double-J Stent Removal Research Articles

Health perceptions of patients with forgotten double-J stent.

In this article, we aimed to determine the health perceptions of the patients who did not apply for double-J stent (DJS) removal on time and evaluate whether health perceptions impact this behavior. Health perceptions of 22 patients who were treated for forgotten double-J stent (FDJS) between January 2017-October 2020 and 25 patients who applied for DJS removal during the given appointment time in the urology department of Elazig Training and Research Hospital and Elazig Fethi Sekin City Hospital were compared using the "Health Perception Scale". Health perception scale scores in the FDJS group and control group were 62-68 (mean = 64.27±1.75) and 63-68 (mean = 65.36±1.55), respectively. With regard to the sub-factors of the scale, control center scores were 21.86±0.77 and 22.08±1.15; precision scores were 16.54±0.80 and 16.56±0.82; importance of health scores were 12.77±0, 92 and 13.32±0.74; and self-awareness points were 13.04 ±0.72 and 13.48±0.58, respectively. There was a statistically significant difference between the health perception scale in total, importance of health, and self-awareness scores between the two groups. At the same time, there was no difference in terms of the control center and precision scores (p∗=0.029, p∗=0.030, p∗=0.028, p=0.460, p=0.951). Patients' and their families' educational status, income levels and lack of follow-up by healthcare professionals play an important role in forgotten DJS cases and patients' perception of health may also have an impact on this behavior.

Primary pyeloplasty for uretero-pelvic obstruction in the USA adult population with or without double-J indwelling ureteral stents. Insurance claims data on contemporary time to removal trends, perioperative complications, health care costs, and re-intervention rates.

Using a large population-based dataset, we primarily sought to compare postoperative complications, health-care expenditures, and re-intervention rates between patients diagnosed with ureteropelvic junction obstruction (UPJO) undergoing stented vs. non-stented pyeloplasty. The secondary objective was to investigate factors that influence the timing of DJ stent removal. Patients ≥18 years old with UPJO treated with primary open or minimally-invasive pyeloplasty were identified using the Merative™ Marketscan® Databases between 2007-2021. Multivariable modeling was implemented to investigate the association between Double-J (DJ) stent placement and post-pyeloplasty complications, hospital costs, and re-intervention rates and the role of the perioperative predictors on time to DJ stent removal. Subgroup analyses stratified by ureteral stenting duration were additionally performed. Out of 4872 patients who underwent primary pyeloplasty, 4154 (85.3%) had DJ placement. Postoperative complications were rare (N.=218, 4.47%) and not associated with ureteral stenting (odds ratio [OR]: 0.78, 95% confidence interval [CI]: 0.55-1.12). The median cost for in-hospital charges was $21,775, with DJ stent placement independently increasing the median aggregate amount (OR: 1.29, 95% CI: 1.09-1.53). Overall, re-interventions were performed in 21.18% of patients, with DJ stenting found to be protective (OR: 0.79, 95% CI: 0.66-0.96). Higher Charlson Comorbidity Index, longer hospital stay, and open surgical approach were independent predictors for prolonged DJ stenting time to removal. Our study suggests that patients undergoing stent-less pyeloplasty did have a higher rate of secondary procedures, but not higher complications when compared to those undergoing stented procedures. Concurrently, the non-stented approach is associated with decreased health-care expenditures, despite the increased rates of secondary procedures.

Effect of indwelling ureteral stents on sexual function: a real-world observational study.

Ureteral DJ stents are commonly used devices in urology. However, stent placement may cause LUTS and affect the quality of life. We evaluated the direct relationship between ureteral stents and sexual function. From October 2022 to December 2023, 82 male and 90 female sexually active patients who underwent ureteroscopy at Beijing Tiantan Hospital, Capital Medical University, were enrolled. The basic information, surgical data, and two questionnaire data including the International Index of Erectile Function-5 and the Female Sexual Function Index of patients before the operation (baseline, T0), on the day of the ureteral DJ tube extraction (T1), and 4weeks after ureteral DJ tube extraction (T2) were collected to analyze the changes in the patients' sexual function. The average age of male patients was 36years and of female patients 39 years. Before the ureteral DJ stent placement, the mean ± SD IIEF-5 score was 22.86 ± 0.91, and the average FSFI score was 31.66 ± 1.44. On the day of the ureteral DJ stent removal, the IIEF-5 score was 16.37 ± 2.62 (p < 0.01) and the FSFI score was 15.83 ± 4.05 (p < 0.01). Four weeks after ureteral DJ stent removal, the average IIEF-5 score was 22.77 ± 1.06 (p = 0.61) and the average FSFI score was 30.99 ± 1.79 (p = 0.78). Indwelling ureteral stents after ureteroscopy can temporarily affect the sexual function of both male and female patients, typically recovering within 4 weeks after stent removal.

Microbial Colonization Pattern of Indwelling Double J Stents in Children.

Indwelling double-J-stent (DJ stent) kept post-urological procedures may cause urinary tract infections (UTIs) due to polymicrobial biofilm formation and colonisation. To determine the incidence and microbiological characteristics of DJ stent related UTIs in a paediatric population. Patients under the age of 18 admitted for DJ stent removal following pediatric urological procedures were enrolled into the study. Prior to surgical removal of the DJ stent, a urine sample was collected and the stent was cystoscopically removed under anesthesia. The ends of the stent were inoculated into culture media and incubated up to 48 hours. When growth was observed, an antibiogram was obtained using a panel of anti-microbial agents. The study group consisted of 27 patients (M: F = 23:4) with a mean age of 4.3 years (1 month - 13 years). The commonest indication for stent placement was Pyeloplasty, 19 (70%). Stent colonisation was found in 8 out of 27 patients (29.6%; CI 12-51%) and E.Coli (33%) was the commonest organism. Polymicrobial growth was noted in 4 patients. Organisms were sensitive to Cephaerazone/ Sulbactam and Amikacin, and resistant to other Cephalosporins. All 8 culture positive patients were asymptomatic and a repeat urine culture revealed no growth. Colonisation did not lead to active UTI and post stent removal the urine became sterile. Microbial colonisation was noted in 30% of patients with indwelling DJ stents. Prior knowledge of culture & sensitivity pattern helps to cover the patients with appropriate antibiotic on the day of stent removal.

Urinary Tract Aspergillosis in a Child with Pelviureteric Junction Obstruction

Abstract Aspergillus spp. are fungi which are mostly nonpathogenic, but some species such as Aspergillus fumigatus, Aspergillus flavus, and Aspergillus niger can cause aspergillosis in humans. Aspergillosis can manifest as pulmonary or extrapulmonary infections, with respiratory involvement being common but infections in other body parts being rare. Urinary aspergillosis, an uncommon manifestation of Aspergillus infection, presents unique challenges in diagnosis and management due to its rarity and varied clinical presentations. It is seen in immunocompromised individuals, patients with underlying structural urinary tract abnormalities, or those undergoing invasive procedures. Here, we present a case of an 8-month-old child who presented with intermittent fever and increased urination since birth. The child underwent bilateral open pyeloplasty with double-J (DJ) stenting. A month later, the child returned with anuria, fever, and abdominal mass, leading to infected DJ stent removal and bilateral percutaneous nephrostomy. Despite antibiotic treatment, fever persisted. A fungal culture was done which showed growth of A. flavus. Liposomal amphotericin B was started for the patient after which he became afebrile, and all the fungal cultures done, thereafter, were negative. Urinary tract aspergillosis is rare, particularly among individuals with a strong immune system. Persistence of urinary tract symptoms despite antibiotic and medical therapy may raise the possibility of fungal infection such as urinary tract aspergillosis.

Easy Way for Double-J Stent Removal in A Pandemic Crisis Covid-19

Easy Way for Double-J Stent Removal in A Pandemic Crisis Covid-19

Spontaneous knot formation complication of double J: two case reports

BackgroundUse of ureteral stents has become an integral part of urological practice. However, it also brought with it many complications. Double J (DJ) stent knotting is a rare stent complication, and only a few cases have been reported in the literature. Although the exact cause is unknown and, in the literature, it is generally thought that knots occur due to traction. In this case report we present for the first time that spontaneous knots can occur due to ureteral peristalsis or ureteral anomalies.Case presentationTwo patients (67 and 35 aged-Caucasian person) with ureteral stones who presented to the emergency department with colicky pain and had no previous history of urological surgery. We observed knot formation in the routine urinary system radiographs taken before stent removal in two patients whose ureters were observed to be narrow during endoscopic ureteral stone treatment. The stents were successfully removed using gentle traction under general anesthesia.ConclusionsWe discussed the cause and solution of spontaneous knot formation. We emphasized the importance of the direct urinary system radiograph taken before DJ stent removal.

Noncystoscopic Removal of Double-J Stent in Women: Feasibility and Safety

ObjectivesTo evaluate the feasibility and safety of a simple non-cystoscopic method previously applied in children for removing double-J stents applied in women by comparing the hospitalization time, operation time, costs, complications, and success rate. Methods180 women who underwent either cystoscopic or non-cystoscopic double-J stent removal in a randomized manner. They were randomly assigned 1:1 to groups of cystoscopic double-J stent removal (n = 90) or non-cystoscopic double-J stent removal (n = 90). The age ranged from 19 to 72 years. After the removal of the double-J stent, the operation time, costs, complications, and success rate were compared between the two groups. ResultsThe operation time of the non-cystoscopic group was lower than that of the cystoscopic group (6.0(5.0,7.0) minutes VS 2.0(2.0,3.0) minutes, P<0.001). The hospitalization costs of the non-cystoscopic group were significantly shorter than that of the cystoscopic group (1361.2(1331.4,1379.2) Yuan VS 873.9(868.5,896.1) Yuan, P<0.001). There were no complications such as infection and massive bleeding in the two groups during and after the operation. Most non-cystoscopic double-J stent removal can succeed in less than three attempts (88/90). All patients in the non-cystoscopic group used this technique to remove the double-J stent. ConclusionsNon-cystoscopic removal of double-J stent has the advantages of short operation time and low hospitalization costs. It is a safe and feasible minimally invasive method to replace cystoscopic removal of the double-J stent.

Unintended placement of a double-J stent in the contralateral renal pelvis during laparoscopic pyeloplasty for pediatric hydronephrosis: a case report.

The double-J stent (DJS) is a commonly used ureteral stent in urological surgeries, which provides support and drainage. However, the DJS may result in various complications such as infection, hematuria, stone formation, stent occlusion, and migration. Normally, one end of the DJS is located in the renal pelvis, and the other end in the bladder. In this case report, we describe the rare occurrence of a misplaced DJS during laparoscopic pyeloplasty, which was unintentionally placed in the contralateral renal pelvis. A 4-month-old male infant was diagnosed with left hydronephrosis. After confirmation of the diagnosis, laparoscopic left pyeloplasty was performed with the placement of a DJS. The patient did not experience any discomfort, such as nausea, vomiting, refusal to feed, crying and restlessness, or fever, after the operation, and was discharged on postoperative day 4. The patient returned to the hospital for DJS removal 6 weeks after the operation. However, the kidneys, ureters, and bladder (KUB) X-ray examination showed that the DJS was unintentionally placed in the contralateral ureter and renal pelvis. The stent was confirmed and removed under cystoscopy. Postoperative examination of the DJS showed that there was a hole in the side of the middle of the stent for urine drainage, with no obstruction or contralateral hydronephrosis. Misplacement of a DJS in the contralateral renal pelvis during laparoscopic pyeloplasty is a rare but potentially serious complication. Surgeons should be cautious when placing the stent and confirm its placement with imaging studies. Patients should be closely monitored for postoperative complications and prompt intervention should be taken if necessary.

Improving Surgical Safety in Living Donor Renal Transplantation With Antiseptic Skin Preparation, Bladder Irrigation, Corner-Saving Vascular Anastomosis, DJ Stenting, and Extravesical Ureteroneocystostomy Modifications: A Comprehensive Approach.

Introduction The antiseptic skin preparation, bladder irrigation, corner-saving vascular anastomosis, DJ stenting, and extravesical ureteroneocystostomy (ABCDE) approach encompasses a range of modifications applied during different stages of the surgical procedure in renal transplantation. These modifications include the following: A, antiseptic skin preparation sequentially with cetrimide 3.35%, chlorhexidine scrub 4%, spirit, and povidone-iodine 10%; B, bladder irrigation with amikacin and betadine solution;C, corner-saving end-to-side vascular anastomosis; D, DJ stenting with early postoperative removal within three weeks; and E, extravesical ureteroneocystostomy using our institute's modified Lich-Gregoir technique. Methods This prospective observational study was conducted at our institution between March 2021 and May 2023. Data were collected from the patients' medical records and analyzed using Statistical Package for the Social Sciences (SPSS) (IBM SPSS Statistics, Armonk, NY, USA). Statistical tests, including t-test, Mann-Whitney test, chi-square test, and Fisher's exact test, were used for analysis. The study assessed various recipient, donor, intraoperative, and post-transplant factors, as well as surgical complications and stent-related factors. Results Out of 72 renal transplantations, 12 (16.6%) had the followingsurgical complications: urinary(n= 4; 5.5%), wound-related (n= 3; 4.1%), andlymphocele(n= 5; 6.9%). The most common complications werelymphocele(n= 5; 6.9%) and urinary leak (n= 4; 5.5%). Surgical complications were more common in male recipients (91.6% versus 8.3%), as well as in recipients with longer dialysis duration (24 ± 17 versus 11.0 ± 7 months) and had extended hospitalization time (16.4 ± 8.6 versus 8.0 ± 2.9 days) (p < 0.05). Wound infectioncorrelated with longer surgeries (>300 minutes) and other complications. Lymphocele patients had higher drain output (>500 mL) on day 1 and longer hospital stays (>15 days). Urinary tract infections (UTIs) were linked to dialysis duration (>24 months), diabetes, and longer indwelling times of DJ stents and urinary catheters. Early DJ stent removal (<3 weeks) reduced UTI incidence and symptoms (p < 0.05). All complications were categorized as minor (3a or less), according to the Clavien-Dindo classification. Conclusion The modified ABCDE surgical approachin renal transplantation decreased the complications, showing favorable outcomes compared to those in the literature.

A Pandemic of Retained Forgotten Stents

Purpose: To review the management of a forgotten/ retained double J stent and attempt to suggest protocols to prevent this scenario. Materials &amp; methods: We included 12 patients with forgotten DJ stents who had their primary surgery done at our hospital between September 2019 and March 2021 and were unable to follow up due to the lockdown imposed for the COVID19 pandemic. Results: Twelve patients underwent their forgotten DJ stent removal by a combination of ESWL, cystolithotripsy, and percutaneous nephrolithotomy. All the patients achieved complete clearance of the encrustations/stone and removal of forgotten DJ stent in a single sitting. Conclusion: A forgotten DJ stent with encrustations and stone formation is a serious urological problem for the patient and the treating doctor. A stent is usually said to be forgotten if the indwelling time period is more than 3-6 months which was not intended by the treating doctor. In our series, the management and intervention depended on the patients' preop status, the severity of the encrustations, location, and the size of the stone. In patients with moderate-to-severe encrustations and stone presence, procedures such as CLT, ureteroscopy, and PCNL were performed. Forgotten/retained stents are a source of severe morbidity and additional/unnecessary hospitalization. In our series, we suggested a few protocols that could be followed in order to prevent a forgotten DJ stent.

Comparison of 24-hour urine composition prior to and after stone removal in nephrolithiasis: a prospective observational study.

To evaluate 24-hour urine composition prior to and after complete stone removal in nephrolithiasis patients to determine potential relationship between kidney stones and patient metabolic status. A prospective observational study was performed with patient enrollment from March 2019 to August 2020. 24-hour urine samples were collected prior to stone removal and 4 weeks after double-J stent removal, and examined the following urinary parameters: volume, creatinine, sodium, calcium, uric acid, citrate, oxalate, potassium, phosphorous, magnesium, and pH value. For each parameter, pairwise t test was performed to compare samples prior to and after stone removal. The number of cases that changed from normal to abnormal or vice versa was also evaluated for each parameter. The study was registered at http://clinicaltrials.gov/ (NCT03846011). A total of 109 patients completed 24-hour urine collections prior to and after stone removal. The urinary calcium and phosphate levels increased significantly after stone removal, showing a mean difference of 0.55 mmol (P=0.015) and 2.35 mmol (P=0.001) respectively. None of the other urinary parameters demonstrated a statistically significant difference when means were compared. The percentage differences for all urinary parameters ranged from 5.4% to 14.1%. The percentages of patients that presented clinically significant changes in urinary parameter values from normal to abnormal or vice versa ranged from 4.6% to 20.1%. Ideally, evaluation of 24-hour urine compositions should be undertaken after total stone removal, especially for patients with calcium stones. For patients who cannot achieve total stone removal, 24-hour urine samples should be thoroughly interpreted as urinary calcium and phosphate levels might be depleted in the presence of urinary stones.

Double J Stent an Indispensable Device in Modern Urology Practice-Timely Removal Prevents Catastrophic Complications: A Retrospective Observational Study

Introduction: Double J (DJ) stent placement is routinely used for various urological procedures. The potential complications of retained or forgotten stents include haematuria, infection, pain, ureteral injury, displacement, fragmentation, encrustation, stone formation, sepsis, renal failure, or even mortality. Various methods have been used alone or in combination for the retrieval of these encrusted stents. Their timely removal is crucial as the potential complications of retained or forgotten stents are very catastrophic and not cost-effective. Aim: To highlight the importance of timely removal/replacement of DJ stents. Materials and Methods: A retrospective observational study was conducted in the Department of Urology at Government Medical College, Patiala, Punjab, India, and data were collected from March 2021 to March 2023. A total of 149 patients who underwent DJ stenting for various procedures in the department or were referred from outside with attempted difficult removal were included in the study. Relevant investigations were performed. Data were collected from the registers maintained in the operation theatre. Data are presented as mean, numbers, and proportions as appropriate. Various procedures were used alone or in combination for stent removal. Results: The mean age of the study participants was 41.50 years with a range from 16 to 70 years. A total of 149 patients were included, and 163 procedures were performed to remove the DJ stents. A total of 24 (14.81%) stents patients developed complications in the form of mild encrustation of the renal and urinary bladder end of the stent, up migration, down migration, broken stents, heavy encrustations at both renal and bladder ends, partial intraperitoneal placement and stone formation at renal and bladder ends. Out of 163 total procedures,149 (91.41%) endoscopic retrievals were done, and 14 (8.59%) multiple procedures were done to remove stent fragments and stones. Postoperative complications were seen in 25 (16.78%) patients. Conclusion: Timely removal of DJ stents prevents catastrophic complications. The phrase by Desiderius Erasmus, “Prevention is better than cure,” holds merit in the present study

Febrile urinary tract infection after Double-J stent removal is associated with restenosis after laparoscopic pyeloplasty: A propensity score matched analysis of 503 children

To analyze the association between the febrile urinary tract infection (fUTI) after Double-J (DJ) stents removal and restenosis after laparoscopic pyeloplasty (LP). We retrospectively reviewed the clinical data of patients who were treated with transperitoneal LP for ureteropelvic junction obstruction from 2016 to 2020. Patients were divided into two groups according to whether they developed fUTI after DJ stent removal within 48h. The 1:3 Propensity Score Matched (PSM) method was used to balance confounding variables. 503 patients were included in the study. 28 (5.57%) patients developed fUTI after DJ stent removal. Compared with the non-fUTI group, age was younger, and weight was lower (P<0.05) in the fUTI group. Restenosis occurred in 11 (2.2%) patients, of which six patients developed fUTI after DJ stent removal. The revision surgery rate in the fUTI group was significantly higher than in the non-fUTI group (21.4% vs. 1.1%, P<0.01). After PSM, the results remained consistent. For 492 patients without restenosis, 22 patients developed fUTI. Compared with the non-fUTI group, the larger anteroposterior diameter (APD) and higher APD/cortical thickness (P/C) ratio were observed in the fUTI group at three months and six months postoperatively (P<0.05), but the difference vanished at 12 months and 24 months after surgery (Figure). FUTI after DJ stent removal is not uncommon after LP, and surgeons are often concerned about the possibility of restenosis. In the present study, although our results demonstrated a significant association between them, restenosis patients comprise only about 20% of fUTI patients. Based on our clinical observations, fUTI is often developed in children from 1 to 6 years of age, and the younger patients may be afraid of voiding because of the postoperative pain after DJ stent removal. Besides, intraoperative manipulation of DJ stent removal may lead to transient edema in the anastomotic site, causing the fUTI. For patients who develop fUTI after DJ stent removal but without persistent symptoms, the transient worsening of hydronephrosis during the early postoperative period may not impact long-term outcomes (As shown in Figure). Additional follow-up is needed to prevent the deterioration of renal function. Our result demonstrated that fUTI after DJ stent removal is associated with restenosis after LP. For fUTI patients without restenosis, APD and P/C ratio exhibited transient worsening at three months and six months postoperatively, decreasing gradually during follow-up. Patients who develop fUTI after DJ stent removal should be monitored.

Impact of the COVID-19 Pandemic on Surgical Treatment of Patients With Urological Diseases at a University Hospital.

Background: The coronavirus disease 2019 (COVID-19) appeared in China and spread quickly to other regions of the country and around the world, changing the way of life of individuals and the routine of healthcare systems.Objective: The aim of the present study was to investigate the impact of the pandemic on the surgical treatment of patients with urological diseases at a university hospital.Materials and methods: A retrospective analysis of the charts of patients with urological diseases submitted to surgical treatment between January 2019 and December 2020 was conducted. The variables of interest were age, sex, and most performed surgical procedures (double-J stent placement, cystoscopy, vasectomy, removal of double-J stent, ureterolithotripsy, endoscopic bladder procedure, kidney transplant, and endoscopic prostate procedure).Results: Around 59.03% of patients with urological diseases who had surgery in 2019 were male; placement of the double-J stent accounted for 35.85% of all surgeries; 3556 surgical procedures were performed. In 2020, 57.22% of the patients were male, placement of the double-J stent accounted for 38.34% of all surgeries, and 3093 surgical procedures took place. Analyzing the types of surgery conducted in 2019 and 2020, a significant reduction occurred in the number of procedures in 2020 (p = 0.000).Conclusion: The pandemic exerted an impact on the surgical treatment of patients with urological diseases at a university hospital. No significant changes occurred with regard to the sex and age of the patients, but a significant difference was found in the number of surgical procedures performed.

Pyeloplasty with the Kangduo Surgical Robot vs the da Vinci Si Robotic System: Preliminary Results.

Objective: To share our experience in robot-assisted pyeloplasty (RAP) with the Kangduo (KD) surgical robot vs the da Vinci Si (DV) robotic system (KD-RAP vs DV-RAP, respectively). Methods: From August 2019 to February 2021, 16 patients with ureteropelvic junction obstruction (UPJO) underwent KD-RAP and other 16 patients with UPJO accepted DV-RAP. All procedures were performed by the same surgeon. The perioperative results and follow-up data were prospectively collected and compared. Results: There was no conversion to open or laparoscopic surgery. The mean operation time was significantly longer in the KD-RAP group than the DV-RAP group (141 ± 28 minutes vs 118 ± 31 minutes, respectively, p = 0.04). The time per stitch was significantly longer in the KD-RAP group than the DV-RAP group (1.7 ± 0.5 minutes vs 1.4 ± 0.3 minutes, respectively, p = 0.05). No significant difference was noted in the estimated blood loss and the postoperative length of hospitalization. At a median follow-up of 19 (range 17-21) and 19.5 (range 14-33) months for the KD-RAP and DV-RAP groups, respectively, no difference was noted in the success rates between the KD-RAP and DV-RAP groups (93.75% and 100%, respectively; p = 0.31). Complications were comparable between the two groups (p = 0.54). One (6.3%) patient developed urinary infection, which responded well to oral antibiotics in KD-RAP group and 2 (12.5%) patients suffered from irritation symptoms of bladder, which improved after removal of Double-J stent in the DV-RAP group. Conclusions: The RAP with the use of the KD system was feasible, safe, and effective. The DV-RAP group showed advantage in the operation time and the time per stitch.

Role of Retrograde Intrarenal Surgery in the Management of Diabetic Renal Papillary Necrosis.

Introduction: It is challenging to diagnose diabetic renal papillary necrosis (RPN) radiologically due to the limitation in performing a contrast study in patients with compromised renal function. Endoscopic management by Double 'J' (DJ) stenting or percutaneous nephrostomy is the preferred treatment. The aim of our study was to analyze the role of retrograde intrarenal surgery (RIRS) in the management of RPN by retrieving necrosed papillae. Methods: This retrospective study included diabetic patients who presented with acute pyelonephritis or urosepsis at our institute. After evaluating with appropriate laboratory and radiological investigations, retrograde pyelography (RGP) and DJ stenting were performed in those who did not respond to intravenous antibiotic therapy. The RIRS was performed in patients who had filling defects in the pelvicaliceal system (PCS) on RGP after 3 weeks at the time of DJ stent removal. Patients with a minimum follow-up period of 6 months were included. Results: A total of 187 patients (81 female, 106 male) with diabetes with a mean age of 58.3 years were enrolled in this study. The mean serum creatinine was 2.7 mg/dL and mean estimated glomerular filtration rate was 32.8 mL/min/1.73 m2. One hundred twenty-six patients (67.3%) had hydroureteronephrosis (HUN), out of whom 74 (58.7%) had necrosed papillae in the PCS. In 61 (32.6%) patients, there was no HUN; however, 25 (41%) of these patients had necrosed papillae in PCS. Necrosed renal papillae were retrieved in 83 patients (46.1%) by RIRS. All the patients were followed up for a minimum period of 6 months; seven patients (3.8%) had recurrent pyelonephritis. Conclusions: The RIRS plays a significant role in the management of diabetic RPN. Retrieving necrosed papillae from the PCS after confirming their presence by RGP prevents ureteric obstruction, which leads to urosepsis, and presumptively prevents or delays future episodes of pyelonephritis.

Reusable vs. single-use cystoscope for removal of double-j stent: a prospective randomized comparison and cost analysis.

Two main types of cystoscopes, reusable cystoscope (RC) and disposable cystoscope, (DC) are used for the removal of ureteric stents. This study aimed to prospectively compare the effectiveness of disposable and reusable cystoscopes for the removal of ureteric stents. Patients who recently underwent double-J stent insertion were recruited and randomly assigned to the disposable and reusable cystoscope groups. Data were collected prospectively, which included pain scores (10-point visual analog scale), operation time, complications, and a 5-point Likert scale satisfaction assessment for surgeons, nurses, and patients. A cost analysis was also performed. The association between categorical data was assessed using the Chi-square/Fisher's exact test. The t-test was used to assess the mean difference in surgery time. Overall, 128 patients (mean age, 46.8 years) were included in the study; 64 procedures were completed using each cystoscope type. Stent removal satisfaction among surgeons and patients was equivalent in both groups, while nurses favored the disposable cystoscope. A significant reduction of 23% in the procedural time and 27% in the total operative time was observed in the disposable cystoscope group. Pain score was the same for both groups. Two patients in the reusable cystoscope group had UTI. No complications were reported in the disposable cystoscope group. Both disposable and reusable cystoscopes are comparable in terms of pain score and surgeons' and patients' satisfaction. Disposable cystoscope is more cost effective than reusable cystoscope.

Complications and Management of Retained Double-J Stents in Children During the Coronavirus Disease-2019 Pandemic.

Double-J (DJ) stents were commonly used for internal drainage after major reconstructive procedures or in cases of obstruction and ureteral injuries. They should be removed or changed within the stipulated time; otherwise, they can lead to various complications such as stent occlusion, migration, breakage, encrustation, stone formation at either end of the stent, and entanglement of the two stents if bilateral stenting was done. The present study focuses on the complications and the management due to delay in the removal of the DJ stents due to the coronavirus disease-2019 pandemic. This is a cross-sectional study over a period of 9 months. Children <12 years were included in the study. The patients' demographic data, indication for DJ stenting, time gap between DJ stenting and removal, complication with delay in DJ stent removal, and its management were recorded. Indwelling duration for >4 months was considered a delay in removal. All patients were followed up for 3 months. A total of 10 patients were included in the study. Encrustation, proximal migration, distal migration, knotting of the stent, and entanglement of the bilateral stents in the bladder were observed. These complications were managed by various endourological procedures such as ureteroscopy, percutaneous nephroscopic, and cystoscopic removal. During follow-up, all patients were symptom-free. Prolonged indwelling stents can cause various complications. Endourological procedures are an essential armamentarium for a pediatric surgeon to manage these complications. Proper patient counseling regarding indwelling stents and maintaining stent registry and sending automatic messages and e-mails to patients may prevent these complications.

Effects of tamsulosin and tamsulosin+solifenacin combination therapy for the treatment of ureteral stent related lower urinary tract symptoms

Objective: To evaluate the effect of tamsulosin and tamsulosin+ solifenacin combination therapy in improving the lower urinary tract symptoms of patients with indwelling double-J ureteral stents. Study design: Prospective observational comparative study Place and duration of study: Department of urology & Renal transplantation (dr. psims and rf) from March 2019 to October 2020. Methods: Total 100 patients having lower urinary tract symptoms after DJ stent insertion were selected for the study. DJ stenting was done in these patients following ureterorenoscopy (URS) and intracorporeal lithotripsy, percutaneous nephrolithotomy (PCNL), ureterolithotomy, pyelolithotomy, pyeloplasty and in patients with obstructive uropathy. All the patients were allocated two different groups. Group A received Tamsulosin 0.4 mg & Group B received Tamsulosin 0.4 mg and Solifenacin 5 mg daily once a day every day. The IPSS questionnaire was filled on day of per urethral catheter removal and on the day of DJ stent removal. Results were made on the day of DJ stent removal by comparing the mean change in IPSS in both groups. Independent sample t-test and paired t-test were applied. P-value < 0.05 was taken as significant. Result: Mean age was 41.6±13.75 years in Group-A and 38.24±12.24 years in Group-B. Total number of male patients was 25 (50%) in Group-A and 31 (62%) in Group-B. Female patients in Group-A were 25 (50%) and 19 (38%) in Group-B. Mean IPSS was 9.32 ±2.39 in Group-A and 9.52 ±3.39 in Group-B at baseline (p=0.62). After 2 weeks IPSS was 3.98 ±1.74 in Group-A and 2.36 ±1.51 in Group-B (p=0.0001). There was a statistically significant difference between group A and group B in the IPSS score. Trial registration: The study protocol was registered on Clinical Trials Registry- India (ICMR-NIMS) on April 30th, 2020 (registration number: CTRI/2020/04/024945). Conclusions: The mean change in IPSS by combined treatment of Tamsulosin and Solifenacin was significant when compared to Tamsulosin alone in treatment of DJ stents related LUTS.