A Prospective Evaluation of a Nurse-Led Stent Removal Service Using the Single-Use Isiris®in a Tertiary Referral Stone Unit and its Impact on Patient Waiting Times

Abstract

Background and Objective Double J (JJ) ureteric stenting represents one of the most significant causes of patient discomfort and dissatisfaction following endourological procedures. At our institution, a large tertiary referral centre for complex stones, standard JJ stent removal was previously undertaken with a flexible cystoscope (FC) in the endoscopy department by a doctor. The pathway was prone to delays through capacity constraints and prioritization being given to cancer investigations. The Isiris® is a single-use stent removal system consisting of a ‘camera on chip’ disposable FC with an integrated grasper. We examine the feasibility of a nurse-led stent removal service using Isiris®, performed as an office-based procedure, and its effect on waiting times. Material and Methods A specialist stone nurse undertook training in FC approved by the British Association of Urological Surgeons (BAUS) and the British Association of Urological Nurses (BAUN). Once competency was reached, a nurseled service was offered to patients in the outpatient setting. A prospective database from April 2018 to March 2020 was maintained to include patient data for stent removals in the nurse-led clinic using Isiris®. This was compared to a retrospective dataset of FC and stent removal between July 2016 and December 2016, performed by a doctor in the endoscopy department. The delays in stent removal compared to the ‘ideal’ stent removal date (planned date plus or minus 3 days tolerance allowed) were compared between the two pathways. Results The specialist nurse undertook BAUS theory training and competency was reached using an approved BAUS/BAUN competency package. 414 stent removals were booked in the nurse group, of which 395 were undertaken. 291 of 395 (74%) patients in the nurse removal Isiris® group had their stent removed on time, whereas only 16 of 54 (30%) patients had their stents removed on time in the FC stent removal group. A delay of more than 21 days was seen in 22% of FC group vs only 2% in the nurse-led Isiris® group. Both planned removal and actual stent dwell time were longer in the FC group compared to Isiris® group (p < 0.0001). There were no major complications with the use of Isiris® for stent removal in the nurse-led clinic. Conclusion This study has demonstrated that it is feasible to introduce a nurse-led stent removal service. The introduction of this service using the Isiris® system has led to a reduction in delays of stent removal, which is likely to translate into significant quality of life improvement for patients and economic benefits for the healthcare system.