SINGLE CENTRE EXPERIENCE OF ENDOUROLOGICAL MANAGEMENT OF RETAINED DOUBLE J STENTS IN THE COVID ERA

Abstract

Introduction - Since their inception in 1967, Double J (DJ) stents have been widely used for the purpose of alleviation extrinsic and intrinsic obstruction. They are used as a modality of maintaining patency as well as drainage of the urinary tract as well as to facilitate the passage of small fragments post intervention. However, delayed removal or failure of follow up may lead to complications in the form of stent encrustation, migration, fracture, stone formation, adjacent organ penetration, urinary tract infections (UTI), ureteral erosion, or fistula formation. Many of these patients remain asymptomatic for months, and such forgotten stents are detected incidentally, resulting in late presentation (2). In the COVID era however, patients who had either been stented prior to or during the pandemic were unable to get their indwelling stents removed. This was due to either fear of approaching a hospital and risking exposure to COVID or an inability to travel amidst restrictions. Our study takes into account the impact of the pandemic with regards to timely stent removal. Materials and methods – Retrospective study design, patients enrolled from a tertiary care centre. Data obtained from hospital records. The eligibility criteria included all patients above the age of 18 with a forgotten stent (>6 months in situ). All records included patients from January 2021 – December 2022. Data collection was done in accordance to SCARE 2020 criteria. Results- Mean age of patients - 49.45 years. 10 patients were females (41.66%) and 14 were males (48.34%). Mean duration of the indwelling stents was 3.68 years (range 6 months to 14 years). 6 patients had formal secondary education, 13 had primary education and 5 were found to be illiterate. 12 patients were from rural India and poor socioeconomic backgrounds. Out of the total patients 6 patients were unaware of indwelling stents. 14 patients cited covid as a reason for their delay in treatment. The commonest indication is DJ stent insertion for obstructive calculi - 8 patients (33%). 7 patients had undergone PCNL (29%). 5 patients required a combination of 2 endourological procedures. 12 patients required a PCNL (50%). Cystolithotrypsy was required in 7 patients. Conclusion – 58.3% of study participants cited covid as a cause for retained DJ stents. All participants were managed endourologically.