lehman D, Walsh R, Landman J. Prospective Randomized Evaluation of Periureteral Botulinum Toxin Type A Injection for Ureteral Stent Pain Reduction. J Urol 2010; 183:598-602. [DOI: 10.1016/j.juro.2009.10.021] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2009] [Indexed: 11/25/2022]
Affiliation(s)
- Mantu Gupta
- Department of Urology, Columbia University College of Physicians and Surgeons, New York, New York
| | - Trushar Patel
- Department of Urology, Columbia University College of Physicians and Surgeons, New York, New York
| | - Keith Xavier
- Department of Urology, Columbia University College of Physicians and Surgeons, New York, New York
| | - Franzo Maruffo
- Department of Urology, Columbia University College of Physicians and Surgeons, New York, New York
| | - Daniel Lehman
- Department of Urology, Columbia University College of Physicians and Surgeons, New York, New York
| | - Rhonda Walsh
- Department of Urology, Columbia University College of Physicians and Surgeons, New York, New York
| | - Jaime Landman
- Department of Urology, Columbia University College of Physicians and Surgeons, New York, New York
| |
Collapse
|
33
|
|
34
|
Natalin RA, Hruby GW, Okhunov Z, Singh H, Phillips CK, Humphrey PA, Gupta M, Landman J. Pilot study evaluating ureteric physiological changes with a novel 'ribbon stent' design using electromyographic and giant magnetoresistive sensors. BJU Int 2008; 103:1128-31. [PMID: 19040534 DOI: 10.1111/j.1464-410x.2008.08184.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To test a novel 'ribbon stent' (RS) design using an extraluminal bipolar electromyographic (EMG) and giant magnetoresistive (GMR) sensor system to characterize ureteric responses. MATERIALS AND METHODS In all, 11 female domestic pigs were divided into three groups to evaluate ureteric physiology: group 1 (two pigs) with an unstented ureter, group 2 (three) with a standard 6 F ureteric stent, and group 3 (six) with the RS. For all groups EMG/GMR evaluation was performed at baseline, immediately after stenting, and at 3 and 7 days after stenting. All pigs underwent standardized retrograde ureteropyelogram evaluation at these time points, and after the final evaluation the pigs were killed and the urinary tract was harvested for histopathological evaluation. RESULTS One stent in group 3 could not be deployed due to a problem with ureteric access. For groups 1, 2 and 3 the ureteric peristaltic activity was 109, 63, 72 events/h at baseline (P = 0.49); 61, 70, and 66 events/h immediately after stenting (P = 0.97); 66, 0, 8 events/h at 3 days after stenting (P = 0.002); and 61, 12, 0 events/h at 7 days after stenting, respectively (P = 0.049). CONCLUSION The RS was deployed easily and safely in the porcine model using a standard technique. As with a standard stent, there was significant ureteric dilation and decrease in peristalsis with the RS.
Collapse
Affiliation(s)
- Ricardo A Natalin
- Department of Urology, Columbia University Medical Center, New York, NY, USA
| | | | | | | | | | | | | | | |
Collapse
|
35
|
Shao Y, Zhuo J, Sun XW, Wen W, Liu HT, Xia SJ. Nonstented versus routine stented ureteroscopic holmium laser lithotripsy: a prospective randomized trial. ACTA ACUST UNITED AC 2008; 36:259-63. [PMID: 18797859 DOI: 10.1007/s00240-008-0153-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2007] [Accepted: 08/29/2008] [Indexed: 12/01/2022]
Abstract
We conducted a prospective, randomized study to evaluate whether postoperative ureteral stenting is necessary after ureteroscopic holmium laser lithotripsy. A total of 115 consecutive patients with distal or middle ureteral calculi amenable to ureteroscopic holmium laser lithotripsy were prospectively randomized into stented group (n = 58) and nonstented group (n = 57). The stent was routinely placed in the treated ureter for 2 weeks. The outcomes were measured with postoperative patient symptoms, stone-free rates, early and late postoperative complications, and cost-effectiveness. The postoperative symptoms were measured with Ureteral Stent Symptom Questionnaire (USSQ). All patients completed a 12-week follow-up. There was no significant difference between two groups with respect to the patient age, stone size, stone location and mean operative time. According to the USSQ, the symptoms of the stented group were significantly worse compared to the nonstented group (P = 0.0001). In the stented group, two patients had high fever for 1 week after the operation, stent migration was found in two patients, and the stents had to be removed earlier in five patients because of severe pain or hematuria. The cost of the stented group was significantly higher than the nonstented group. The stone-free rate was 100% in both groups. No hydronephrosis or ureteral stricture was detected by intravenous pyelogram in the 12th week postoperative follow-up. In conclusion, we believe that routine stenting after ureteroscopic intracorporeal lithotripsy with the holmium laser is not necessary as long as the procedure is uncomplicated for distal or middle ureteral calculis less than 2 cm.
Collapse
Affiliation(s)
- Yi Shao
- Department of Urology, Shanghai Jiaotong University Affiliated First People's Hospital, No 85, Wujin road, 200080, Shanghai, China
| | | | | | | | | | | |
Collapse
|
36
|
In vitro simulation of stent fracture mechanisms in ureteric nitinol wire stents. ACTA ACUST UNITED AC 2008; 36:241-5. [PMID: 18751973 DOI: 10.1007/s00240-008-0149-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2008] [Accepted: 08/02/2008] [Indexed: 10/21/2022]
Abstract
The ZebraStent is a new-concept lumen-less teflon-coated nitinol double-J wire-stent, designed to facilitate the passage of residual fragments after extracorporeal shock wave lithotripsy. In clinical practice we observed a small number of stent fractures. Hence, an experimental model was designed to simulate the physical forces that may lead to material fatigue of the stent. Flexion force was simulated by "half circular kidney mimicking structures" (HCKMS) into which the upper part of the stent was placed. All experiments were done for a minimum of 5 million cycles representing a stent indwelling time of 9 months, or until stent fracture, and simulating respiratory kidney movement. It was demonstrated that as the diameter of the HCKMS decreases, thus leading to an increased bending of the stent, the likelihood of stent fracture increased proportionally and occurred earlier. From our results it appears that stent fractures can be avoided by observing a maximum indwelling time of 6-8 weeks (which should suffice for the duration of a average SWL treatment), by choosing the correct (and shortest possible) stent length, and perhaps by manufacturer's modifications decreasing the stent's resistance to flexion. The ZebraStent concept remains appealing if it is considered as a short-term stent for post-SWL residual fragments.
Collapse
|
37
|
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.
Collapse
Affiliation(s)
- Hamdy M Ibrahim
- Al-Adan Urology Unit, Ministry of Health, Kuwait City, Kuwait
| | | | | | | | | |
Collapse
|
38
|
Kouba E, Wallen EM, Pruthi RS. Management of ureteral obstruction due to advanced malignancy: optimizing therapeutic and palliative outcomes. J Urol 2008; 180:444-50. [PMID: 18550089 DOI: 10.1016/j.juro.2008.04.008] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2007] [Indexed: 11/30/2022]
Abstract
PURPOSE Treatment of ureteral obstruction due to advanced abdominal or pelvic malignancy is a clinical challenge. We discuss improvements and modern day outcomes in the palliative treatment of patients with ureteral obstruction by antegrade or retrograde ureteral decompression. Also, potential areas of clinical investigation involving ureteral stent improvement and pharmacological management of relief of symptoms resulting from ureteral obstruction are discussed. MATERIALS AND METHODS A literature search was performed using the Entrez-PubMed(R) database. All relevant literature on ureteral obstruction, advanced malignancy and nephrostomy, ureteral stent and associated topics concerning palliative care and quality of life were reviewed and analyzed. RESULTS Presenting symptoms are varied and depend on the acuity of the underlying problem. Mechanisms underlying the pain and symptoms of extrinsic ureteral compression have not fully been explored but they may include prostaglandin and renin-angiotensin pathways with medical interventions potentially directed at such therapeutic targets. Progressive obstructive uropathy may likely lead to clinical manifestations, such as uremia, electrolyte imbalances and persistent urinary tract infections, if obstruction is not bypassed. New approaches to antegrade and retrograde stenting, and the evaluation of new stent materials may help minimize the complications and side effects of such procedures. Unfortunately the finding of ureteral obstruction due to malignancy carries a poor prognosis with a resulting median survival of 3 to 7 months. This prognosis highlights the importance of maintaining quality of life in these patients. CONCLUSIONS Patients presenting with symptoms of ureteral obstruction due to advanced malignancy should be informed of the therapeutic options in the context of the poor prognosis. In the meantime research is needed to find methods of urinary diversion and pharmacological intervention for symptomatic relief without compromising quality of life in patients at the end of life.
Collapse
Affiliation(s)
- Erik Kouba
- Division of Urologic Surgery and Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | | | | |
Collapse
|
39
|
Lee JW, Park SC, Seo IY. The Clinical Characteristics of Malignant Ureteral Obstruction Secondary to Non-genitourinary Malignancy. Korean J Urol 2008. [DOI: 10.4111/kju.2008.49.1.49] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Jea Whan Lee
- Department of Urology, Wonkwang University School of Medicine, Institute of Wonkwang Medical Science, Iksan, Korea
| | - Seung Chol Park
- Department of Urology, Wonkwang University School of Medicine, Institute of Wonkwang Medical Science, Iksan, Korea
| | - Ill Young Seo
- Department of Urology, Wonkwang University School of Medicine, Institute of Wonkwang Medical Science, Iksan, Korea
| |
Collapse
|
40
|
Abstract
There has been a shift toward minimally invasive surgery in all surgical subspecialties in recent decades. Ureterorenoscopy represents an area in which there have been numerous advances that have resulted in excellent patient outcomes with low morbidity. Technologic advances such as miniaturization of ureteroscopes and improved video imaging have expanded the indications for ureteroscopy. The entire upper urinary tract can now be accessed for diagnosis and treatment of many common urologic conditions. Technologic research and development will continue to drive future improvements in the technique and applications for ureteroscopy.
Collapse
Affiliation(s)
- Darren T Beiko
- Department of Urology, Queen's University, Kingston General Hospital, 76 Stuart Street, Kingston, Ontario K7L 2V7, Canada.
| | | |
Collapse
|
41
|
Rolston KVI, Bodey GP, Safdar A. Polymicrobial Infection in Patients with Cancer: An Underappreciated and Underreported Entity. Clin Infect Dis 2007; 45:228-33. [PMID: 17578784 DOI: 10.1086/518873] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2007] [Accepted: 03/24/2007] [Indexed: 12/30/2022] Open
Abstract
Polymicrobial infections account for ~15% of infections in immunocompromised patients with cancer. However, limited information exists regarding the spectrum and microbiology of these infections, even in severely neutropenic patients. Most studies describe only monomicrobial bloodstream infections in detail, and information regarding polymicrobial infections and nonbacteremic infections is often incomplete or not provided at all. The current lack of well-established definitions for various infections in the immunocompromised host, including pneumonia, neutropenic enterocolitis, and polymicrobial infections, probably plays an important role in the paucity of published information. In this review, we briefly describe the limited information available regarding polymicrobial infections in patients with cancer and address the need for establishing consensus definitions for site-specific polymicrobial infections in neutropenic and nonneutropenic patients. We anticipate that, as factual information regarding such infections becomes available, a more comprehensive understanding of the true scope and impact of these infections will emerge, leading to appropriate modifications in the diagnostic work-up and in the therapeutic approaches used in treating these patients.
Collapse
Affiliation(s)
- Kenneth V I Rolston
- The University of Texas, M. D. Anderson Cancer Center, Houston, TX 77030, USA
| | | | | |
Collapse
|
42
|
Al-Kandari AM, Al-Shaiji TF, Shaaban H, Ibrahim HM, Elshebiny YH, Shokeir AA. Rapid Communication: Effects of Proximal and Distal Ends of Double-J Ureteral Stent Position on Postprocedural Symptoms and Quality of Life: A Randomized Clinical Trial. J Endourol 2007; 21:698-702. [PMID: 17705753 DOI: 10.1089/end.2007.9949] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To evaluate the effect of the position of the proximal and distal ends of Double-J ureteral stents on postprocedural flank pain, lower urinary-tract symptoms, and quality of life. PATIENTS AND METHODS The study included 120 patients who required unilateral Double-J ureteral stents for various indications. They were randomized into two equal groups. Group 1 had longer stents, with the proximal end in the upper calix and the distal end crossing the midline of the bladder. Group 2 had proper stent length with the proximal end in the pelvis and the lower end just beyond the vesicoureteral junction. Patients answered a questionnaire regarding flank pain, dysuria, and urgency as well as quality of life after 1 week of stenting. RESULTS Forty patients (67%) of group 1 and 43 (72%) of group 2 had mild flank pain, especially during urination. There was no significant difference in the degree of flank pain in the two groups. Moderate to severe dysuria was reported by 53 patients (88%) in group 1 and 11 patients (18%) in group 2 (P < 0.001). Moderate to severe urgency was reported by 48 patients (80%) in group 1 and in 14 (23%) in group 2 (P < 0.001). A worse quality of life was reported by patients in group 1, among whom moderate to severe bother was noted by 51 (85%) compared with group 2, in which moderate to severe bother was reported by only 13 patients (22%) (P < 0.001). CONCLUSION Ureteral stents are associated with flank pain and lower urinary-tract symptoms. The flank pain was not affected by the length of stent. Urgency and dysuria as well as a worse quality of life were significantly more common in the patients who had longer stents.
Collapse
Affiliation(s)
- Ahmed M Al-Kandari
- Urology Unit, Adan Hospital, Kuwait., Department of Surgery, Kuwait University, Kuwait
| | | | | | | | | | | |
Collapse
|
43
|
Abstract
OBJECTIVE To investigate the potential beneficial and adverse effects of routine ureteric stent placement after ureteroscopy. DESIGN Systematic review and meta-analysis of randomised controlled trials. DATA SOURCES Cochrane controlled trials register (2006 issue 2), Embase, and Medline (1966 to 31 March 2006), without language restrictions. Review methods We included all randomised controlled trials that reported various outcomes with or without stenting after ureteroscopy. Two reviewers independently extracted data and assessed quality. Meta-analyses used both fixed and random effects models with dichotomous data reported as relative risk and continuous data as a weighted mean difference with 95% confidence intervals. RESULTS Nine randomised controlled trials (reporting 831 participants) were identified. The incidence of lower urinary tract symptoms was significantly higher in participants who had a stent inserted (relative risk 2.25, 95% confidence interval 1.14 to 4.43, for dysuria; 2.00, 1.11 to 3.62, for frequency or urgency) after ureteroscopy. There was no significant difference in postoperative requirement for analgesia, urinary tract infections, stone free rate, and ureteric strictures in the two groups. Because of marked heterogeneity, formal pooling of data was not possible for some outcomes such as flank pain. A pooled analysis showed a reduced likelihood of unplanned medical visits or admission to hospital in the group with stents (0.53, 0.17 to 1.60), although this difference was not significant. None of the trials reported on health related quality of life. Cost reported in three randomised controlled trials favoured the group without stents. The overall quality of trials was poor and reporting of outcomes inconsistent. CONCLUSIONS Patients with stents after ureteroscopy have significantly higher morbidity in the form of irritative lower urinary symptoms with no influence on stone free rate, rate of urinary tract infection, requirement for analgesia, or long term ureteric stricture formation. Because of the marked heterogeneity and poor quality of reporting of the included trials, the place of stenting in the management of patients after uncomplicated ureteroscopy remains unclear.
Collapse
Affiliation(s)
- Ghulam Nabi
- Academic Urology Unit, Institute of Applied Health Sciences, College of Life Sciences and Medicine, University of Aberdeen, Health Sciences Building, Aberdeen AB25 2ZD.
| | | | | | | |
Collapse
|
44
|
Kim SD, Sung LH, Noh CH. The Usefulness of Ureteral Stenting for Acute Ureteral Obstruction in Pregnancy. Korean J Urol 2006. [DOI: 10.4111/kju.2006.47.11.1220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Sung Dae Kim
- Department of Urology, Sanggye Paik Hospital, College of Medicine, Inje University, Seoul, Korea
| | - Luck Hee Sung
- Department of Urology, Sanggye Paik Hospital, College of Medicine, Inje University, Seoul, Korea
| | - Choong Hee Noh
- Department of Urology, Sanggye Paik Hospital, College of Medicine, Inje University, Seoul, Korea
| |
Collapse
|