Ureteral stent retrieval using the crochet hook technique in females

Pregnancy Outcomes in a Cohort of Patients Who Underwent Double-J Ureteric Stenting-A Single Center Experience

Background and Objectives: Minimally invasive procedures, such as double-J ureteric stenting, could be a promising therapeutic alternative to conservative management of obstructive urinary tract pathology. We aimed to evaluate the safety and effectiveness of double-J ureteric stenting in pregnant women with ureterohydronephrosis or urolithiasis, along with their infectious complications, and to assess the pregnancy outcomes of this cohort of patients in comparison with a control group. Materials and Methods: This observational retrospective study included 52 pregnant patients who underwent double-J ureteric stenting for urologic disorders in the Urology Department of ‘C.I. Parhon’ University Hospital, and who were followed up at a tertiary maternity hospital- ‘Cuza-Voda’, Iasi, Romania. The control group (63 patients) was randomly selected from the patient’s cohort who gave birth in the same time frame at the maternity hospital, without urinary pathology. Clinical, sonographic, and laboratory variables were examined. Descriptive statistics, non-parametric tests, and a one-to-one propensity score-matched analysis were used to analyze our data. Results: The univariate analysis indicated a significant statistical difference between the control group and the interventional group regarding maternal age (p = 0.018), previous maternal history of renal colic (p = 0.005) or nephrolithiasis (p = 0.002). After applying the propensity score-matched analysis, cesarean delivery rates (p < 0.001), preterm labour (p = 0.039), premature rupture of membranes (p = 0.026), preterm birth rates (p = 0.002), and post-partum UTI rates (p = 0.012) were significantly different between the control group and the matched treatment group. Ureterohydronephrosis, whether simple (n = 37; 71.2%) or infected (n = 13; 25%), was the main indication for double-J ureteric stenting. Complications such as pain (n = 21; 40.3%), stent migration (n = 3; 5.76%) or encrustation (n = 2; 3.84%), as well as reflux pyelonephritis (n = 2; 3.84%) and gross hematuria (n = 1; 1.92%) were recorded during follow-up. Conclusions: Our results show that double-J stenting is a safe and effective treatment option for pregnant patients with obstructive urological disorders.

Novel method to decrease the exposure time of the extraction string of the ureteral stent and its efficiency and safety verification in the clinic

Ureteral stent removal by an extraction string is advantageous. However, the increased risk of complications attributed to the continuous exposure of the string outside the urethra must be managed. This paper introduces a method to decrease the exposure time, and conducts a retrospective study to verify its efficiency and safety. A total of 231 male patients undergoing routine ureteroscopy (URS) were included, and all of them accepted indwelling ureteral stents with strings. Among them, 123 patients (Normal-S group) underwent the normal method to determine the length of string (L_string), which was shortened to 4 cm (cm) past the urethral meatus; 108 patients (Novel-S group) underwent the novel method (L_string = L_urethra + 2 cm), the length of urethra (L_urethra) was measured during ureteroscopy by ureteroscope body. The demographic characteristics, stent indwelling and removal-related variables, complications, and medical costs in each group were recorded. There was no significant difference in demographic characteristics, the rate of UTI, the operative duration of URS, or the VAS pain scores for stent removal between the 2 groups. For the Novel-S group, the stent dwelling time was longer, the self-rated discomfort and symptom, the stent dislodgement rate, the numbers of clinic or emergency visits and the overall medical cost post operation was lower in comparison with the Normal-S group, while the rate of removal of stents by hand was lower, the time for removing ureteral stents was longer. This novel method improved stenting comfort, avoided ureteral stent dislodgement, decreased complications, and lowered medical costs, it was safe and reliable and merits widespread application.

Efficacy of the direct grasping technique using pean forceps under fluoroscopy to replace ureteral stents in women

Purpose : To evaluate the efficacy of the direct grasping technique using pean forceps under fluoroscopic guidance for ureteral stent replacement in women. Methods : Between April 2018 and September 2020, 28 female patients underwent ureteral stent replacements at our facility, and 184 stent replacement procedures were performed. A total of 127 stents were replaced using pean forceps under fluoroscopic guidance (pean forceps group), and 57 stents were replaced using the cystoscope (cystoscopy group). Clinical characteristics and surgical outcomes were compared between the groups. Results : All stents were successfully replaced. There was a statistically significant difference in the procedure time between the two groups (median [interquartile range], pean forceps group : 10.8 [8.2-13.9] minutes vs. cystoscopy group : 15.8 [11.1-20.9] minutes, P < 0.001). There were no intraoperative complications in either group and no difference in the incidence of postoperative complications (pean forceps group : 1.6% vs. cystoscopy group : 1.8%, P = 1.000). Fluoroscopy time was longer in the pean forceps group, although this difference was not statistically significant (pean forceps group : 38.9 [22.6-60.1] seconds vs. cystoscopy group : 33.0 [20.0-48.9] seconds, P = 0.0558). Conclusion : The direct grasping technique using pean forceps under fluoroscopy may be a beneficial alternative to cystoscopy for ureteral stent replacement in women. J. Med. Invest. 68 : 326-329, August, 2021.

Feasibility and safety of magnetic-end double-J ureteral stent insertion and removal in children

PURPOSE

The need for surgical removal of a double-J ureteral stent (DJUS) is considered one of its disadvantages. Apart from increased cost, repeated exposure to general anesthesia is a concern in children. Alternative techniques have been described, all failing to become integrated into mainstream practice. Stents with a distal magnetic end, although introduced in the early 1980s, have only recently gained acceptance. We report the feasibility and safety of insertion and removal of a magnetic-end double-J ureteral stent (MEDJUS) in a pediatric population.

MATERIALS AND METHODS

We retrospectively analyzed the use of the Magnetic Black-Star Urotech^® MEDJUS between 11/2016 and 12/2019 in children. Stents were removed in the outpatient clinic using a transurethral catheter with a magnetic tip.

RESULTS

MEDJUS insertion was attempted in 100 patients (65 boys). Mean age was 7.8 years (0.5-18). The stent was placed in an antegrade procedure (n = 47), by a retrograde route (n = 10), and during open surgery (n = 43). Stent insertion was successful in 84 cases (84%). All 16 failures occurred during the antegrade approach in laparoscopic pyeloplasty, with inability to push the stent and its magnet through the ureterovesical junction in 14. Magnetic removal was attempted in 83 patients, successful in 81 (98%). There was no added morbidity with the MEDJUS.

CONCLUSIONS

The use of MEDJUS is a safe and effective strategy that obviates the need for additional general anesthesia in children. Its insertion is similar to that with regular DJUS, and its easy and less time-consuming removal benefits both the patient and the hospital and validates its clinical use.

Forgotten ureteral double-J stents and related complications: a real-world experience

Background

Double-J (DJ) stents are among the basic and commonly used tools in urology. The DJ stent generally needs to be replaced or removed within 6 weeks to 6 months to avoid complications like encrustations, stone formation, fractures and blockades of stents. However, in many cases the stent is forgotten. In this retrospective study, we report our experience in the management of forgotten stents and steps taken by us in preventing DJ stent-related morbidity.

Results

Of the total of 30 patients, 80% (n = 24) underwent previous procedures in other hospitals and the remaining 20% (n = 6) were from our hospital. The mean age of the patients was 56.66 years. The mean duration of the indwelling stent in situ was 13.83 months. The indications of indwelling stents included ureteroscopic lithotripsy, extracorporeal shock wave lithotripsy and percutaneous nephrolithotomy. Presenting complaints for which patients visited hospital were flank pain (n = 10; 33.33%), dysuria (n = 9; 30%), hematuria (n = 3, 10%) and fever (n = 2; 6.66%).

Conclusion

Forgotten DJ stents can be a source of severe morbidity. Patients’ and relatives’ educational level and counseling before and after the procedure may play a significant role in reducing stent-related complications.

Radiological retrograde ureteric stent exchange in women: a single-centre review

AIM

To evaluate the safety and efficacy of modified wire loop technique for retrograde stent exchange.

MATERIALS AND METHODS

All patients were from the KK Women and Children's Hospital where there is no on-site urology service. Patients were identified retrospectively from the institutional radiological information system (RIS) database. In total, 270 stents were removed and 238 replaced for 79 patients between January 2012 to December 2016. Success rates for stent removal and exchange as well as skin dose and fluoroscopy time were assessed.

RESULTS

Stent exchange was successful in 234/238 (98%) of cases. Failure was due to loss of access (one case), inability to snare stent due to distorted anatomy (two cases), and extensive encrustation of stent (one case). In 252/270 (93%) cases, stent was removed using modified snare while in 18 (7%) cases, other snare devices were used. Average fluoroscopy time per stent for stent exchange was 573 seconds and average skin dose was 12,494 DAP/mGy•cm².

CONCLUSION

Fluoroscopy-guided retrograde ureteric stent exchange using the modified snare loop technique is effective, quick, and can be performed easily with equipment used in daily intervention practice. It may also be coupled with ureteroplasty, which may help the patient achieve eventual stent-free status.

Double J stent removal in paediatric patients by Vellore Catheter Snare technique: a randomised control trial

BACKGROUND

Double J (DJ) stents placed at the end of paediatric urological procedures require another cystoscopy under general anaesthesia for removal. The second author developed a reproducible technique for snaring the DJ stent using an infant feeding tube (6-Fr or 8-Fr) and a 3-0 polypropylene suture per urethra. Having demonstrated the proof of concept, ethical clearance was obtained for an institutional randomised controlled trial.

OBJECTIVE

The aim of the study was (1) to describe the Vellore Catheter Snare (VeCS) technique for DJ stent removal, (2) to study the efficacy of the technique and (3) to compare the costs of VeCS technique with cystoscopy on an intention-to-treat basis.

STUDY DESIGN

The study design was that of a randomised control trial with parallel groups as a non-inferiority study.

RESULTS

Forty children with unilateral indwelling DJ stents were enrolled from January to August 2018. They were randomised by unequal allocation (1:3) to cystoscopic and VeCS technique removal arms. The VeCS technique and cystoscopy were successful in 86.67% (26/30) and in 100% (10/10) cases, respectively, with no statistically significant difference in the outcome (p = 0.223). The average cost for cystoscopic removal of the stent was INR 14,579 and was INR 5636.5 for the VeCS technique (on an intention-to-treat basis).

DISCUSSION

While per-urethral catheterisation is an outpatient/ward procedure in children, cystoscopy is not. Other techniques such as extraction strings and magnetic stents with their extraction device were found to have certain disadvantages. The VeCS technique, using common disposables, circumvented the need for inpatient admission, disinfected equipment usage and operation theatre time in 87% children, thereby reducing the costs incurred by the patient.

CONCLUSION

The VeCS technique for DJ stent removal is a practical low-cost safe alternative to cystoscopic removal of DJ stents in children. Although the technique has a high success rate, it still needs the backup option of cystoscopy under general anaesthesia.

A prospective and randomized comparison of rigid ureteroscopic to flexible cystoscopic retrieval of ureteral stents

Background

Flexible cystoscopy has become an accepted alternative for stent retrieval. However, it is associated with higher cost. Some reports have described experiences of using rigid ureteroscope to retrieve ureteral stents. We compared rigid ureteroscopic to flexible cystoscopic retrieval of ureteral stents in a prospective and randomized clinical trial.

Methods

Three hundred patients treated with ureteral stents between July 2012 and July 2013 were accrued in this study. These patients were divided into two groups using the random number table method. Group A, with 162 patients, had stents removed with a flexible cystoscope and Group B, with 138 patients, had stents removed with a rigid ureteroscope. All procedures were performed under topical anesthesia by the same urologist. Patients in each group were compared in terms of preoperative, perioperative, and postoperative data. Postoperative data were collected using telephone interview on the postoperative day two. The postoperative questionnaire used included three items: hematuria, irritable bladder symptoms, and pain scores.

Results

All the stents were retrieved successfully. No statistical differences were noted between the two groups in terms of gender, age, laterality and duration of the stents, operative time, postoperative hematuria, irritable bladder symptoms, and pain scores. The per-use cost of instrument was much higher for the flexible cystoscopic group, RMB 723.1 versus 214.3 (USD 107.9 versus 28.2), P < 0.05.

Conclusion

Ureteral stent retrieval using rigid ureteroscope under topical anesthesia is as safe and effective as flexible cystoscope but with a much lower cost to patients.

Trial registration

This study was registered with Chinese Clinical Trial Registry on March 27, 2017 (retrospective registration) with a trial registration number of ChiCTR-IOR-17010986.

Developing a preoperative predictive model for ureteral length for ureteral stent insertion

BACKGROUND

Ureteral stenting has been a fundamental part of various urological procedures. Selecting a ureteral stent of optimal length is important for decreasing the incidence of stent migration and complications. The aim of the present study was to develop and internally validate a model for predicting the ureteral length for ureteral stent insertion.

METHODS

This study included a total of 127 patients whose ureters had previously been assessed by both intravenous urography (IVU) and CT scan. The actual ureteral length was determined by direct measurement using a 5-Fr ureteral catheter. Multiple linear regression analysis with backward selection was used to model the relationship between the factors analyzed and actual ureteral length. Bootstrapping was used to internally validate the predictive model.

RESULTS

Patients all of whom had stone disease included 76 men (59.8%) and 51 women (40.2%), with the median and mean (± SD) ages of 60 and 58.7 (±14.2) years. In these patients, 53 (41.7%) right and 74 (58.3%) left ureters were analyzed. The median and mean (± SD) actual ureteral lengths were 24.0 and 23.3 (±2.0) cm, respectively. Using the bootstrap methods for internal validation, the correlation coefficient (R2) was 0.57 ± 0.07.

CONCLUSION

We have developed a predictive model, for the first time, which predicts ureteral length using the following five preoperative characteristics: age, side, sex, IVU measurement, and CT calculation. This predictive model can be used to reliably predict ureteral length based on clinical and radiological factors and may thus be a useful tool to help determining the optimal length of ureteral stent.

Ultrasound-Guided Ureteral Stent Removal in Women

OBJECTIVES

The purpose of this study was to develop a fast, comfortable, and safe method of ureteral stent removal in women.

METHODS

From February 2014 to July 2015, a retrospective multicenter controlled study including 82 female outpatients was conducted. The control group was composed of 46 patients who underwent stent removal using a 22F cystoscope. The experimental group was composed of 36 patients who underwent stent removal under ultrasound guidance with a 15F spiral-ending device. Exclusion criteria were pelvic organ prolapse quantification stage II or higher and complicated stents (with migration or encrustation).

RESULTS

All studied patients had successful ureteral stent removal. No complications were seen in both groups. Differences between mean visual analog pain scale scores and stent removal durations were statistically significant in favor of the experimental group (P = .0077 and .0075, respectively).

CONCLUSIONS

The proposed method for ureteral stent removal in women under ultrasound guidance was shown to be faster and to have lower visual analog pain scale scores, in comparison with removal by a cystoscope, which makes it an attractive option for outpatient urologic praxis in uncomplicated cases, and because it is free of the risk of ionizing radiation and more comfortable, it can be used in pregnant patients.

Correlation between the operation time using two different power settings of a Ho: YAG laser: laser power doesn't influence lithotripsy time

BACKGROUND

This study investigated the correlation between the operation time using two different power settings of a Ho: YAG laser.

FINDINGS

A total of 68 patients underwent cystolithotripsy from April 2010 to October 2011 In Fifty-six of these patients underwent cystolithotripsy by one surgeon using a Ho: YAG laser for bladder calculi. This study assessed these patients in two groups; the 30 W laser generator group with the settings of 2.5 J x 5 Hz (30 W group) and the 100 W laser generator group as the settings of 3.5 J x 5 Hz (100 W group). The operation time in these two groups were assessed.A total of 56 patients including 45 male and 11 female patients that underwent cystolithotripsy using a Ho: YAG laser for bladder calculi by one surgeon were enrolled in this study. The patients' characteristics including age (mean; 68.8 vs 68.4 yr), gender (male; 74.2 vs 88.0%), stone burden (mean; 34.9 vs 41.3 mm), number of stones (mean; 3.2 vs 2.0) and stone's CT density (mean; 981.5 vs 902.0 HU) showed no significant differences. All patients were stone free following treatment. The median total length of the operation was 19 minutes (mean: 34.6 ± 36.1) in the 30 W group and 29 minutes (mean: 44.4 ± 38.8) in the 100 W group, which was not significantly different.

CONCLUSIONS

The results showed that the power settings of Ho: YAG laser show no differences in the operation time for bladder calculi lithotripsy.

Changing to a loop-type ureteral stent decreases patients' stent-related symptoms

The first indwelling ureteral splint was described in 1967. A ureteral stent can cause unpleasant side effects, such as urinary frequency, urgency, incontinence, hematuria, bladder pain and flank pain, which have a negative impact on a patient's quality of life. It is necessary to minimize the amount of material in the bladder in order to decrease stent-related symptoms. This study investigated the stent-related symptoms after changing from a double pigtail to a loop-type ureteral stent in the same patient group. This study followed 25 patients who underwent ureteral stent exchange from double pigtail to loop-type ureteral stent between September 2009 and February 2010. Ureteral stents were exchanged using topical, conscious sedation and general anesthesia for the various procedures including stent exchange, before/after shock wave lithotripsy and before/after ureteroscopy. The stent length was selected to be the same as whole ureteral length and the caliber based on the previous stent. A self-administered stent-related symptom questionnaire was used to assess stent-related symptoms in comparison to the previous double-pigtail stents. A total of 25 patients with a median age of 56.5 years underwent ureteral stent exchange. All patients had stone disease except two patients who had ureteral stricture. Almost all of stent-related symptoms without nocturia showed a significantly lower score with the loop-type ureteral stent than in double-pigtail stent. None of the patients experienced urinary tract infection either before or after undergoing ureteral stent exchange. Changing to loop-type ureteral stent significantly decreased ureteral stent-related symptoms.

Ureteroscopic removal of forgotten ureteral stent

A 69-year-old female had a right ureteral stent placed due to ureteral stricture resulting from cervical cancer in March 2008. The ureteral stent migrated to the ureter and was not exchanged. A new ureteral stent was inserted, and was exchanged every 3 months. The patient was referred to our department to remove the forgotten ureteral stent. In January 2012, her old ureteral stent was removed ureteroscopically, and no ureteral stent encrustation was found.

Encrusted Ureteral Stent Retrieval Using Flexible Ureteroscopy with a Ho: YAG Laser

A 23-year-old female had bilateral ureteral stents placed due to bilateral renal stones and hydronephrosis. The bilateral ureteral stents were changed every 3 months. A kidney ureter bladder (KUB) film showed left encrustation along the ureteral stent thus necessitating removal; however, the ureteral stent could not be removed cystoscopically. The ureteral stent was, therefore, extracted using flexible ureteroscopy (URS) with a holmium (Ho): yttrium aluminum garnet (YAG) laser.