Abstract
BackgroundUreteral stent removal using an extraction string is advantageous because it can obviate an invasive cystoscopy, but there is a paucity of data on how patients feel about it, and how bothersome or beneficial it is.We performed this study to evaluate patients’ preference for stent removal using an extraction string and which parameters could affect it.MethodsIn total, 114 consecutive patients undergoing ureteral stent insertion after ureteroscopic stone removal (URS) for unilateral recurrent ureter stones were enrolled. Patients were randomized to a string group or a no string group.Stent removal was performed on the first visit within 7 days postoperatively. All patients were asked to complete the ureteral stent symptom questionnaire, to rate the degree of pain during stent removal using a visual analog scale (VAS) and to answer to questions regarding their preference.ResultsNo significant differences were found in domain total scores including urinary symptoms (p = 0.17), pain (p = 0.62), general health (p = 0.37), work performance (p = 0.41). However, regarding separate questions for ‘dysuria’ and ‘difficulties with heavy physical activity’, there were significant intergroup differences (p = 0.03 and p = 0.04, respectively). Particular, a significantly higher proportion of patients in the string group checked ‘stoppage of sexual intercourse due to stent-related problems’ than in the no string group (p = 0.03).VAS score on stent removal was significantly higher in the no string group than the string group (p = 0.005).Among the patients who remember the experience of an indwelling ureteral stent in the past, 85 % (17/20) of the no string group answered ‘No’ to the question of ‘difference between the methods used in this time and in the past’. On the contrary, 84.2 % (16/19) answered ‘Yes’ to the same question in the string group. And, all 16 patients of the string group who noted differences between the methods preferred ureteral stent removal using an extraction string to the past method.ConclusionsDespite of minor increased morbidity related to the extraction string, patients preferred ureteral stent removal using the extraction string after URS. The patients with the extraction string felt less pain on stent removal than flexible cystoscopic stent removal.Trial registrationKCT0001700. The trial was registered in the Clinical ResearchInformation Service (CRiS), Republic of Korea; registration date: 18/11/2015.
Highlights
Ureteral stent removal using an extraction string is advantageous because it can obviate an invasive cystoscopy, but there is a paucity of data on how patients feel about it, and how bothersome or beneficial it is
Do you think there is any difference between the methods used in this time and in the past regarding ureteral stent maintenance and removal?
Many studies have assessed how in situ-related stent discomfort can be alleviated, how long ureteral stents should be in-place, and the possibility of eliminating use of a ureteral stent after a ureteroscopic procedure. These studies consistently show that medications, such as alpha-blocker and anticholinergic agents, only alleviate some in situ-related ureteral stent symptoms. [11,12,13,14,15,16] ureteral stent indwelling durations have been shortened [17, 18] and an indwelling ureteral stent is not required under certain conditions [19,20,21]
Summary
Ureteral stent removal using an extraction string is advantageous because it can obviate an invasive cystoscopy, but there is a paucity of data on how patients feel about it, and how bothersome or beneficial it is. We performed this study to evaluate patients’ preference for stent removal using an extraction string and which parameters could affect it. The method is advantageous because it can obviate an invasive cystoscopic procedure, but there is wide variability in its clinical application and a paucity of data on how many urological surgeons use extraction strings, how patients feel about them, and how bothersome or beneficial they are. The primary objective of this study was to evaluate patients’ preference for removing a ureteral stents using an extraction string. A secondary objective was to evaluate parameters that could affect patients’ preference using a visual analog scale (VAS) for pain during ureteral stent removal and the Ureteral Stent Symptom Questionnaire (USSQ) with respect to their ureteral stent in situ
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