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Bosio A, Ferretti S, Alessandria E, Vitiello F, Vercelli E, Campobasso D, Micai L, Gozzo C, Bertello G, Guarino GG, Alice C, Bisconti A, Fop F, Gontero P. Patients undergoing double J substitution with a pigtail suture stent report a significant decrease of stent-related symptoms. Results from a prospective multicenter longitudinal trial. World J Urol 2024; 42:186. [PMID: 38517489 PMCID: PMC10959803 DOI: 10.1007/s00345-024-04879-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 02/10/2024] [Indexed: 03/24/2024] Open
Abstract
PURPOSE To compare stent-related symptoms (SRS) in patients with double J (DJ) undergoing substitution with a pigtail suture stent (PSS) after ureteroscopy (URS), through the Ureteral Stent Symptom Questionnaire (USSQ). MATERIALS AND METHODS Patients with DJ undergoing URS for stone treatment were enrolled in this prospective multicenter longitudinal study. The USSQ was submitted thrice: 2 weeks after DJ, 2 weeks after PSS and 4 weeks after PSS removal (baseline). PRIMARY ENDPOINT to compare Urinary Symptom Index Score and the rate of patients with pain 2 weeks after DJ and PSS. Secondary endpoints: to compare other USSQ scores and single answers 2 weeks after DJ and PSS, and DJ and PSS USSQ scores with baseline. RESULTS 93 patients were enrolled. 2 weeks Urinary Symptom Index Score (p < 0.001) and the percentage of patients complaining of pain (60.2% vs 88.2%, p < 0.001) were significantly in favour of PSS compared to DJ. 2 weeks scores were significantly improved with PSS compared to DJ: Pain Index (p < 0.001), VAS (p < 0.001), General Health Index (p < 0.001) and Work Performance Index (p < 0.001). All urinary symptoms were significantly decreased with PSS, including renal pain during micturition and pain interfering with life. Pain Index Score (p = 0.622) and VAS (p = 0.169) were comparable to baseline with PSS, while differed with DJ. CONCLUSIONS Patients undergoing DJ substitution with PSS after URS report a significant decrease of SRS. Urologists may consider positioning PSS after URS in pre-stented patients to reduce the impact of SRS.
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Affiliation(s)
- Andrea Bosio
- Department of Urology, AOU Città della Salute e della Scienza, Molinette University Hospital, Turin, Italy.
- Department of Surgical Sciences, University of Turin, Turin, Italy.
| | - Stefania Ferretti
- Department of Urology, AOU University Hospital, Parma, Italy
- Department of Urology, AOU University Hospital, Modena, Italy
| | - Eugenio Alessandria
- Department of Urology, AOU Città della Salute e della Scienza, Molinette University Hospital, Turin, Italy
| | - Federico Vitiello
- Department of Urology, AOU Città della Salute e della Scienza, Molinette University Hospital, Turin, Italy
| | - Eugenia Vercelli
- Department of Urology, AOU Città della Salute e della Scienza, Molinette University Hospital, Turin, Italy
| | | | - Luca Micai
- Department of Urology, AOU Città della Salute e della Scienza, Molinette University Hospital, Turin, Italy
| | - Claudia Gozzo
- Department of Urology, AOU Città della Salute e della Scienza, Molinette University Hospital, Turin, Italy
| | - Glauco Bertello
- Department of Urology, AOU Città della Salute e della Scienza, Molinette University Hospital, Turin, Italy
| | | | - Claudia Alice
- Department of Urology, AOU Città della Salute e della Scienza, Molinette University Hospital, Turin, Italy
| | - Alessandro Bisconti
- Department of Urology, AOU Città della Salute e della Scienza, Molinette University Hospital, Turin, Italy
| | - Fabrizio Fop
- Department of Nephrology, AOU Città della Salute e della Scienza, Molinette University Hospital, Turin, Italy
| | - Paolo Gontero
- Department of Urology, AOU Città della Salute e della Scienza, Molinette University Hospital, Turin, Italy
- Department of Surgical Sciences, University of Turin, Turin, Italy
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Zhang L, Wu Y, Chen Y, Qian S, Duan L, Huang Y, Ding J, Qi J, Cao J. Triangular prismatic JJ stent does not cause more discomfort than tubular ones: a randomised controlled trial comparison. World J Urol 2024; 42:67. [PMID: 38308763 DOI: 10.1007/s00345-023-04758-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 05/29/2023] [Indexed: 02/05/2024] Open
Abstract
OBJECTIVE To compare the stent-related symptoms (SRS) of three commonly used, readily accessible ureteric JJ stents after uncomplicated flexible ureteroscopic lithotripsy (FURL), in a prospective randomised controlled single-blind parallel-group study, in order to see whether structural difference might influence SRS. PATIENTS AND METHODS Patients undergoing FURL were randomised into three groups: the Cook Group received conventional 6 F Cook Universa Soft JJ stents as control, the Kang Yi Bo (KYB) Group received 6 F KYB anti-reflux JJ stents, and the Urovision Group received 7 F Urovision Visiostar ESWL JJ stents. The ureteric stent symptom questionnaire (USSQ) was administered at 1 week, 4 weeks (before stent removal), and 5 weeks (one week after stent removal as baseline evaluation) after stent insertion. Both raw and baseline-adjusted USSQ domain subscores at 1 week and 4 weeks were compared. RESULTS A total of 146 patients were included in the analysis. The KYB Group showed significantly lower P6&7 subscore yet higher urinary symptoms score 1 week and 4 weeks after stents insertion than both Cook and Urovision, whilst the Urovision Group achieved similar scores in most domains with Cook. CONCLUSIONS Although the KYB anti-reflux JJ stent might prevent vesicoureteral reflux, it induces significantly stronger urinary symptoms, both at 1 week or 4 weeks after stent insertion, with or without baseline correction. Despite the unique triangular prismatic shape, the Urovision Visiostar stent does not cause heavier urinary symptoms or pain compared to the conventional cylinder shape counterparts.
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Affiliation(s)
- Lin Zhang
- Department of Urology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University, School of Medicine, 1665 Kongjiang Rd. Yangpu District, Shanghai, 200092, China
| | - Yanyuan Wu
- Department of Urology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University, School of Medicine, 1665 Kongjiang Rd. Yangpu District, Shanghai, 200092, China
| | - Yuangui Chen
- Department of Urology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Subo Qian
- Department of Urology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University, School of Medicine, 1665 Kongjiang Rd. Yangpu District, Shanghai, 200092, China
| | - Liujian Duan
- Department of Urology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University, School of Medicine, 1665 Kongjiang Rd. Yangpu District, Shanghai, 200092, China
| | - Yunteng Huang
- Department of Urology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University, School of Medicine, 1665 Kongjiang Rd. Yangpu District, Shanghai, 200092, China
| | - Jie Ding
- Department of Urology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University, School of Medicine, 1665 Kongjiang Rd. Yangpu District, Shanghai, 200092, China.
| | - Jun Qi
- Department of Urology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University, School of Medicine, 1665 Kongjiang Rd. Yangpu District, Shanghai, 200092, China.
| | - Jianwei Cao
- Department of Urology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University, School of Medicine, 1665 Kongjiang Rd. Yangpu District, Shanghai, 200092, China.
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Zheng C, Wang J, Jian T, Lu J, Wang C, He L. Comparation of intraureteral stent and conventional stent at different stages: a systematic review with meta-analysis. Minerva Urol Nephrol 2023; 75:696-710. [PMID: 37350583 DOI: 10.23736/s2724-6051.23.05233-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
INTRODUCTION Stent related symptom (SRS) is the most common adverse effect of ureteral stenting. In recent years, many efforts have been made to develope modified ureteral stents to ameliorate SRS. It has been reported that intraureteral stents have the potential to improve the tail end adverse effect of the bladder and alleviate SRS. However, there still lack of evidence for the efficacy and the safety of clinically applying intraureteral stents. The aim of this work is to investigate the efficacy and safety of intraureteral stents. EVIDENCE ACQUISITION A systematic review was performed by using the PubMed, Web of Science, Medline, Embase, and Cochrane library. The studies published before February 2023 were included. The study selection was following the guideline from Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA). The searching strategy was: "Pigtail suture stent" OR "Intra-ureteric stent" OR "Suture Stent" OR "Intraureteral stent" AND "Ureteroscopy" OR "Urinary calculi" OR "Stent-related symptoms" OR "Lower urinary tract symptoms". The data from randomized clinical trials which meet the selection criteria were extracted. Revman 5.4 was employed to proceed the meta-analysis. EVIDENCE SYNTHESIS A total of six randomized clinical trials of intraureteral stents were included in this systematic review and meta-analysis. According to the different investigation time, the results could be divided into four stages: early-stage, middle-stage, late-stage, and long-term evaluation. Urinary symptoms, pain score, and general health were significantly improved in intraureteral stents group at middle stage. For late-stage, intraureteral stent achieved better outcomes in urinary symptoms index, VAS score, quality of life, general health, and pain score. However, for early-stage and long-term evaluation, there was no significant difference between two groups. CONCLUSIONS This systematic review and meta-analysis reveal that regardless of the stage of treatment, the efficacy and safety of intraureteral stent are no worse than that of conventional stent. During 7-14 days postoperation, which is the most commonly time for clinically using ureteral stent, most of the outcomes of intraureteral stent are better than those of conventional stent. Hence, it is confirmed that intraureteral stent is worth for more clinical study and application.
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Affiliation(s)
- Chao Zheng
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Changchun, China
| | - Jixue Wang
- Department of Urology, The First Hospital of Jilin University, Changchun, China
| | - Tengteng Jian
- Department of Urology, The First Hospital of Jilin University, Changchun, China
| | - Ji Lu
- Department of Urology, The First Hospital of Jilin University, Changchun, China
| | - Chunxi Wang
- Department of Urology, The First Hospital of Jilin University, Changchun, China
| | - Liang He
- Department of Urology, The First Hospital of Jilin University, Changchun, China -
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Bosio A, Alessandria E, Vitiello F, Vercelli E, Micai L, Gozzo C, Bisconti A, Gontero P. One hundred and one pigtail suture stents after ureteroscopy: focus on insertion, removal and complications. Minerva Urol Nephrol 2023; 75:555-558. [PMID: 37199531 DOI: 10.23736/s2724-6051.23.05162-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Affiliation(s)
- Andrea Bosio
- Department of Urology, Molinette University Hospital, Città della Salute e della Scienza, Turin, Italy -
| | - Eugenio Alessandria
- Department of Urology, Molinette University Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Federico Vitiello
- Department of Urology, Molinette University Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Eugenia Vercelli
- Department of Urology, Molinette University Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Luca Micai
- Department of Urology, Molinette University Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Claudia Gozzo
- Department of Urology, Molinette University Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Alessandro Bisconti
- Department of Urology, Molinette University Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Paolo Gontero
- Department of Urology, Molinette University Hospital, Città della Salute e della Scienza, Turin, Italy
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Isbir C, Çolak Ş, Taşan L, Taşkınlar H. Lower urinary tract effects of ureteral stent length and intravesical position. Pediatr Surg Int 2023; 39:258. [PMID: 37653165 DOI: 10.1007/s00383-023-05542-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/22/2023] [Indexed: 09/02/2023]
Abstract
PURPOSE Ureteral stents can cause lower urinary tract problems such as stent-related irritative symptoms and urinary tract infections. This study aimed to determine the lower urinary tract effects of ureteral stent length and intravesical position in children. METHODS Patients who underwent double-J stenting after urological procedures between January 2017 and January 2022 were included in the study. The patients were assessed in terms of age, irritative symptoms, urinary tract infections, and stent length. The intravesical position of the ureteral stents was grouped as cross-trigonal and ipsilateral. The distribution of irritative symptoms, frequency of urinary tract infections and stent length were analyzed according to intravesical location. RESULTS A total of 47 patients were included in the study. The median age was 5 years (range: 1-16). Cross-trigonal stent position was significantly associated with symptoms of urgency (p = 0.046), suprapubic pain (p = 0.002), and lower mean age (p = 0.004). Urinary tract infections were more frequent in patients whose placed stents were longer than recommended (p < 0.001) or were in cross-trigonal position (p = 0.043). CONCLUSION Our results suggest that stent-related irritative symptoms and urinary tract infections can be reduced in pediatric patients using a suitably sized ureteral stent and considering its intravesical position.
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Affiliation(s)
- Caner Isbir
- Faculty of Medicine, Department of Pediatric Surgery, Mersin University, Mersin, Turkey.
| | - Şener Çolak
- Faculty of Medicine, Department of Pediatric Surgery, Mersin University, Mersin, Turkey
| | - Lara Taşan
- Faculty of Medicine, Department of Pediatric Surgery, Mersin University, Mersin, Turkey
| | - Hakan Taşkınlar
- Faculty of Medicine, Department of Pediatric Surgery, Mersin University, Mersin, Turkey
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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.
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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.
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Tzou KY, Chen KC, Wu CC, Hu SW, Ho CH. The intraureteral placement of the stent's distal end decreases stent-related urinary symptoms: a prospective randomized clinical trial. World J Urol 2022; 40:2129-2134. [PMID: 35678894 DOI: 10.1007/s00345-022-04057-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 05/16/2022] [Indexed: 01/13/2023] Open
Abstract
PURPOSE We compared intraureteral stent placement (CIU-SP) with conventional stent placement (C-SP) regarding the stent-related symptoms. METHODS We randomized patients who underwent ureteroscopic lithotripsy into two groups. In CIU-SP group, a 16-cm or 18-cm stent was placed with its distal end above the ureterovesical junction. In C-SP group, a 22-cm or 24-cm stent was placed in a conventional method. Stent-related symptoms were assessed with the Ureteral Stent Symptom Questionnaire (USSQ) before the stent was removed, around 7 days after the operation. The primary outcome was the urinary symptoms; the secondary outcomes included postoperative pain and quality of life. RESULTS We randomized 103 patients, of which 91 (45 in CIU-SP and 46 in C-SP) entered the final analysis. Regarding the primary endpoint, the CIU group had less urinary symptoms; the mean USSQ urinary symptom score was significantly lower in the CIU-SP versus C-SP group (25.5 ± 6.3 vs 31.7 ± 5.9, P < 0.001). The CIU-SP group also had more favorable profiles in the following outcomes: lower USSQ body pain score (15.5 ± 5.3 vs 20.1 ± 5.2, P < 0.001), lower overall pain score (3.2 ± 2.2 vs 5.7 ± 2.3, P < 0.001), less number of pain site (1.0 ± 0.9 vs 1.7 ± 0.9, P = 0.001, lower USSQ general health score (10.4 ± 3.7 versus 13.9 ± 3.4, P < 0.001), and lower USSQ work performance score (5.2 ± 3.3 versus 6.7 ± 2.8, P = 0.033). In either group, there was no complication of Clavien-Dindo Class 2 or greater. CONCLUSION The complete intraureteral placement significantly decreases stent-related urinary symptoms and pain. It is also associated with better postoperative general health condition and is less likely to limit physical activity and work ability.
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Affiliation(s)
- Kai-Yi Tzou
- Department of Urology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.,Department of Urology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Kuan-Chou Chen
- Department of Urology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.,Department of Urology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chia-Chang Wu
- Department of Urology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.,Department of Urology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Su-Wei Hu
- Department of Urology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - 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.
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Kim KW, Park SH, Im G, Lee SB, Baba Y, Lee C, Choi YH, Kim HH. CFD study on vesicoureteral reflux in the urinary tract with double J stent. Comput Biol Med 2022; 145:105456. [DOI: 10.1016/j.compbiomed.2022.105456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 03/20/2022] [Accepted: 03/23/2022] [Indexed: 11/26/2022]
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Janssen P, Tailly T. New Stent Technologies. Urol Clin North Am 2021; 49:185-196. [PMID: 34776051 DOI: 10.1016/j.ucl.2021.08.004] [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: 10/20/2022]
Abstract
Ureteral stents are an indispensable part of any (endo-) urologic practice. Despite the widely demonstrated advantages of stents, they also carry a considerable risk of side effects and complications, such as urinary symptoms, pain, hematuria, decreased quality of life, stent-related infection, and encrustation. Multiple pathways in preventing or mitigating these side effects and complications and improving stent efficacy have been and are being investigated, including stent architecture and design, biomaterials, and coatings. This article provides an update on currently researched and available stents as well as future perspectives.
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Affiliation(s)
- Pieter Janssen
- Department of Urology, University Hospital Ghent, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - Thomas Tailly
- Department of Urology, University Hospital Ghent, Corneel Heymanslaan 10, 9000 Ghent, Belgium.
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Vogt B, Blanchet LH. 10-Year Experience with Reinforced Ureteral Stents for Malignant Ureteral Obstruction. Res Rep Urol 2021; 13:581-589. [PMID: 34430510 PMCID: PMC8374531 DOI: 10.2147/rru.s326274] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 07/31/2021] [Indexed: 12/25/2022] Open
Abstract
Introduction Malignant ureteral obstruction (MUO) hinders the management of malignant diseases. Indwelling stent is a common method to release renal obstruction, but stent failure with obstruction is frequent. The studies conclude that stent obstruction divides survival by 2 or even 4. We carried out the present study in order to evaluate drainage efficiency and overall survival by using stents with distinctive degrees of stiffness. Materials and Methods We performed an analysis of 156 patients with MUO drainage at a single institution from June 2009 to June 2019. Results Of the 156 patients, 128 (82.1%) died with a mean survival time of 15.3 ± 14.4 months after the first ureteral stent procedure (USP). In order to study stent failure and overall survival, the patients were divided into 3 groups. Group 1 with patients died soon after only one USP (n=37). Group 2 with patients had more than one USP and no obstruction (n=41). Patients in Group 3 had more than one USP and at least one stent obstruction (n=62). During the study period, 556 USPs were analysed separately. The stent failure with obstruction occurred in 23.0% (128/556) of USP at a mean of 4.4 ± 3.6 months. In case of stent failure, a progressive choice of stents was shaped to overcome each failure by focusing on the criterion of increasingly stiff stents. Patients in Group 1 died soon at mean of 4.9 ± 4.8 months. The mean survival time of patients in Groups 2 and 3 were, respectively, 19.4 ± 11.2 and 21.5 ± 16.3 months (P = 0.19). Conclusion MUO is a serious disease but this study is the first to prevent survival rate from falling by choosing the stent stiffness suitable for the patient. The active detection of stent failure has been shown to be essential for preserving survival.
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Affiliation(s)
- Benoît Vogt
- Department of Urology, Polyclinique de Blois, La Chaussée Saint-Victor, 41260, France
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Vogt B, Chokri I. Characterization of Sonic Hedgehog/Gli1 Signal Expression in Human Ureter Either Un-Stented or Fitted with Double-Pigtail Stent or a Thread. Res Rep Urol 2021; 13:529-533. [PMID: 34345615 PMCID: PMC8324979 DOI: 10.2147/rru.s324192] [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] [Received: 06/10/2021] [Accepted: 07/21/2021] [Indexed: 12/02/2022] Open
Abstract
Introduction The Sonic Hedgehog/Gli1 signal is involved in smooth muscle activity. An experiment showed that the double-pigtail stent caused ureteral inflammation and decreased Gli1 expression in smooth muscle cells. The innovative pigtail-suture stent (JFil® or MiniJFil®) with a thin 0.3F suture thread significantly decreased stent-related symptoms. Fortuitously, a dilation of the ureter containing the sutures was discovered, and a previous study confirmed that the sutures caused less ureteral inflammation than the double-pigtail stent. However, the mechanisms involved in the ureteral dilation are still unknown. In this study, we assessed ureteral Gli1 expression in the human ureter when it was un-stunted or when fitted with a double-pigtail stent or a suture thread. Material and Methods After consent and inclusion of patients in the protocol, nine segments of ureters were collected during cystectomy procedures for bladder cancers. There was no selection or exclusion, and patients with large tumors were included. Gli1 expression was assessed on the histological section to control the reflection of an active hedgehog signal. The expression of Gli1 in smooth muscle cells of the stented ureter was subjectively compared to un-stented ureter. Results A decrease in the intensity of Gli1 expression of smooth muscle cells was observed in all cases of ureter fitted with a double-pigtail stent. For the un-stunted ureters and the ureters fitted with the thin 0.3F suture thread, Gli1 staining of smooth muscle cells was heterogeneous, and the small number of cases did not allow us to conclude. Conclusion Apart from the cases of ureters fitted with the double-pigtail stent, Gli1 expression of smooth muscle was heterogeneous. The Shh/Gli1 pathway may not be involved in ureteral dilation by the thread. A broader exploration of molecular mechanisms could make it possible to obtain the mechanisms involved in the dilation of the ureter by the thread.
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Affiliation(s)
- Benoît Vogt
- Department of Urology, Polyclinique de Blois, La Chaussée Saint-Victor, 41260, France
| | - Ilham Chokri
- Laboratory of Anatomocytopathology, Laboratoire Léonard de Vinci, Chambray-lès-Tours, 37170, France
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12
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Taguchi K. Editorial Comment to Impact of differential ureteral stent diameters on clinical outcomes after ureteroscopy intracorporeal lithotripsy: A systematic review and meta-analysis. Int J Urol 2021; 28:1000. [PMID: 34296477 DOI: 10.1111/iju.14653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Kazumi Taguchi
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
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Bosio A, Alessandria E, Agosti S, Vitiello F, Vercelli E, Bisconti A, Piana P, Fop F, Gontero P. Pigtail Suture Stents Significantly Reduce Stent-related Symptoms Compared to Conventional Double J Stents: A Prospective Randomized Trial. EUR UROL SUPPL 2021; 29:1-9. [PMID: 34337527 PMCID: PMC8317849 DOI: 10.1016/j.euros.2021.03.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Double J (DJ) ureteral stents are commonly inserted after ureteroscopy (URS) procedures for stone treatment. However, stent-related symptoms are still a major issue. OBJECTIVE To determine whether a commercially available pigtail suture stent (PSS) can reduce stent-related symptoms compared to a conventional DJ stent after uncomplicated URS. DESIGN SETTING AND PARTICIPANTS We designed a randomized, single-blind, parallel-group trial from January to November 2020. The inclusion criteria were stone-free URS without intraprocedural complications. Patients with distal ureteral stones were excluded. INTERVENTION Insertion of a PSS or DJ stent after URS. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The primary endpoint was the Urinary Symptom Index score on the Ureteral Stent Symptoms Questionnaire (USSQ) 2 wk after URS. Secondary endpoints were USSQ domain scores and responses to individual USSQ questions at 2 d and 2 wk after surgery. RESULTS AND LIMITATIONS A total of 78 patients were randomized and treated according to protocol. The Urinary Symptom Index score (p = 0.004), overall Visual Analogue Scale (VAS) score (p = 0.022), and the percentage of patients complaining of pain (63.9% vs 86.1%, p = 0.029) were significantly in favor of PSS at both 2 d and 2 wk after URS. At 2 d, the VAS score among patients with pain (p = 0.025) and the General Health Index score (p = 0.036) were significantly better in the PSS group. No severe complications occurred in either group. Study limitations are the exclusion of patients with distal ureteral stones and the limited sample size. CONCLUSIONS PSS significantly reduced stent-related symptoms after URS, in particular urinary symptoms and pain, compared to conventional DJ stents, and showed a good safety profile. PATIENT SUMMARY Stents are hollow tubes placed in the passage between the kidney and the bladder (ureter). The standard stent has two coiled ends (double J stent) to keep it in place in both the kidney and the bladder. We tested a commercial stent with two strings at the bladder end (pigtail suture stent) after procedures to remove stones from the upper urinary tract and found that it caused less stent-related symptoms compared to a double J stent.
This trial is registered at Clinicaltrials.gov as NCT03344120.
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Affiliation(s)
- Andrea Bosio
- Department of Urology, Città della Salute e della Scienza, Molinette University Hospital, Turin, Italy
| | - Eugenio Alessandria
- Department of Urology, Città della Salute e della Scienza, Molinette University Hospital, Turin, Italy
| | - Simone Agosti
- Department of Urology, Città della Salute e della Scienza, Molinette University Hospital, Turin, Italy
| | - Federico Vitiello
- Department of Urology, Città della Salute e della Scienza, Molinette University Hospital, Turin, Italy
| | - Eugenia Vercelli
- Department of Urology, Città della Salute e della Scienza, Molinette University Hospital, Turin, Italy
| | - Alessandro Bisconti
- Department of Urology, Città della Salute e della Scienza, Molinette University Hospital, Turin, Italy
| | - Paolo Piana
- Department of Urology, Città della Salute e della Scienza, Molinette University Hospital, Turin, Italy
| | - Fabrizio Fop
- Department of Nephrology, Dialysis and Renal Transplantation, Città della Salute e della Scienza, Molinette University Hospital, Turin, Italy
| | - Paolo Gontero
- Department of Urology, Città della Salute e della Scienza, Molinette University Hospital, Turin, Italy
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