Does preoperative tamsulosin improve primary access in paediatrics ureteroscopy?

PD01-09 URETERAL STENT PLACEMENT FOLLOWING URETEROSCOPY INCREASES EMERGENCY DEPARTMENT VISITS IN A STATEWIDE QUALITY IMPROVEMENT INITIATIVE

DOSE A URETERAL ACCESS SHEATH FACILITATE URETEROSCOPY?

This review aims to determine whether the use of ureteral stents with extraction strings in adult patients undergoing upper urinary tract endoscopic procedures results in a higher incidence of urinary tract infections (UTIs) compared to stents without strings. A systematic literature search was conducted using PubMed, Scopus, and Google Scholar. Studies evaluating differences in UTI rates among adult patients with ureteral stents with or without extraction strings were included. Data on UTI rates, antibiotic prophylaxis protocols, and stent dwell time were extracted. The review included 11 trials published between 2015 and 2023. One multicenter retrospective study involving 4,392 patients reported a significantly higher UTI rate in patients with extraction strings (2.1% vs 1.1%, p = 0.006). In the remaining 10 studies, including four randomized controlled trials, the differences were not statistically significant. Antibiotic prophylaxis was described in five studies. In two studies, a single perioperative antibiotic dose was administered, with a total UTI rate of 6.8% (28/410). In contrast, three studies using prolonged prophylactic antibiotic regimens reported a total UTI rate of 3.2% (13/403). The impact of stent dwell time on UTI risk could not be determined. The risk of bias was high in 10 studies and moderate in one retrospective study. Based on low-quality evidence, the difference in UTI risk between ureteral stents with and without extraction strings appears to be minimal and statistically insignificant. Well-designed studies with standardized methodologies are needed to clarify these findings.

Antimicrobial Prophylaxis for Postoperative Urinary Tract Infections in Transurethral Resection of Bladder Tumors: A Systematic Review and Meta-Analysis.

Transurethral resection of prostate (TURP) and laser prostate surgery are common surgeries for benign prostate hyperplasia (BPH). We conducted an investigation using hospital database to evaluate the clinical factors associated with post-operative usage of alpha-blockers and antispasmodics. This study was conducted using retrospective clinical data from the hospital database, which contained newly diagnosed BPH patients between January 2007 and December 2012 who subsequently received prostate surgery. The study end-point was the use of alpha-blockers or antispasmodics for at least 3 months duration after 1 month of surgery. The exclusion criteria was prostate cancer diagnosed before or after the surgery, recent transurethral surgeries, history of open prostatectomy, and history of spinal cord injury. Clinical parameters, including age, body mass index, preoperative prostate specific antigen value, comorbidities, preoperative usage of alpha-blockers, anstispasmodics and 5-alpha reductase inhibitors, surgical methods, resected prostate volume ratios, and preoperative urine flow test results, were evaluated. A total of 250 patients receiving prostate surgery in the database and confirmed pathologically benign were included. There was significant association between chronic kidney disease (CKD) and the usage of alpha-blockers after prostate surgery (OR = 1.93, 95% CI 1.04-3.56, p = 0.036). Postoperative antispasmodics usage was significantly associated with preoperative usage of antispasmodics (OR = 2.33, 95% CI 1.02-5.36, p = 0.046) and resected prostate volume ratio (OR = 0.12, 95% CI 0.02-0.63, p = 0.013). BPH patients with underlying CKD were more likely to require alpha-blockers after surgery. In the meantime, BPH patients who required antispasmodics before surgery and who received lower prostate volume resection ratio were more liable to antispasmodics after prostate surgery.

Kidney transplantation is the treatment of choice for patients with end-stage kidney disease. In a previous review we concluded that the routine use of ureteric stents in kidney transplantation reduces the incidence of major urological complications (MUC). Unfortunately, this reduction appears to lead to a concomitant rise in urinary tract infections (UTI). For kidney recipients UTI is now the commonest post-transplant complication. This represents a considerable risk to the immunosuppressed transplant recipient, particularly in the era of increased immunologically challenging transplants. There are a number of different approaches taken when considering ureteric stenting and these are associated with differing degrees of morbidity and hospital cost. This review aimed to look at the benefits and harms of early versus late removal of the ureteric stent in kidney transplant recipients. We searched the Cochrane Kidney and Transplant Specialised Register up to 27 March 2017 through contact with the Information Specialist using search terms relevant to this review. Studies contained in the Specialised Register are identified through search strategies specifically designed for CENTRAL, MEDLINE, and EMBASE; handsearching conference proceedings; and searching the International Clinical Trials Register Search Portal and ClinicalTrials.gov. All RCTs and quasi-RCTs were included in our meta-analysis. We included recipients of kidney transplants regardless of demography (adults or children) or the type of stent used. Two authors reviewed the identified studies to ascertain if they met inclusion criteria. We designated removal of a ureteric stent before the third postoperative week (< day 15) or during the index transplant admission as "early" removal. The studies were assessed for quality using the risk of bias tool. The primary outcome of interest was the incidence of MUC. Further outcomes of interest were the incidence of UTI, idiosyncratic stent-related complications, hospital-related costs and adverse events. A subgroup analysis was performed examining the difference in complications reported depending on the type of ureteric stent used; bladder indwelling (BI) versus per-urethral (PU). Statistical analyses were performed using the random effects model and results expressed as relative risk (RR) with 95% confidence intervals (CI). Five studies (1127 patients) were included in our analysis. Generally the risk of bias of the included studies was judged low or unclear; they addressed the research question and utilised a prospective randomised design. It is uncertain whether early stent removal verus late stent removal improved the incidence of MUC (5 studies, 1127 participants: RR 1.87, 95% CI 0.61 to 5.71; I2 = 21%; low certainty evidence). The incidence of UTI may be reduced in the early stent removal group (5 studies, 1127 participants: RR 0.49 95% CI 0.30 to 0.81; I2 = 59%; moderate certainty evidence). This possible reduction in the UTI incidence was only apparent if a BI stent was used, (3 studies, 539 participants, RR 0.45 95% CI 0.29 to 0.70; I2 = 13%; moderate certainty evidence). However, if an externalised PU stent was used there was no discernible difference in UTI incidence between the early and late group (2 studies, 588 participants: RR 0.60 95% CI 0.17, 2.03; I2 = 83%; low certainty evidence). Data on health economics and quality of life outcomes were lacking. Early removal of ureteric stents following kidney transplantation may reduce the incidence of UTI while it uncertain if there is a higher risk of MUC. BI stents are the optimum method for achieving this benefit.

Background: In kidney transplantation (Ktx), ureteral stents are routinely used in many transplant centers. However, the impact of stents on complication rates and graft survival and the optimal duration of stenting are still being debated. In this study, 1 - and 5 -year patient and graft survival and complication rates following KTx with an ureteral stent were analyzed. Methods: Data from 1381 patients transplanted between 2000 and 2010 at the Department of Surgery, Innsbruck, were retrospectively analyzed. Complication Rates, shortterm and longterm outcome were investigated and risk factors for patient and graft survival were identified. Results: Out of 1381 patients (mean age: 48,5±14,3 years), 302 (21,9%) patients were transplanted using the Lich-Gregoir (LG) technique, 1059 (76,7%) patients were operated using a Leadbetter-Politano (LP) technique while in 20 (1,4%) patients a nonstandardized ureteral anastomosis was required. 597 (43,2%) patients were operated using a ureteral stent while 784 (66,8%) patients did not receive a stent. Patients without splints had a higher rate of urological complications (stent vs. no stent: 13,1% vs. 8,0%) and a significantly shorter survival to complication time (p=0.004) indicating the benefitial impact of routine stents on early urological complications. In contrast, the technique of ureteral anastomosis (LG vs. LP) did not impact on complication rates. 1 - and 5 - year patient survival was comparable between the groups (stent vs. no stent: 1yr: 95,6% vs. 96,2%, 5yr: 87,6% vs. 87,4%,p=n.s.) while graft survival was inferior in patients without a stent (stent vs. no stent: 1yr: 98,2% vs. 91,1%, 5yr: 84,8% vs. 78,9%,p=0.02). Conclusion: The routine use of ureteral stents is associated with reduced early complication rates, prolonged survival to complication time and an improved graft survival. These benefits may be particularly favorable in patients with an increased surgical risk or recipients of marginal grafts.

To compare patients with and with no stenting after ureteroscopy for ureteric calculi, as placing such stents is routine, although many patients complain of pain and urinary symptoms. In all, 45 patients with ureteric calculi amenable to ureteroscopic management were prospectively randomized into a stented (23) or an unstented (22) group. Standard ureteroscopic basketing and lithotripsy was used, through a ureteroscope (8.5 F) with or without ureteric dilatation. Symptom questionnaires were completed by the patients after treatment, and they were followed radiographically to assess stone-free rate and evidence of obstruction. There was no statistically significant difference in age, stone size, operative duration or hospital stay between the groups (P > 0.05). Furthermore, there was no statistical difference in flank pain or urinary symptoms (P > 0.05), except haematuria, between the groups; haematuria was more severe and prolonged in the stented group (P = 0.001). Uncomplicated ureteroscopy for removing calculi is safe with no stent after treatment, and after considering complications and side-effects we think that the routine use of ureteric stents after uncomplicated ureteroscopy for stone extraction is unnecessary.

Background: Despite significant advancements in renal transplantation, certain basic surgical practices such as the routine use of ureteral stents (US) remain controversial. A recent met-analysis of ureteral stenting concluded that the routine use of US resulted in improved outcomes. In contrast, the indiscriminate use of US can lead to adverse complications. Objective: To better define this question, we reviewed our single center experience in which US were placed selectively.Methods: 301 patients were eligible to be enrolled. 55 living donor and 246 deceased-donor charts were analyzed for donor and recipient clinical characteristics, immunosuppressive therapy and outcomes.Results: 28 US were placed for either small bladder capacity (n=7), unhealthy appearing bladder tissue (n=8) or for an uncertain vascular supply to the ureter (n=13). Patients with US did not develop urinary leaks, 8 (28%) developed complications including obstruction, encrustation, and urinary tract infections. 12 (4.3%) non-stented patients developed a clinically significant urinary leak. Risk factors for urinary leaks included dual and en-bloc pediatric donor kidney transplants, extended criteria donors and the use of single U stitch technique for ureteral anastomoses.Conclusion: Our results demonstrate that the majority of patients can be successfully transplanted without the routine use of US. Selective use of US should be reserved for high-risk situations.

EVALUATION OF THE UROLOGICAL COMPLICATIONS OF LIVING RELATED RENAL TRANSPLANTATION AT A SINGLE CENTER DURING THE LAST 10 YEARS: IMPACT OF THE DOUBLE-J STENT

OBJECTivES: The routine use of a ureteric stent remains controversial due to high incidence of its complications. In our routine practice, we prefer selective stenting of problematic anastomoses. The aim of this study is to evaluate incidence of major urological complications in recipients with selective ureteral stenting and without ureteral stenting. maTERial and mETHOdS: We retrospectively reviewed 236 patients who received a kidney transplant (144 living related, 88 cadaver) in our clinic between 2001 and 2009. All patients underwent extravesical Lich-Gregoir ureteroneocystostomy. Ureteral stenting had been used only in patients who had a high risk of urological complications. RESulTS: A total of 236 kidney transplantation had been performed between 2001 and 2009. Of these 236 patients, a total of 6 were excluded due to primary non-function. Of the remaining 230 procedures, 164 (71%) performed without ureteral stent. Overall 17 (7.4%) urological complications were observed. Urological complication rates were 6.1% and 10.6 % in the non-stented and selectively stented group, respectively. In the living related donor group, a total of 6 patients (4.2%) had urological complications. Urological complications further decreased to 3.3% in patients who received a living donor kidney without stenting. COnCluSiOnS: Kidney transplantation without ureteric stenting is safe in patients at low risk for urological complications. We prefer stentless ureteroneocystostomy surgery in low risk living related kidney transplantation. Selective ureteral stenting may be recommended high risk group for urological complications. KEYWORdS: Kidney transplantation, Ureter stents, Stents, Urological complications doi: 10.5262/tndt.2011.1001.14 Aki F T ve ark: Bobrek Nakli Hastalarinda Secilmis Olgularda Ureter Stent Kullaniminin Urolojik Komplikasyonlar Uzerine Etkisi Turk Neph Dial Transpl 2011; 20 (1): 83-87 84 Turk nefroloji diyaliz ve Transplantasyon dergisi Turkish Nephrology, Dialysis and Transplantation Journal

When is Prior Ureteral Stent Placement Necessary to Access the Upper Urinary Tract in Prepubertal Children?

Assessing the Impact of Ureteral Stent Design on Patient Comfort

Analysis of the use of prophylactic ureteral stents in preventing iatrogenic ureteral injury during radical hysterectomy for cervical Cancer.

A Randomized Outcomes Trial of Ureteral Stents for Extracorporeal Shock Wave Lithotripsy of Solitary Kidney or Proximal Ureteral Stones