Comparison of a magnetic retrieval device vs. flexible cystoscopy for removal of ureteral stents in renal transplant patients: A randomized controlled trial

Comparison of the Removal Efficiency and Safety of Magnetic Versus Conventional Ureteral Stents: A Systematic Review and Meta-analysis

Context

The incidence of urolithiasis is increasing year by year. Ureteral stents are a popular treatment option for this condition. Efforts to improve the material and structure of stents to increase comfort and reduce complications have led to the introduction of magnetic stents.

Objective

To evaluate differences in removal efficiency and safety for magnetic and conventional stents.

Evidence acquisition

This study was conducted and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Data were extracted according to the PRISMA principles. We collected and combined data from randomized controlled trials on magnetic versus conventional stents to evaluate the efficiency of their removal and the associated effects. Data synthesis was performed using RevMan 5.4.1 and heterogeneity was evaluated using I² tests. A sensitivity analysis was also performed. Key metrics included the stent removal time, Visual Analog Scale (VAS) pain scores, and Ureteral Stent Symptom Questionnaire (USSQ) scores for various domains.

Evidence synthesis

Seven studies were included in the review. We found that magnetic stents had a shorter removal time (mean difference [MD] -8.28 min, 95% confidence interval [CI] -15.6 to -0.95; p = 0.03) and their removal was associated with less pain (MD -3.01 points, 95% CI -3.83 to -2.19; p < 0.01) in comparison to conventional stents. USSQ scores for urinary symptoms and sexual matters were higher for magnetic than for conventional stents. There were no other differences between the stent types.

Conclusions

Magnetic ureteral stents have the advantages of a shorter removal time, less pain during removal, and low cost in comparison to conventional stents.

Patient summary

For patients undergoing treatment of urinary stones, a thin tube called a stent is often temporarily inserted in the tube between the kidney and the bladder to allow stones to pass. Magnetic stents can be removed without any need for a second surgical procedure. Our review of studies comparing two types of stents suggests that magnetic stents are superior to conventional stents in terms of efficiency and comfort during removal.

The Function Improved of the Newly Designed Magnetic-End Ureteric Stenting Retrieval Device: A Clinical Prospective Randomized and Control Trial in a Multicenter Study

Objective

To demonstrate the advantage of our newly designed magnetic ureteric stenting retrieval device over traditional nonmagnetic ureteric stents and other retrieval devices without cystoscopy intervention on clinical application and cost-related outcomes. Patients and Methods. A total of 333 patients were recruited into two study groups: magnetic-end ureteral stent (Group A) and conventional ureteral stent (Group B). The effects were evaluated by Ureteral Stent Symptom Questionnaire (USSQ) scores, complications of the indwelling stent, visual analog scale (VAS) pain scores at stent removal, and cost-analysis outcomes between the magnetic ureteric stenting retrieval device and traditional double-J ureteral stent (DJUS) removed by cystoscopy.

Results

The VAS of the pain score of patients undergoing magnetic stent removal with the retrieval device was 2 ± 0.97, whereas that of patients undergoing conventional ureteral stent removal with cystoscopy was 5.76 ± 1.53 (p < 0.001). The removal of magnetic stents by a retrieval device proved to be less painful than cystoscopy-mediated stent removal (p < 0.001). Obviously, the total cost for the magnetic stent removal was much lower than the conventional ureteral stent removal, although the magnetic stent costs more than the conventional ureteral stent. The improved magnetic stent used in our study showed a remarkable cost saving of 705/111 USD Chinese Yuan (CNY) per patient when compared with the conventional ureteral stent.

Conclusion

We reported the integrated design features of the improved magnetic stent in the world, which was granted a patent in China. USSQ scores and rate of complications in the magnetic stent were as equally acceptable as a conventional stent. Furthermore, successful stent insertion rate reached 100% by both the antegrade and retrograde approaches, and no failure case of magnetic stent removal was reported in our study.

Feasibility and Safety of a Simple Non-cystoscopic Double-J Tube Removal Technique in Children

Objective: Double-J tube placement is an important procedure during upper urinary tract surgery. A primary drawback is the requirement of a second double-J tube removal under a cystoscope. Therefore, a simple and feasible alternative is required to remove the double-J tube without cystoscopy. The present study reported the feasibility and safety of a simple non-cystoscopic double-J tube removal technique. Method: We retrospectively analysed children who underwent pyeloplasty and ureterovesical reimplantation between June 2015 and August 2021. A simple device (a catheter with a suture) was used to pull out the double-J tube. Patient characteristics, detailed surgical procedures, success and complication rates and reasons for failure were evaluated. Result: A total of 613 children were included. The mean age of patients was 6.2 months (3 months-14 years). Non-endoscopic methods were used to remove the double-J tube in all except 6 patients (0.9%). Of the 6 patients who required ureteroscopy or cystoscopy, 4 had retraction of the double-J tube into the ureter, and 2 (0.6%) had bladder stones. Of the 613 patients, 479 (76.0%) required one attempt, 127 (20.1%) required two attempts and 19 (3.0%) required several attempts. No serious postoperative complications occurred in all patients. The most common complications were gross haematuria (22.5%), pain urinating (17.9%), difficulty in urinating (3.6%), foreskin injury (1.7%), and penile oedema (1.3%). No urethral strictures developed during the follow-up period. Conclusion: The study results demonstrated that the modified and simple non-cystoscopic double-J tube removal technique is a safe and an effective alternative to cystoscopy in clinical practise.