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Lim EJ, Choo ZW, Mangat R, Durai P, Biligere S, Tan Y, Yeung Marcus LH, Seet Li Ting NA, Heng CT, Ferreti S, Gauhar V. Outcomes of a non-randomised audit of single pigtail suture stents in urolithiasis management of Asian patients in Singapore. Asian J Urol 2024; 11:324-330. [PMID: 38680586 PMCID: PMC11053326 DOI: 10.1016/j.ajur.2022.03.013] [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: 08/22/2021] [Accepted: 03/18/2022] [Indexed: 11/16/2022] Open
Abstract
Objective Double-J (DJ) ureteric stents are commonly placed perioperatively for semirigid or flexible ureteroscopic renal surgery. It is believed that lesser stent material within the bladder mitigates stent-related symptoms. This study aimed to evaluate the J-Fil ureteral stent, a single pigtail suture stent compared with conventional DJ stent in relation to stent symptoms in an Asian population undergoing ureterorenal intervention. Methods Based on internal audit committee recommendation approval, the records of 50 patients retrieved, available data of 41 patients who were prospectively enrolled into two groups (Group 1 [J-Fil stent group], n=21 and Group 2 [DJ stent group], n=20) between August 2020 to January 2021, were analysed. Parameters compared were nature of procedure, stone location and size, ease of deployment or removal, and complications. A modified universal stent symptom questionnaire was used to assess morbidity of stent symptoms within 48 h of insertion and at removal. Results Both groups had similar median age, distribution in male to female ratio, and stone size. The overall median universal stent symptom questionnaire score at insertion was similar for bladder pain, flank or loin pain, and quality of life between Group 1 and 2; however, at removal Group 1 fared significantly better than Group 2, especially for flank or loin pain and pain at voiding. Both groups had similar ease in insertion with no hospital readmissions. Conclusion Our audit favoured the single pigtail suture stent in Asian ureters in mitigating stent-related issues. It showed a good safety profile with easy deployment and removal. It promises a new standard in stenting.
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Affiliation(s)
- Ee Jean Lim
- Urology Department, Singapore General Hospital, Singapore
| | - Zhen Wei Choo
- Urology Department, Tan Tock Seng Hospital, Singapore
| | - Reshma Mangat
- Urology Department, Ng Teng Fong Hospital, Singapore
| | - Pradeep Durai
- Urology Department, Ng Teng Fong Hospital, Singapore
| | | | - Yiquan Tan
- Urology Department, Ng Teng Fong Hospital, Singapore
| | | | | | | | - Stefania Ferreti
- Urology Department, Azienda Ospedaliera-Uiversitaria (Hospital and University of Parma), Parma, Italy
| | - Vineet Gauhar
- Urology Department, Ng Teng Fong Hospital, Singapore
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Yoon JH, Park S, Park S, Moon KH, Cheon SH, Kwon T. Renal function is associated with prognosis in stent-change therapy for malignant ureteral obstruction. Investig Clin Urol 2018; 59:376-382. [PMID: 30402570 PMCID: PMC6215786 DOI: 10.4111/icu.2018.59.6.376] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Accepted: 10/15/2018] [Indexed: 11/18/2022] Open
Abstract
Purpose The authors performed this study to investigate the risk factors for predicting stent failure and to evaluate its impact on prognosis. Materials and Methods Between January 2002 and March 2017, we retrospectively reviewed 117 consecutive patients who underwent retrograde ureteral stenting and exchanging at least once every 3 months for malignant ureteral obstruction. The patients were classified according to their pre-stenting chronic kidney disease (CKD) stage. The factors affecting stent failure were analyzed using a logistic regression model. Overall survival (OS) was estimated, and the prognostic significance of each variable was estimated using Cox proportional-hazards regression modeling. Results Before stenting, 91 patients were CKD stages 1–3 and 26 patients were CKD stages 4–5. These two groups differed significantly only in pre-stenting estimated glomerular filtration rate (eGFR), bilateral obstruction, and pre-stenting pyuria. Among the 117 patients, stent failure occurred in 30 patients (25.6%), and there were no differences between the groups. Pre-stenting pyuria and post-stenting complications were significant predictors of stent failure. There were 79 deaths in total, including 56 in the CKD stages 1–3 group and 23 in the CKD stages 4–5 group. In the multivariate analysis predicting patient OS, pre-stenting eGFR and post-stenting disease progression were significant factors. Conclusions Internal ureteral stenting was effective for maintaining renal function in malignant ureteral obstruction. However, it did not restore renal function, which is related to the prognosis of the patients. Therefore, to improve patients' renal function and prognosis, patients who require stenting must be quickly recognized and treated.
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Affiliation(s)
- Ji Hyung Yoon
- Department of Urology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Sejun Park
- Department of Urology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Sungchan Park
- Department of Urology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Kyung Hyun Moon
- Department of Urology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Sang Hyeon Cheon
- Department of Urology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Taekmin Kwon
- Department of Urology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
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Kim HW, Park CJ, Seo S, Park Y, Lee JZ, Shin DG, Moon HS, Lee JH. Evaluation of a Polymeric Flap Valve-Attached Ureteral Stent for Preventing Vesicoureteral Reflux in Elevated Intravesical Pressure Conditions: A Pilot Study Using a Porcine Model. J Endourol 2016; 30:428-32. [DOI: 10.1089/end.2015.0711] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Hyeon Woo Kim
- Department of Medical System Engineering, Gwangju Institute of Science and Technology (GIST), Gwangju, South Korea
| | - Chang-Ju Park
- Department of Medical System Engineering, Gwangju Institute of Science and Technology (GIST), Gwangju, South Korea
| | - Seungwan Seo
- School of Mechatronics, Gwangju Institute of Science and Technology (GIST), Gwangju, South Korea
| | - Yangkyu Park
- Department of Medical System Engineering, Gwangju Institute of Science and Technology (GIST), Gwangju, South Korea
| | - Jeong Zoo Lee
- Department of Urology, Pusan National University Hospital, Busan, South Korea
| | - Dong Gil Shin
- Department of Urology, Pusan National University Hospital, Busan, South Korea
| | - Hong Sang Moon
- Department of Urology, Hanyang University Guri Hospital, Guri, South Korea
| | - Jong-Hyun Lee
- Department of Medical System Engineering, Gwangju Institute of Science and Technology (GIST), Gwangju, South Korea
- School of Mechatronics, Gwangju Institute of Science and Technology (GIST), Gwangju, South Korea
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A Randomized Controlled Trial to Compare the Safety and Efficacy of Tadalafil and Tamsulosin in Relieving Double J Stent Related Symptoms. Adv Urol 2015; 2015:592175. [PMID: 26788054 PMCID: PMC4691600 DOI: 10.1155/2015/592175] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 11/17/2015] [Accepted: 11/25/2015] [Indexed: 11/18/2022] Open
Abstract
Objectives. To evaluate the safety and efficacy of Tadalafil and Tamsulosin in treating Double J stent related symptoms. Methods. In a prospective study, 161 patients with DJ related symptoms were randomized into 3 groups: Group A patients (54), Group B patients (53), and Group C patients (54). They were given Tadalafil, Tamsulosin, and placebo, respectively, at 1st week till removal of DJ stent at 3rd week. All patients completed Ureteral Stent Symptom Questionnaire (USSQ) at 1st week and at 3rd week. The statistical significant difference among groups was determined by the t-test, Kruskal-Wallis test and multivariate analysis were used to assess association of the variables within the three groups, and the level of significance was set at P < 0.05. Results. Tadalafil and Tamsulosin were comparable in relieving urinary symptoms, general health, and work performance (OR = 0.65, 1.8, and 0.92). But Tadalafil was more effective in relieving body pain, sexual problems, and additional problems than Tamsulosin (OR = 5.95, 19.25, and 2.69) and was statistically significant as P < 0.05. Conclusion. Tadalafil was as effective as Tamsulosin in relieving urinary symptom but more effective in relieving sexual symptoms and body pain.
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Sakamoto S. Editorial Comment to Stenting for malignant ureteral obstruction: Tandem, metal or metal-mesh stents. Int J Urol 2015; 22:637. [DOI: 10.1111/iju.12835] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Shinichi Sakamoto
- Department of Urology; Chiba University Graduate School of Medicine; Chiba Japan
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Liatsikos E, Kallidonis P, Stolzenburg JU, Karnabatidis D. Ureteral stents: past, present and future. Expert Rev Med Devices 2014; 6:313-24. [DOI: 10.1586/erd.09.5] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Dellis AE, Keeley FX, Manolas V, Skolarikos AA. Role of α-blockers in the treatment of stent-related symptoms: a prospective randomized control study. Urology 2013; 83:56-61. [PMID: 24210570 DOI: 10.1016/j.urology.2013.08.067] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Revised: 07/29/2013] [Accepted: 08/01/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To properly use the Ureteric Symptom Score Questionnaire (USSQ) to evaluate, in a randomized control study, the effect of 2 different α-blockers in improving symptoms and quality of life in patients with indwelling ureteral stents. METHODS After institutional review board approval, 150 consecutive patients with a double-J ureteral stent inserted after extracorporeal shockwave lithotripsy (ESWL) or ureteroscopic stone treatment were randomly assigned to receive tamsulosin 0.4 mg, alfuzosin 10 mg, or placebo. The validated USSQ was completed 1 and 4 weeks after stent insertion and 4 weeks after stent removal. The Kruskal-Wallis test for independent samples for non-normally distributed ordinal variables, chi-square to compare proportions or differences, and 1-way analysis of variance (ANOVA) for independent samples to compare for differences in case of continuous variables were used for statistical analysis of the results. RESULTS Patients receiving α-blockers expressed an overall statistically significant lower urinary (P <.001), pain (P <.001 with stent in situ), and general health index (P <.002) scores. Sexual life and quality of life were also positively influenced. Quality of work was not influenced. No patients had to discontinue medication because of side effects or underwent stent removal before the due date. There was no difference in various outcomes between the 2 α-blockers. CONCLUSION Stent-related morbidity is a reality in the majority of patients. Simple medication, such as α-blockers, reduce stent-related symptoms and the negative impact on quality of life. It seems that stent-related symptom improvement is independent to the type of α-blocker.
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Affiliation(s)
- Athanasios E Dellis
- Second Department of Surgery, University of Athens, Aretaieion Hospital, Chalandri, Athens, Greece.
| | - Francis X Keeley
- Bristol Urological Institute, Southmead Hospital, North Bristol NHS Trust, United Kingdom
| | - Victor Manolas
- First Department of Urology, University General Hospital of Athens, Laiko Hospital, Athens, Greece
| | - Andreas A Skolarikos
- Second Department of Urology, University of Athens, Sismanoglio Hospital, Northern Athens, Greece
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Zhang MQ, Zou T, Huang YC, Shang YF, Yang GG, Wang WZ, Zhou JM, Wang L, Chen F, Xie H. Braided thin-walled biodegradable ureteral stent: preliminary evaluation in a canine model. Int J Urol 2013; 21:401-7. [PMID: 24147536 DOI: 10.1111/iju.12297] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Accepted: 09/10/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To evaluate a novel designed degradable ureteral stent. METHODS A total of 24 male Beagles, each with bilateral stents implanted (a biodegradable ureteral 4.5-Fr stent and a standard 4-Fr biostable stent) were divided into four groups. Intravenous pyelography, B-mode ultrasonography, and blood and urine tests were carried out before the procedure (0 weeks), and at 1-, 2-, 3- and 4-week intervals. Meanwhile, the mechanical characteristics of stents were tested, and scanning electron microscopy images of the biodegradable braided stents were obtained at different time-points postoperatively. In addition, histopathological changes were compared between the two different stents. RESULTS All biodegradable braided stents began degrading at 1 week, and had completely degraded by 4 weeks. Hydronephrosis was equivalent during the first 2 weeks, but less with the biodegradable stents than with the control biostable stents at 3 and 4 weeks. Preoperative and postoperative blood and urine results were similar. The mechanical properties of the biodegradable stents were better than conventional biostable stents. Scanning electron microscopy images obtained at different weekly intervals showed that stents degraded in a predictable fashion. Histological testing of the urinary tract showed that the stent-related tissue reactivity of the two different stents were similar. CONCLUSIONS Our novel braided thin-walled biodegradable stents provide temporary renal drainage as good as commercially available biostable stents. They also have good biocompatibility and physical characteristics. Therefore, they might have clinical application.
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Affiliation(s)
- Ming Qing Zhang
- Department of Urology, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
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Abdallah MM, Selim M, Abdelbakey T. Thermo-expandable metallic urethral stents for managing recurrent bulbar urethral strictures: To use or not? Arab J Urol 2013; 11:85-90. [PMID: 26579252 PMCID: PMC4442926 DOI: 10.1016/j.aju.2012.12.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2012] [Revised: 12/17/2012] [Accepted: 12/18/2012] [Indexed: 11/25/2022] Open
Abstract
Objectives To assess the role of temporary thermally expandable urethral stents in maintaining urethral patency in patients with a recurrent bulbar urethral stricture. Patients and methods Twenty-three men with a recurrent bulbar urethral stricture after several attempts at direct visual internal urethrotomy (DVIU) and/or failed urethroplasty were managed with a thermally expandable, biocompatible nickel–titanium alloy urethral stent (Memokath® MK044, Pnn Medical, Kvistgaard, Denmark). The stents were applied by a special mounting device via a rigid urethroscope after DVIU. All patients were followed using plain radiography, uroflowmetry and urine analysis every 3 months for 1 year, and then every 6 months. Results The mean (SD) age of the patients was 55.4 (7.3) years and the mean (SD) stricture length was 3.6 (1.2) cm. All patients tolerated the stent, with minimal discomfort in some patients. Four patients (17%) had urinary tract infections, three (13%) had haematuria, three (13%) had obstructed stents due to encrustation, in five (22%) the stent migrated, and two patients had no delayed complications. The mean (SD) follow-up was 17.4 (6.1) months. Conclusion Urethral stenting with nickel–titanium alloy thermally expandable stents can be an acceptable temporary procedure for patients with recurrent bulbar urethral strictures who are unfit for or who refuse urethroplasty. However, they have limitations; the search for an ideal urethral stent continues.
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Affiliation(s)
| | - Mohamed Selim
- Urology Department, Menoufiya University Hospital, Menoufiya, Egypt
| | - Tarek Abdelbakey
- Urology Department, Menoufiya University Hospital, Menoufiya, Egypt
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Kim JH, Song K, Jo MK, Park JW. Palliative care of malignant ureteral obstruction with polytetrafluoroethylene membrane-covered self-expandable metallic stents: initial experience. Korean J Urol 2012; 53:625-31. [PMID: 23061000 PMCID: PMC3460005 DOI: 10.4111/kju.2012.53.9.625] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Accepted: 06/21/2012] [Indexed: 11/18/2022] Open
Abstract
Purpose We assessed the efficacy and safety of insertion of a polytetrafluoroethylene membrane-covered self-expandable metallic stent (UVENTA stent) for palliation of malignant ureteral obstruction on the basis of our early results. Materials and Methods Eighteen patients underwent UVENTA stent insertion for extrinsic malignant ureteral obstructions of 20 ureters. The UVENTA stents were deployed retrogradely under cystoscopy and fluoroscopy. Candidates for the procedure had preexisting double-J stents that were nonfunctional or caused excessive bladder irritation. We recorded the success and patency rate in addition to any complications associated with the procedure. Results The mean length of obstruction was 10.6 cm (range, 2 to 20 cm). Two ureters were obstructed in the upper ureter, 9 in the lower ureter, and 9 in multiple levels of ureter. Simultaneous balloon dilation was performed in 12 ureters. UVENTA stents were successfully inserted in all patients. No obstruction of the UVENTA stents occurred during the mean follow-up period of 7.3 months (patency rate 100%), but de novo ureteral obstruction developed in 4 ureters. There were no instances of stone formation, hyperplastic reaction, encrustation, or migration. Abnormally elevated serum creatinine decreased to normal levels and hydronephrosis gradually resolved during the 4 weeks after UVENTA insertion. No significant complications developed except for transient and self-limiting hematuria and mild lower abdominal pain. Conclusions UVENTA stents may relieve malignant ureteral obstruction safely and easily. Long-term follow-up is necessary to assess the role of this stent in the treatment of malignant ureteral obstruction.
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Affiliation(s)
- Jae Han Kim
- Department of Urology, Korea Cancer Center Hospital, Seoul, Korea
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Abstract
Objectives: To review the evidence-based literature on the causes, characteristics, and options to manage double J stent-related symptoms. Methods: We performed a Medline database assessment on papers that investigated the prevalence, mechanisms, risk factors, bothersome and management of double-J stent-related symptoms. Articles in English were reviewed and summarized. Results: Stent-related symptoms have a high prevalence and may affect over 80% of patients. They include irritative voiding symptoms including frequency, urgency, dysuria, incomplete emptying; flank and suprapubic pain; incontinence, and hematuria. Assessment tools are important to determine their intensity and allow for comparisons between different points in the timeline. The Urinary Stent Symptom Questionnaire (USSQ) is the most proper tool used for this purpose. Management should be focused on the prevention and management of symptoms. In this sense, research has focused on new materials and stent designs that would be more compatible to the physiologic properties of the urinary tract and medications that can ameliorate the sensitivity and motor response of the bladder. Conclusions: Stent-related symptoms are very common in the Urological clinical setting. It is of major importance for the urologist to understand their physiopathology and to be familiar with ways to avoid or manage them.
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Affiliation(s)
- Ricardo Miyaoka
- Department of Urologic Surgery, University of Minnesota, Minneapolis, MN, USA
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Affiliation(s)
- Daniel Yachia
- Department of Urology. Hillel Yaffe Medical Center, Hadera - Israel, Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa - Israel. E-mail:
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Lumiaho J, Heino A, Aaltomaa S, Välimaa T, Talja M. A short biodegradable helical spiral ureteric stent provides better antireflux and drainage properties than a double-J stent. ACTA ACUST UNITED AC 2011; 45:129-33. [DOI: 10.3109/00365599.2010.544673] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Juha Lumiaho
- Department of Surgery, Kuopio University Hospital, Kuopio, Finland
| | - Antero Heino
- Department of Surgery, Kuopio University Hospital, Kuopio, Finland
| | - Sirpa Aaltomaa
- Department of Surgery, Kuopio University Hospital, Kuopio, Finland
| | - Tero Välimaa
- Institute of Biomaterials, Tampere University of Technology, Tampere, Finland
| | - Martti Talja
- Department of Surgery, Päijät-Häme Central Hospital, Lahti, Finland
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Li G, Wang ZX, Fu WJ, Hong BF, Wang XX, Cao L, Xu FQ, Song Q, Cui FZ, Zhang X. Introduction to biodegradable polylactic acid ureteral stent application for treatment of ureteral war injury. BJU Int 2011; 108:901-6. [PMID: 21223480 DOI: 10.1111/j.1464-410x.2010.09992.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE • To study the operability and effectiveness of a biodegradable ureteral stent for clinical treatment of ureteral war injury using a canine model. MATERIALS AND METHODS • A device was designed and employed to generate firearm fragment wounds in unilateral ureters (on randomly chosen sides) of nine beagles (Group A). The wounded ureters were then debrided and sutured. • Intravenous pyelography (IVP) and radioactive renography were performed 40, 80 and 120 days postoperatively. In Group B, firearm fragment wounds were made to the bilateral ureters in nine beagles. A polylactic acid stent was placed unilaterally (on a randomly chosen side) whereas the ureter on the other side was debrided and sutured without stenting. • Both IVP and radioactive renography were performed 40, 80 and 120 days postoperatively. The operability and effectiveness of the biodegradable ureteral stent were studied thereafter. RESULTS • In Group A, hydronephrosis and hydroureter occurred and worsened postoperatively on the wounded sides in all nine beagles. The ratio of the renal partial concentration indices (RPCI) between the kidneys (unwounded side : wounded side) increased. • The ratio of the kidney washout half-time between the kidneys (unwounded side : wounded side) decreased. In Group B, neither hydronephrosis nor hydroureter was found postoperatively in the stented ureters but both occurred in the unstented ureters in all nine beagles. • The ratio of RPCI between kidneys (stented side : unstented side) increased whereas the kidney washout half-time ratio between the stented and unstented sides decreased. Differences were significant. CONCLUSION • In Group A, the new canine model for firearm fragment wounds was tested and proved to be operable and effective. In Group B, hydronephrosis and hydroureter were effectively prevented in ureters by biodegradable stent placement compared with the non-stented ureters where hydronephrosis and hydroureter occurred. The renal concentration capacity was effectively protected and the half-time of kidney washout was shortened.
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Affiliation(s)
- Gang Li
- Department of Urology, The General Hospital of PLA, Beijing, China
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Wang HJ, Lee TY, Luo HL, Chen CH, Shen YC, Chuang YC, Chiang PH. Application of resonance metallic stents for ureteral obstruction. BJU Int 2010; 108:428-32. [DOI: 10.1111/j.1464-410x.2010.09842.x] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Sountoulides P, Pardalidis N, Sofikitis N. Endourologic management of malignant ureteral obstruction: indications, results, and quality-of-life issues. J Endourol 2010; 24:129-42. [PMID: 19954354 DOI: 10.1089/end.2009.0157] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Obstruction of the upper urinary tract is a problem commonly faced by practicing urologists. The constant evolution in endourology has effectively facilitated minimally invasive management of upper-tract obstruction. In a case in which malignancy is the cause of obstruction, however, the situation significantly changes. Questions arise regarding the need for relieving the obstruction, the means to accomplish this, and the benefits and drawbacks of each technique regarding both their efficacy and their impact on the patients well-being and the crucial issue of quality of life in the face of malignancy.
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Liatsikos EN, Karnabatidis D, Katsanos K, Kallidonis P, Katsakiori P, Kagadis GC, Christeas N, Papathanassiou Z, Perimenis P, Siablis D. Ureteral Metal Stents: 10-Year Experience With Malignant Ureteral Obstruction Treatment. J Urol 2009; 182:2613-7. [DOI: 10.1016/j.juro.2009.08.040] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2009] [Indexed: 11/26/2022]
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Current world literature. Curr Opin Obstet Gynecol 2009; 21:450-5. [PMID: 19724169 DOI: 10.1097/gco.0b013e3283317d6c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Skolarikos AA, Papatsoris AG, Mitsogiannis IC, Chatzidarellis L, Liakouras C, Deliveliotis C. Current status of ureteroscopic treatment for urolithiasis. Int J Urol 2009; 16:713-7. [PMID: 19674169 DOI: 10.1111/j.1442-2042.2009.02364.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Intracorporeal treatment of urolithiasis is characterized by continuous technological evolution. In this review we present updated data upon the use of ureteroscopy for the management of urolithiasis. Novel digital flexible ureteroscopes are used in clinical practice. Ureteroscopic working tools are revolutionized resulting in safer and more efficient procedures. Special categories of stone patients such as pregnant women, children and patients on anticoagulation medication can now undergo uneventful ureteroscopy. Routine insertion of stents and access sheaths as well as bilateral ureteroscopy is still a controversial issue. Future perspectives include smaller and better instruments to visualize and treat a stone, while robotic ureteroscopy is becoming a fascinating reality.
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Affiliation(s)
- Andreas A Skolarikos
- Athens Medical School, 2nd Department of Urology, Sismanoglio Hospital, Athens, Greece.
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Marković Z, Masulović D, Markovic B, Anojcić P, Mladenović A. [How to prevent tissue overgrowth and incrustation of metal stents in the urinary tract in patients with pelvic malignancy] b ]. ACTA CHIRURGICA IUGOSLAVICA 2009; 56:171-173. [PMID: 20420016 DOI: 10.2298/aci0904171m] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
At the current level of stent application in urology each irreversible urostasis contraindicated for surgical therapy implies consideration of indications for metal stent insertion. Stent incrustation which leads directly into a new uroobstruction is a characteristic complication of this method. Available experience in different uroobstructive conditions has shown that very different clinical aspects of stent usage may directly determine the possibility of their incrustation. Stent incrustation may occur in the early postprocedural course or several months later. After that, prevention of stent incrustation starts with postprocedural evaluation, selection of the stent type, and it is subsequently continued by insertion technique and lasts practically permanently after the insertion (infection control, promotion of diuresis and maintenance of normal urodynamics). Authors present own experianse in clinical aplication of metal stents in uroradiology strictures for period of last 15 years.
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Affiliation(s)
- Z Marković
- Medicinski fakultet Univerziteta u Beogradu
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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.
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Affiliation(s)
- Ricardo A Natalin
- Department of Urology, Columbia University Medical Center, New York, NY, USA
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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.
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