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Sener TE, Ozgur G, Cetin M, Pietropaolo A, Tzelves L, Esperto F, Somani B, Tanidir Y. Foley catheter after ureteroscopy and JJ stent placement: a randomised prospective European Association of Urology Section of Urolithiasis-Young Academic Urologists (EULIS-YAU) endourology study. BJU Int 2024. [PMID: 39129326 DOI: 10.1111/bju.16504] [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: 08/13/2024]
Abstract
OBJECTIVES To evaluate the effects of inserting a Foley catheter after ureteroscopy (URS) and JJ stent placement on pain scores, voiding patterns, biochemical parameters and postoperative complications. PATIENTS AND METHODS A randomised clinical trial (1:1) with adult patients following unilateral URS + JJ stent placement was planned. In Group A, no Foley catheter was placed, in Group B, a Foley catheter was placed following URS + JJ stent placement. The primary objective was to evaluate effect of placing a Foley catheter on International Prostate Symptom Score (IPSS), Ureteric Stent Symptom Questionnaire (USSQ) score and postoperative biochemical parameters. The secondary objective was to evaluate postoperative complications. RESULTS A total of 112 patients were included (56/group). A ureteric access sheath was used in each patient. Patients had similar demographic and surgical parameters. The pre- and postoperative biochemical analyses including white blood cell count, C-reactive protein, procalcitonin and creatinine levels were similar between the two groups. The IPSS were similar between the two groups. All the subdomains of the USSQ were similar between two groups except Total Body Pain score, which was lower in Group B. The visual analogue scale scores were similar. Complications were all Clavien-Dindo Grade I and II, and the complication rate was 5.4% and 8.9% in Group A and B, respectively. CONCLUSION Placing a Foley catheter following URS + JJ stent placement did not show significant effects on postoperative biochemical parameters and voiding symptoms. However, a Foley catheter lowered the Total Body Pain score on the USSQ without having significant effects on VAS scores. The practice of placing a Foley catheter following URS and JJ stent placement should be based on surgeon's preference keeping in mind the potential positive effect on pain scores.
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Affiliation(s)
- Tarik Emre Sener
- Department of Urology, Marmara University Hospital, Istanbul, Turkey
| | - Gunal Ozgur
- Department of Urology, Marmara University Hospital, Istanbul, Turkey
| | - Mehmet Cetin
- Department of Urology, Marmara University Hospital, Istanbul, Turkey
| | - Amelia Pietropaolo
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Lazaros Tzelves
- Department of Urology, University College of London Hospital, London, UK
| | | | - Bhaskar Somani
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Yiloren Tanidir
- Department of Urology, Marmara University Hospital, Istanbul, Turkey
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Bellos TC, Manolitsis IS, Katsimperis SN, Angelopoulos PA, Kapsalos-Dedes SG, Deligiannis PK, Tzelves LI, Kostakopoulos NA, Mitsogiannis IC, Varkarakis IM, Papatsoris AG, Skolarikos AA, Deliveliotis CN. Ureteral stent related symptoms: A comparative study. Arch Ital Urol Androl 2024; 96:12231. [PMID: 38441229 DOI: 10.4081/aiua.2024.12231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Accepted: 12/29/2023] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND In urology, ureteral stents are used to treat obstructive diseases. Hematuria (54%), fever, discomfort, and lower urinary system symptoms are the predominant symptoms related to ureteral stent. AIM This article links stent symptoms to double-j width and length, as well as patient's height, weight, and body mass index (BMI). Ureteric Stent Symptoms Questionnaire (USSQ) was used to measure ureteral stent symptoms at 1st and 4th week of stent in situ as well as the 4th week after pigtail removal. METHODS A 200-patient prospective study, where patients were allocated into four groups following ureteral stent insertion depending on the stent characteristics. Those groups were: 4.8 Fr./26 cm (Group A), 4.8 Fr./28 cm (Group B), 6 Fr/26 cm (Group C), and 6 Fr/28 cm (Group D). RESULTS Men comprised 53.5% of 200 patients. Participants had an average age of 49 ± 15.5 years, height of 175 ± 8.94 cm, and BMI of 23.8 ± 7.6 cm. The laboratory results were identical between groups. At the first and fourth week, groups had similar urine symptoms, pain severity, health status and occupational activities. The difference in pain location was statistically significant. Group A had 82.4% renal back pain in the first week, whereas Group B had 68.8%, Group C 31.3% and Group D 62.5 (p=0.04). At the fourth week, 64.7% of Group A patients reported kidney front pain, compared to 100% of Group B, 93.3% of Group C, and 100% of Group D (p=0.04). There was statistical significance in the sexual activity of the patients. 24.4% of Group C patients stopped sexual activity before stent installation, compared to 10.6%, 8.3%, and 6.4% of the other groups (p=0.03). A moderate percentage of patients had active sexual activity at week 4 (Group A: 7.8%, Group B: 5.8%, Group C: 8.2%, Group D: 4.1%), p=0.83. In multivariate analysis, urinary catheter group, age, weight, height, and BMI did not significantly affect urine index score (UIS), pain index score (PIS), general health (GH), quality of work (QW), and quality of sex (QS). CONCLUSIONS Despite various attempts to establish the best ureteral stent, the effect of double-j stent physical features on stent-related symptoms remained unknown. No verdict is conceivable without adequate empirical data.
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Bao X, Sun F, Yao H, Wang D, Liu H, Tang G, Wang X, Zhou Z, Wu J, Cui Y. Distal end of Double-J ureteral stent position on ureteral stent-related symptoms: A systematic review and meta-analysis. Front Surg 2022; 9:990049. [PMID: 36034359 PMCID: PMC9411969 DOI: 10.3389/fsurg.2022.990049] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 08/01/2022] [Indexed: 11/13/2022] Open
Abstract
Background Most patients suffer from ureteral stent-related symptoms (USRS) caused by indwelling ureteral stents. Nevertheless, various medications to alleviate discomfort as well as novel stents are continually being developed, and in recent years, some researchers have believed that proper intravesical stent placement can relieve USRS. Objective To determine appropriate intravesical ureteral stent position may alleviate USRS. Methods Up to May 1, 2022, the PubMed, Embase, Scopus and Web of Science databases were thoroughly searched, and two independent reviewers included relevant studies that met the PICO (Patient, Intervention, Comparison, Outcome) criteria. Studies methodological quality were assessed by ROB2 and ROBINS-I. Ureteral stent symptom questionnaire (USSQ), international prostate symptom score (IPSS) and quality of life (QoL) was used to quantify the USRS. According to intravesical ureteral stent position, Group A was defined as the contralateral group, that is distal end of ureteral stent crossed the bladder midline, whereas Group B was classified as ipsilateral group, meaning stent end did not cross the midline. Results Six studies incorporating a total of 590 patients were eligible. In terms of USSQ score, the meta-analysis showed that contralateral group was associated with a significant increase in USSQ total (MD, 17.55; 95% CI, 12.04 to 23.07; P < 0.001), urinary symptoms (MD, 2.74; 95% CI, 0.48 to 5.01; P = 0.02), general health (MD, 4.04; 95% CI, 2.66 to 5.42; P < 0.001), work performance (MD, 1.36; 95% CI, 0.75 to 1.98; P < 0.001) and additional problems (MD, 0.89; 95% CI, 0.47 to 1.32; P < 0.001) scores while not associated with a significant increase in body pain (MD, 3.13; 95% CI, −0.19 to 6.44; P = 0.06) and sexual matters (MD, 1.01; 95% CI, −0.03 to 2.06; P = 0.06). As for IPSS, although no significant differences in IPSS total (MD, 2.65; 95% CI, −0.24 to 5.54; P = 0.07) or voiding symptoms (MD, −0.84; 95% CI, −3.16 to 1.48; P = 0.48) scores were found, ipsilateral group was associated with a significant decrease in storage symptoms (MD, 1.92; 95% CI, 0.91 to 2.93; P = 0.0002). Furthermore, ipsilateral group was linked to a significant decrease in QoL score (MD, 1.00; 95% CI, 0.18 to 1.82; P = 0.02). Conclusion This meta-analysis proven that correct intravesical stent position was critical, and patients with stents crossing the midline experienced more severe USRS than those who did not. Further high-quality randomized controlled trials are needed to corroborate our findings.
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Affiliation(s)
- Xingjun Bao
- Second Clinical Medical College, Binzhou Medical University, Yantai, China
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Fengze Sun
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Huibao Yao
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Di Wang
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Hongquan Liu
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Gonglin Tang
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Xiaofeng Wang
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Zhongbao Zhou
- Department of Urology, Beijing TianTan Hospital, Capital Medical University, Beijing, China
| | - Jitao Wu
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
- Correspondence: Yuanshan Cui Jitao Wu
| | - Yuanshan Cui
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
- Correspondence: Yuanshan Cui Jitao Wu
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Taguchi M, Yasuda K, Kinoshita H. Prospective randomized controlled trial comparing a ureteral stent crossing versus not crossing the bladder midline. World J Urol 2022; 40:1537-1543. [PMID: 35294582 PMCID: PMC8924725 DOI: 10.1007/s00345-022-03978-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 02/24/2022] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To evaluate the correlation between the position of a ureteral stent and stent-related symptoms in a single-center randomized study. METHODS A total of 113 patients who required ureteral stent placement after lithotripsy were randomized at a 1:1 ratio into groups with stents crossing and not crossing the bladder midline. The ureteral stent remained in place until postoperative day 14, when we obtained each patient's International Prostate Symptom Score (IPSS), overactive bladder symptom score (OABSS), and visual analog scale (VAS) pain score. RESULTS Comparing changes from baseline IPSS and OABSS scores between the two groups, the midline crossing group had a worse OABSS total score than the not crossing group (3.0 ± 2.8 vs. 2.0 ± 3.3; p = 0.032). There was no significant difference between the crossing and not crossing groups in IPSS total score (6.8 ± 7.6 vs. 5.1 ± 8.5; p = 0.14). The OABSS urgency mean score was significantly lower in the not crossing than in the crossing group (1.1 ± 1.8 vs. 1.6 ± 1.8; p = 0.042). However, there was no significant difference between groups for remaining items of the IPSS and OABSS and the mean VAS total pain score (1.9 ± 2.7 vs. 1.2 ± 1.9; p = 0.14). CONCLUSION A ureteral stent that crossed the bladder midline led to worse urinary symptoms. Choosing the appropriate stent length for each patient is important to minimize stent-related symptoms. TRIAL REGISTRATION DATE 1 October 2018; number: UMIN000034067.
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Affiliation(s)
- Makoto Taguchi
- Department of Urology, Osaka Saiseikai Izuo Hospital Based On Social Welfare Organization Saiseikai Imperial Gift Foundation Inc, Osaka, Japan
- Department of Urology and Andrology, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka 573-1010 Japan
| | - Kaneki Yasuda
- Department of Urology, Osaka Saiseikai Izuo Hospital Based On Social Welfare Organization Saiseikai Imperial Gift Foundation Inc, Osaka, Japan
| | - Hidefumi Kinoshita
- Department of Urology and Andrology, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka 573-1010 Japan
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Mehra K, Manikandan R, Dorairajan LN, Sreenivasan Kodakkattil S, Kalra S. Effect of Ureteral Stent Length and Position of Stent Coil in Bladder on Stent-Related Symptoms and Quality of Life of Patients. Cureus 2020; 12:e11669. [PMID: 33391907 PMCID: PMC7769726 DOI: 10.7759/cureus.11669] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Introduction: Various standardized questionnaires can evaluate ureteral stent-related symptoms. The present study utilized a validated instrument, Ureteral Stent Symptoms Questionnaire (USSQ), to know the impact of the length of double J stent (DJS) in comparison to ureter length on patients and their quality of living. Materials and Method: This study is a prospective clinical study conducted in the Department of Urology at a tertiary care center in South India. Patients who underwent DJS after endoscopic ureteral lithotripsy were included in the study. On a computerized tomography scan, the ureteral to stent length ratio (USR) was calculated. USSQ scores at the time of DJS removal and two weeks thereafter were recorded. The distal coil of the stent in the bladder was recorded as grade 1 - not crossing the midline and grade 2 - crossing the midline. Different symptom scores were compared between both grades of bladder coil and for USR of all the patients. Result: A total of 157 patients were included in the study. Over 46 (29.3%) patients had grade-1 and 111 (70.7%) had grade-2 bladder coil. Totally 93 (59.23%) patients reported pain, while 64 (40.77%) patients had no pain. Grade-2 coil patients had more pain than grade 1 (P=0.01). There was a weak inverse relationship between the USR and urinary symptom (P=0.004), pain symptom (P=0.04), and quality of work (P=0.005). Conclusion: Stent length or position of the intravesical stent coil does not appear to affect the quality of life except for the pain. Hence, choosing stent length according to ureteral length seems to have a minimal role in decreasing stent-related morbidity.
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Affiliation(s)
- Ketan Mehra
- Urology and Renal Transplantation, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, IND
| | - Ramanitharan Manikandan
- Urology and Renal Transplantation, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, IND
| | - Lalgudi N Dorairajan
- Urology and Renal Transplantation, Jawaharlal Institute of Post Graduate Medical Education and Research, Pondicherry, IND
| | | | - Sidhartha Kalra
- Urology and Renal Transplantation, Jawaharlal Institute of Post Graduate Medical Education and Research, Pondicherry, IND
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Kuo J, Rabley A, Domino P, Otto B, Moy ML, Bird VG. Evaluation of Patient Factors That Influence Predictive Formulas for Determining Ureteral Stent Length When Compared to Direct Measurement. J Endourol 2020; 34:805-810. [PMID: 32316762 DOI: 10.1089/end.2020.0066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objectives: To compare direct ureteral length measurements with predictive formulas used for the preoperative assessment of ureteral length, and to evaluate patient factors that impact the accuracy of these predictive formulas. Methods: Patients undergoing ureteral stenting for benign and malignant indications were included. Clinical factors analyzed were gender, race, height, weight, prior abdominal or pelvic surgery, radiation therapy, pelvic organ prolapse (POP), laterality, hydronephrosis, and pre-existing ureteral stent. Three predictive formulas and a common height-based formula were used. Direct ureteral measurements were obtained with a ruled 5F ureteral catheter. Predictive formulas were compared with direct ureteral measurements using scatterplot and Spearman's correlation coefficient. Univariate and multivariate logistic regressions were used to evaluate patient factors associated with ≥2 cm deviation from direct ureteral measurements. Results: A total of 108 patients (134 ureters) were analyzed. All predictive formulas correlated poorly with direct ureteral measurements, although as much as 60% of ureteral stent lengths were accurately predicted. Several patient factors significantly impacted accuracy of formulas: male gender (p = 0.04), POP (p = 0.05), body mass index (BMI) ≥25 (p = 0.03), and pre-existing ureteral stent (p = 0.05). Conclusion: Our study suggests that predictive formulas for ureteral stent length have poor accuracy when compared to direct measurement, especially for patients with elevated BMI and POP. Our institution considers direct ureteral measurement the gold standard for determining ureteral stent length-a method that is universally applicable and independent of patient factors.
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Affiliation(s)
- Jennifer Kuo
- Department of Urology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Andrew Rabley
- Department of Urology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Paula Domino
- Department of Urology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Brandon Otto
- Department of Urology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Meredith Louis Moy
- Department of Urology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Vincent G Bird
- Department of Urology, University of Florida College of Medicine, Gainesville, Florida, USA
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Vogt B. A New Customized Ureteral Stent with Nonrefluxing Silicone End-piece to Alleviate Stent-related Symptoms in Malignant Diseases. Urology 2019; 137:45-49. [PMID: 31899228 DOI: 10.1016/j.urology.2019.12.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 12/11/2019] [Accepted: 12/21/2019] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To evaluate the stent-related symptoms using a new customized ureteral stent with a nonrefluxing silicone end-piece. METHODS By decreasing the amount of material within the bladder, it should be possible to attenuate the stent-related symptoms. To minimize the amount of material, 17 consecutive patients already fitted with a double-pigtail stent for malignant ureteral obstruction agreed to be fitted with a customized stent where the bladder loop was replaced by a nonrefluxing silicone end-piece. The ureteral stent symptom questionnaire was prospectively administered to patients at baseline with double-pigtail stent and Day 15 after customized stent placement. RESULTS No difficulty in the placement of the customized stent was encountered. No stent failure, no dislodgment and no calcification were observed 6 months after stenting. The scores for the main domain "Urinary symptoms" (34.4 ± 3.6 vs 23.0 ± 7.0; P = .0004) and the question "Global quality of life" (4.4 ± 2.0 vs 2.4 ± 2.1; P = .01) were significantly decreased by the replacement of the double-pigtail stent by the customized stent. CONCLUSION The customized ureteral stent may constitute an improvement in the field of stent-related symptoms and seems fit for use in its current shape. Studies exploring and exploiting new concepts are greatly required to reduce stent-related symptoms in all patients including those with cancer.
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Affiliation(s)
- Benoît Vogt
- Department of Urology, Polyclinique de Blois, La Chaussée Saint-Victor, France.
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Vogt B. Challenges To Attenuate Ureteric Stent-Related Symptoms: Reflections On The Need To Fashion A New Dynamic Stent Design Consequent Upon A Case Report. Res Rep Urol 2019; 11:277-281. [PMID: 31696096 PMCID: PMC6815756 DOI: 10.2147/rru.s224068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 10/02/2019] [Indexed: 11/23/2022] Open
Abstract
Double-pigtail stent has been widely used in urology for half a century now, but this device reduces the patient’s quality of life. Moreover, indwelling stent-related symptoms induce additional suffering to the pre-existing bladder disease. Novel concepts to prevent stent-related symptoms are greatly required. It has been suggested that changes in the size, form and stent positioning could ease discomfort. By decreasing the amount of material within the bladder, it should be possible to attenuate the stent-related symptoms. A customized stent has been developed to alleviate bladder symptoms. The major characteristic of this stent was in the replacement of the bladder part of the double-pigtail stent by a nonrefluxing silicone end-piece. Three months after stenting, the patient complained of sudden discomfort in the bladder area. On the X-ray, the end-pieces of the customized stents seemed to have slipped in the bladder. The customized stents were replaced by new ones after truncating and adjusting their lengths to the exact ureteric length and stent-related symptoms were then improved again. In the field of stent-related symptoms, stent mobility needs more attention than its intravesical position. The case hereby reported illustrates the variations of the symptoms which seem related to the stent mobility, the necessary shaping of the stent and, the possible research avenues for an innovative dynamic ureteric stent.
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Affiliation(s)
- Benoît Vogt
- Department of Urology, Polyclinique de Blois, La Chaussée Saint-Victor 41260, France
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Intravesical stent position as a predictor of quality of life in patients with indwelling ureteral stent. Int Urol Nephrol 2019; 51:1949-1953. [DOI: 10.1007/s11255-019-02262-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Accepted: 08/17/2019] [Indexed: 11/26/2022]
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Sharma G, Sharma AP, Mavuduru RS, Devana SK, Bora GS, Singh SK, Mandal AK. Role of phosphodiesterase inhibitors in stent-related symptoms: a systematic review and meta-analysis. World J Urol 2019; 38:929-938. [DOI: 10.1007/s00345-019-02862-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 06/24/2019] [Indexed: 10/26/2022] Open
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Mansouri A, Tostivint V, Rouvellat P, Roumiguié M, Gamé X, Huyghe E, Rischmann P, Thanwerdas J, Malavaud P. [Is the ureteral length associated with the patient's size?]. Prog Urol 2019; 29:127-132. [PMID: 30709777 DOI: 10.1016/j.purol.2018.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 08/26/2018] [Accepted: 12/12/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To assess the relation between the ureteral length and the patients' size. PATIENTS AND METHOD Prospective study made between September 2012 and May 2014, on 87 patients with 42 men and 45 women, in whom the ureteral measure was performed during the various procedures that require the use of a pigtail stent. The average age of the population was 53 years old (±15.9) with an average height of 168.3cm (±8.4). This has been achieved through ureteral catheter combining fluoroscopy and endoscopy. RESULTS The ureteral average length was 23.5cm (±2.33). The ureteral average length was 23.8cm (±2.18) for man and 23.2cm (±2.44) for women. In this population, there were a positive correlation between the size of the patients and the length of the ureters (r=0.75; P=0.01). However, this correlation was not found in all subgroups, particularly among women (r=0.16; P=0.30) and on the right side of men (r=0.34; P=0.12). This correlation was still true for the left side in the men's group (r=0.50; P=0.02). CONCLUSION In this study, there is a positive correlation between the patients' size and the ureteral length. But this correlation is not found in some subgroups. It is better to perform in vivo the ureteral measurement to have the precise length in order to set up a pigtail stent adapted to the patient. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- A Mansouri
- Service d'urologie, hôpital Jean-Rougier, 46000 Cahors, France.
| | - V Tostivint
- Service d'urologie, d'andrologie et de transplantation rénale, CHU Rangueil, 31059 Toulouse, France
| | - P Rouvellat
- Service d'urologie, d'andrologie et de transplantation rénale, CHU Rangueil, 31059 Toulouse, France
| | - M Roumiguié
- Service d'urologie, d'andrologie et de transplantation rénale, CHU Rangueil, 31059 Toulouse, France
| | - X Gamé
- Service d'urologie, d'andrologie et de transplantation rénale, CHU Rangueil, 31059 Toulouse, France
| | - E Huyghe
- Service d'urologie, d'andrologie et de transplantation rénale, CHU Rangueil, 31059 Toulouse, France
| | - P Rischmann
- Service d'urologie, d'andrologie et de transplantation rénale, CHU Rangueil, 31059 Toulouse, France
| | - J Thanwerdas
- Service d'urologie, hôpital Jean-Rougier, 46000 Cahors, France
| | - P Malavaud
- Service d'urologie, d'andrologie et de transplantation rénale, CHU Rangueil, 31059 Toulouse, France
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Influence of biofilms on morbidity associated with short-term indwelling ureteral stents: a prospective observational study. World J Urol 2018; 37:1703-1711. [PMID: 30483946 DOI: 10.1007/s00345-018-2569-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 11/15/2018] [Indexed: 10/27/2022] Open
Abstract
PURPOSE To evaluate the influence of biofilms on morbidity associated with short-term ureteral stenting using contemporary methods of biofilm examination and validated assessment of symptoms. METHODS Patients undergoing temporary ureteral stenting for secondary ureterorenoscopy due to urinary calculi were prospectively included. The German Ureteral Stent Symptoms Questionnaire (USSQ) was used to assess stent-associated morbidity. Biofilms were removed from stents using 'pinhole extraction', a novel, validated, abrasion-based technique. Extracted biofilms were analyzed for total mass, bacterial load and mineral components. Correlation between total biofilm mass and USSQ total score was the primary outcome variable analyzed using Spearman correlation. Secondary outcomes included correlations between various biofilm characteristics and symptoms. RESULTS 94 patients were included in the analysis. Extracted biofilm mass had a median of 37.0 mg (0-310.2 mg) per stent. No correlation between total biofilm mass and USSQ total score was found (Spearman r = 0.012; p = 0.911). Correlations between biofilm characteristics and morbidity were generally weak and not significant. Significant correlations could be found between biofilm mass and hematuria (r = 0.280; p = 0.007), and between the number of bacteria (qPCR) and the USSQ subscore for pain (r = 0.243; p = 0.019) and the intake of analgesics (r = 0.259; p = 0.012). CONCLUSION Based on elaborated biofilm examination methods and validated self-reported outcome measures, our findings indicate that biofilms might aggravate some lower urinary tract symptoms but are not the main trigger for stent-associated morbidity in short-term ureteral stenting.
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14
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Taguchi M, Yoshida K, Sugi M, Matsuda T, Kinoshita H. A ureteral stent crossing the bladder midline leads to worse urinary symptoms. Cent European J Urol 2018; 70:412-417. [PMID: 29410895 PMCID: PMC5791404 DOI: 10.5173/ceju.2017.1533] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Revised: 10/22/2017] [Accepted: 10/29/2017] [Indexed: 11/22/2022] Open
Abstract
Introduction To investigate the correlation between the position of a ureteral stent and stent-related symptoms, excluding the influence of ureteroscopic maneuvers. Material and methods From January 2016 to December 2016, we analyzed 130 patients who placed a ureteral stent before ureteroscopic lithotripsy (URSL). A total of 108 patients were enrolled, including 77 (71.3%) men and 31 (28.7%) women, and the mean age was 58.9 ±14.3 years. On the day before URSL, plain radiography (kidney, ureter, bladder X-ray [KUB]) was used to confirm the stone location and ureteral stent position. According to KUB, we defined the crossing midline group as when the distal loop of the ureteral stent was crossing the bladder midline, and the not crossing midline group as when the distal loop of the ureteral stent was not crossing the bladder midline. We assessed urinary symptoms of the two groups using the overactive bladder symptom score (OABSS) on the day before URSL. Results The crossing midline group had a worse total OABSS (p <0.001) and worse scores for each item of daytime frequency (p = 0.047), nocturia (p <0.001), urgency (p = 0.002), and urgency incontinence (p = 0.045) than did the not crossing group. In multivariate analysis, stent position had the strongest association with the total OABSS (p = 0.002) among the other factors of age, sex, body mass index, stent side, stent diameter, stent length and stent indwelling time. Conclusions This study shows that a ureteral stent crossing the bladder midline leads to worse urinary symptoms. Choosing the appropriate stent length for each patient is important for improving stent-related symptoms.
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Affiliation(s)
- Makoto Taguchi
- Kansai Medical University Hospital, Department of Urology and Andrology, Osaka, Japan
| | - Kenji Yoshida
- Kansai Medical University Hospital, Department of Urology and Andrology, Osaka, Japan
| | - Motohiko Sugi
- Kansai Medical University Hospital, Department of Urology and Andrology, Osaka, Japan
| | - Tadashi Matsuda
- Kansai Medical University Hospital, Department of Urology and Andrology, Osaka, Japan
| | - Hidefumi Kinoshita
- Kansai Medical University Hospital, Department of Urology and Andrology, Osaka, Japan
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Taguchi M, Inoue T, Muguruma K, Murota T, Kinoshita H, Matsuda T. Impact of loop-tail ureteral stents on ureteral stent-related symptoms immediately after ureteroscopic lithotripsy: Comparison with pigtail ureteral stents. Investig Clin Urol 2017; 58:440-446. [PMID: 29124244 PMCID: PMC5671964 DOI: 10.4111/icu.2017.58.6.440] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 06/27/2017] [Indexed: 11/23/2022] Open
Abstract
Purpose To evaluate urination-related quality of life (QoL) in patients with an indwelling ureteral stent immediately after ureteroscopic lithotripsy (URSL) for upper urinary calculi. We compared the effects of loop-tail and pigtail ureteral stents on urination-related QoL. Materials and Methods Of 135 patients who underwent URSL between May 2014 and March 2015 at our hospital, we retrospectively analyzed the records of 70 patients (42 men, 28 women; median age, 63 years) in whom the stent tail was positioned inside the bladder without crossing the midline and who completed the core lower urinary tract symptoms score (CLSS) questionnaire pre- and postoperatively. Results There were significant differences in incomplete emptying (p=0.048) and bladder pain (p=0.041) between patients with loop-tail versus pigtail ureteral stents after URSL. In the multivariate analysis, stent type had a stronger association with incomplete emptying (p=0.022) and bladder pain (p=0.018) than age, sex, body mass index, stent side, operation time, diameter of ureteral access sheath, and stent type. Conclusions Patients with loop-tail ureteral stents had better urination-related QoL in the immediate post-URSL stage than patients with pigtail stents.
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Affiliation(s)
- Makoto Taguchi
- Department of Urology and Andrology, Kansai Medical University General Medical Center, Osaka, Japan.,Department of Urology and Andrology, Kansai Medical University, Osaka, Japan
| | - Takaaki Inoue
- Department of Urology and Andrology, Kansai Medical University General Medical Center, Osaka, Japan
| | - Kouei Muguruma
- Department of Urology and Andrology, Kansai Medical University General Medical Center, Osaka, Japan
| | - Takashi Murota
- Department of Urology and Andrology, Kansai Medical University General Medical Center, Osaka, Japan
| | - Hidefumi Kinoshita
- Department of Urology and Andrology, Kansai Medical University, Osaka, Japan
| | - Tadashi Matsuda
- Department of Urology and Andrology, Kansai Medical University, Osaka, Japan
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Betschart P, Zumstein V, Piller A, Schmid HP, Abt D. Prevention and treatment of symptoms associated with indwelling ureteral stents: A systematic review. Int J Urol 2017; 24:250-259. [DOI: 10.1111/iju.13311] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Accepted: 01/11/2017] [Indexed: 11/26/2022]
Affiliation(s)
- Patrick Betschart
- Department of Urology; St. Gallen Cantonal Hospital; St. Gallen Switzerland
| | - Valentin Zumstein
- Department of Urology; St. Gallen Cantonal Hospital; St. Gallen Switzerland
| | - Alberto Piller
- Department of Urology; St. Gallen Cantonal Hospital; St. Gallen Switzerland
| | - Hans-Peter Schmid
- Department of Urology; St. Gallen Cantonal Hospital; St. Gallen Switzerland
| | - Dominik Abt
- Department of Urology; St. Gallen Cantonal Hospital; St. Gallen Switzerland
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Kang DH, Cho KS, Ham WS, Chung DY, Kwon JK, Choi YD, Lee JY. Ureteral stenting can be a negative predictor for successful outcome following shock wave lithotripsy in patients with ureteral stones. Investig Clin Urol 2016; 57:408-416. [PMID: 27847914 PMCID: PMC5109799 DOI: 10.4111/icu.2016.57.6.408] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 09/08/2016] [Indexed: 11/27/2022] Open
Abstract
Purpose To evaluate ureteral stenting as a negative predictive factor influencing ureteral stone clearance and to estimate the probability of one-session success in shock wave lithotripsy (SWL) patients with a ureteral stone. Materials and Methods We retrospectively reviewed the medical records of 1,651 patients who underwent their first SWL. Among these patients, 680 had a ureteral stone measuring 4–20 mm and were thus eligible for our study. The 57 patients who underwent ureteral stenting during SWL were identified. Maximal stone length (MSL), mean stone density (MSD), skin-to-stone distance (SSD), and stone heterogeneity index (SHI) were determined by pre-SWL noncontrast computed tomography. Results After propensity score matching, 399 patients were extracted from the total patient cohort. There were no significant differences between stenting and stentless groups after matching, except for a higher one-session success rate in the stentless group (78.6% vs. 49.1%, p=0.026). In multivariate analysis, shorter MSL, lower MSD, higher SHI, and absence of a stent were positive predictors for one-session success in patients who underwent SWL. Using cutoff values of MSL and MSD obtained from receiver operator curve analysis, in patients with a lower MSD (≤784 HU), the success rate was lower in those with a stent (61.1%) than in those without (83.5%) (p=0.001). However, in patients with a higher MSL (>10 mm), the success rate was lower in those with a stent (23.6%) than in those without (52.2%) (p=0.002). Conclusions Ureteral stenting during SWL was a negative predictor of one-session success in patients with a ureteral stone.
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Affiliation(s)
- Dong Hyuk Kang
- Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Kang Su Cho
- Department of Urology, Gangnam Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Won Sik Ham
- Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Doo Yong Chung
- Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Jong Kyou Kwon
- Department of Urology, Severance Check-Up, Yonsei University Health System, Seoul, Korea
| | - Young Deuk Choi
- Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Joo Yong Lee
- Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
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Koprowski C, Kim C, Modi PK, Elsamra SE. Ureteral Stent-Associated Pain: A Review. J Endourol 2016; 30:744-53. [DOI: 10.1089/end.2016.0129] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Christopher Koprowski
- Division of Urology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Christopher Kim
- Division of Urology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Parth K. Modi
- Division of Urology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Sammy E. Elsamra
- Division of Urology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
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The German linguistic validation of the Ureteral Stent Symptoms Questionnaire (USSQ). World J Urol 2016; 35:443-447. [PMID: 27339622 DOI: 10.1007/s00345-016-1875-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Accepted: 06/02/2016] [Indexed: 11/27/2022] Open
Abstract
PURPOSE We developed and validated the German version of the Ureteral Stent Symptoms Questionnaire (USSQ) for male and female patients with indwelling ureteral stents. METHODS The German version of the USSQ was developed following a well-established multistep process. A total of 101 patients with indwelling ureteral stents completed the German USSQ as well as the validated questionnaires International Prostate Symptom Score (IPSS) or International Consultation on Incontinence Questionnaire (ICIQ) and the Short Form Health Survey (SF-36). Patients completed questionnaires at 1 and 2-4 weeks after stent insertion and 4 weeks after stent removal. Statistical analyses were performed to assess the psychometric properties of the questionnaire. RESULTS The German version of the USSQ showed good internal consistency (Cronbach's α = .72-.88) and test-retest reliability [intraclass correlation coefficient (ICC) = .81-.92]. Inter-domain associations within the USSQ showed substantial correlations between different USSQ domains, indicating a high conceptual relationship of the domains. Except from urinary symptoms and general quality of life, German USSQ showed good convergent validity with the corresponding validated questionnaires. All USSQ domains showed significant sensitivity to change (p ≤ .001). CONCLUSION The new German version of the USSQ proved to be a reliable and robust instrument for the evaluation of ureteral stent-associated morbidity for both male and female patients. It is expected to be a valid outcome measure in the future stent research.
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Staubli SE, Mordasini L, Engeler DS, Sauter R, Schmid HP, Abt D. Economic Aspects of Morbidity Caused by Ureteral Stents. Urol Int 2016; 97:91-7. [DOI: 10.1159/000443379] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 12/14/2015] [Indexed: 11/19/2022]
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