double-J Stent Removal Research Articles

MP53-04 DOUBLE-FACE AUGMENTATION URETEROPLASTY WITH BUCCAL MUCOSAL GRAFT: A NOVEL SURGICAL TECHNIQUE FOR RECONSTRUCTION OF COMPLEX URETERAL STRICTURES AND INJURIES

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Ureter (including Pyeloplasty) and Bladder Reconstruction (including fistula), Augmentation, Substitution, Diversion II (MP53)1 Sep 2021MP53-04 DOUBLE-FACE AUGMENTATION URETEROPLASTY WITH BUCCAL MUCOSAL GRAFT: A NOVEL SURGICAL TECHNIQUE FOR RECONSTRUCTION OF COMPLEX URETERAL STRICTURES AND INJURIES Mohamed Nafie Mohamed NafieMohamed Nafie More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002083.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The aim of this study is to demonstrate our new surgical technique in reconstruction of long-segment ureteral stricture or injury that is not amenable to primary excision and anastomosis. We used this technique as an alternative to intestinal segment interposition due to its high morbidities or tubularized graft interposition due to its high failure rate. METHODS: From January 2019 to January 2021, seven cases of complex upper ureteric stricture were operated by our new technique of double augmentation with buccal mucosal grafts (posterior inlay graft quilted to the psoas muscle and anterior onlay graft fixed to an omental flap as adouble _face augmentation). The perioperative and follow-up data were recorded. Surgical success was assessed by serial ultrasound, ureterograms and renal scan. Complete success was defined as the absence of clinical symptoms, no need for ancillary procedures normal ureterograms and a stable estimated glomerular filtration rate (eGFR) without serious complications. RESULTS: At median follow-up of 10 months (range, 4-23), all patients achieved the successful criteria of treatment without serious complications. The median length of stricture was 4.5 cm (range, 4-7). The median length of the harvested buccal mucosa graft was 7 cm (range, 5-10), 1.7 cm width ( range 1.5- 2) divided in two long grafts. The median operative time was 150min (range, 120-230). The median estimated blood loss was 100 ml (range, 50-200). The median hospital stay was 2.5 days (range, 2-4). The median time for DJ stent removal was 1.5 months (range, 1-2). Retrograde ureterogram was done at the time of DJ stent removal, followed by serial ultrasound every three month, Intravenous urography at 6 month and renal isotope scan at one year then ultrasound every 6 months. CONCLUSIONS: The double_ face augmentation ureteroplasty with buccal mucosal graft is a feasible and safe surgical technique for complex ureteral strictures and injuries, with low peri-operative morbidity and excellent intermediate-term outcomes. It can be used as a substitution to intestinal segment incorporation or tubularized graft. Source of Funding: No © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e940-e940 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mohamed Nafie More articles by this author Expand All Advertisement Loading ...

Identifying Silent Fungal Infections Complicating Obstructive Uropathy Due to Renal Papillary Necrosis in Diabetic Patients –A Step Towards Preventing Recurrent Obstructive Uropathy

Introduction and Objectives: Renal papillary necrosis is one of the common causes of obstructive uropathy in diabetic patients. During removal of necrosed renal papilla, many patients were observed to have fluffy necrotic material in the ureter, and renal pelvis, and a few among them present again with recurrent episodes of obstructive uropathy and sepsis following DJ stent removal. Our study aimed to identify the significance of this fluffy necrotic material and its evaluation by histopathological examination (HPE). Materials and Methods: This is a prospective observational study done in our institute by compiling data of 56 patients admitted with obstructive uropathy secondary to renal papillary necrosis who underwent a protocol-based treatment from 2016 to 2019. All these patients underwent initial DJ stenting followed by check flexible ureteroscopy or nephroscopy after 6 weeks. The white, necrotic fluffy material collected during initial DJ stenting or with subsequent flexible ureteronephroscopy was sent for HPE. All these patients were followed up for 1-3 years. Results: Out of 56 patients, 15 patients had fluffy necrotic material in the bladder on initial cystoscopy, of which 1 patient was diagnosed with aspergillosis and 1 patient with candida infection on HPE. During check flexible ureteroscopy (FU), 19 patients had minimal burden of fluffy necrotic material in renal pelvis, of which one patient was diagnosed with aspergillosis, one with candida (same patient diagnosed on cystoscopy), and one patient with both aspergillus and candida colonies on HPE. 5 patients had the significant burden of fluffy necrotic material in the renal pelvis, requiring removal via percutaneous nephroscopic access. Among these 5 patients, 2 were diagnosed with aspergillosis and 1 with candida infection on HPE. A total of 32 patients had single papilla, and 24 had multiple papillae in the pelvicalyceal system. 5 out of 7 patients with positive fungal pathology had negative fungal cultures. Compared to our historical data of 4% mortality and 22% recurrent obstructive uropathy in the 3 years preceding the adoption of this protocol, with the present protocol, no patient developed recurrent pyelonephritis during follow-up of 1–3 years after DJ stent removal following complete evacuation of necrotic material and appropriate antifungal treatment. Conclusion: This study highlights the need for check ureterorenoscopy and removal of all necrotic papillae and debris to establish a microbiological and histopathological diagnosis along with proper antifungal treatment to prevent episodes of recurrent pyelonephritis and obstructive uropathy.

COMPARISON OF PAIN INTENSITY BETWEEN LIDOCAINE GEL AND INTRAURETRAL TRAMADOL WITH LIDOCAINE GEL IN THE DJ STENT REMOVAL

Objective: To determine the difference in pain intensity between the administration of a combination of tramadol and intraurethral lidocaine gel with only lidocaine gel during the removal of DJ stents. Material & Methods: This study was a prospective randomized clinical trial with 22 patients that were divided into 2 groups. Group 1 was given a combination of tramadol and lidocaine gel urethral injection 3 to 5 minutes before DJ stent removal, whereas group 2 was given lidocaine gel urethral injection 3-5 minutes before the removal. The inclusion criteria in this study was all patients with a DJ stent placement with 1 to 3 months prior to release who were willing to participate. The Wong-Baker scale was used directly to determine the scale of pain during the procedure. Mann Whitney analysis was used to analyze the findings. Results: Most patients in group 1 are shown to have a pain rating of 2. There are 2 patients with a high pain rating scale of 6 and 7. In group 2, most patients claimed that the procedure was painless. The average Wong-Baker pain scale in group 1 (2.9) compared to group 2 (0.36) was significantly different. Conclusion: The combination of intraurethral tramadol and 2% lidocaine gel can significantly decrease pain during DJ stent removal more effectively than sole intraurethral 2% lidocaine gel based on the Wong-Baker pain scale.

In situ Management of Large Upper Ureteric Calculus by Mini-Percutaneous Nephrolithotomy in the Era of Retrograde Intrarenal Surgery.

PurposeThe aim of the study is to demonstrate the ease and success of in situ management of large upper ureteric stones with mini percutaneous nephrolithotomy (PCNL).MethodsThis was a prospective observational study conducted in the Department of Urology between January 2018 and June 2019. All patients underwent standard prone mini PCNL with 15Fr amplatz with 80 cases of fluoroscopic and 12 cases of ultrasound guided access. In three cases of tortuous ureters, wire was passed via retrograde catheter and retrieved via amplatz to straighten the ureter. Calculi fragmented with laser.ResultsA total of 77 patients were included in this study, 62 unilateral and 15 bilateral cases (92 renal units). The mean age was 45.4±13.7 years (range 17–71), male to female ratio was 61:16, the disease laterality (left: right) was 28:34. The mean stone size was 17.6±1.4 mm. Mean operative time was 22.4±1.5 min. 88% patients were discharged as day care. Complication rate was 6.5%, three patients had transient fever and two patients had distal migration of small fragments and they were extracted at the time of DJ stent removal by rigid ureteroscopy (100%).ConclusionWe conclude that it is easy and effective to deal with large upper ureteric calculus when it is in a fixed position. In situ management of large upper ureteric calculus by mini-PCNL can be done safely and effectively as it is a fast procedure, prevents unnecessary manoeuvres, less complication rates and has good stone clearance rates.

Effect of Ureteral Stent Length and Position of Stent Coil in Bladder on Stent-Related Symptoms and Quality of Life of Patients.

Introduction: Various standardized questionnaires can evaluate ureteral stent-related symptoms. The present study utilized a validated instrument, Ureteral Stent Symptoms Questionnaire (USSQ), to know the impact of the length of double J stent (DJS) in comparison to ureter length on patients and their quality of living.Materials and Method: This study is a prospective clinical study conducted in the Department of Urology at a tertiary care center in South India. Patients who underwent DJS after endoscopic ureteral lithotripsy were included in the study. On a computerized tomography scan, the ureteral to stent length ratio (USR) was calculated. USSQ scores at the time of DJS removal and two weeks thereafter were recorded. The distal coil of the stent in the bladder was recorded as grade 1 - not crossing the midline and grade 2 - crossing the midline. Different symptom scores were compared between both grades of bladder coil and for USR of all the patients.Result: A total of 157 patients were included in the study. Over 46 (29.3%) patients had grade-1 and 111 (70.7%) had grade-2 bladder coil. Totally 93 (59.23%) patients reported pain, while 64 (40.77%) patients had no pain. Grade-2 coil patients had more pain than grade 1 (P=0.01). There was a weak inverse relationship between the USR and urinary symptom (P=0.004), pain symptom (P=0.04), and quality of work (P=0.005).Conclusion: Stent length or position of the intravesical stent coil does not appear to affect the quality of life except for the pain. Hence, choosing stent length according to ureteral length seems to have a minimal role in decreasing stent-related morbidity.

Forgotten double J stent in crossed renal fused ectopia: a rare case report

Ureteral double J (DJ) sent has now become one of the most commonly used tools in endourology. Complications are bound to occur if forgotten to remove, such as encrustations, infection, migration, renal dysfunction, hydronephrosis. Crossed renal fused ectopia is a very rare congenital malformation due to abnormal kidney ascent with fusion during embryogenesis in the first trimester. we report a very rare case of forgotten DJ stent in crossed fused ectopia, in 66 years old diabetic patient post left ureterorenoscopy (URS) done 3 years back. Retrograde intrarenal surgery (RIRS) was done for DJ stent removal right.

An Alternative Loop Snare Technique with Many Loops Using a Simple Guide-Wire for Removal of a Double J Stent: A Case Series

Background: Removal of a double J (DJ) stent has been conventionally performed with conventional snare wires, tissue forceps, or stone baskets under fluoroscopic guidance. However, if the lumen is collapsed, is very wide, or if the tip of the DJ stent is lodged in the bladder wall, the procedure becomes difficult. Patients and Methods: We retrospectively reviewed four patients who had undergone retrieval or replacement of their DJ stents by interventional radiologists with an alternative loop snare technique using a guide-wire after conventional attempts using a snare catheter had failed. Results: Five DJ stents were completely removed without any complications. Conclusion: The loop snare technique using a guide-wire could be an alternative and inexpensive approach for difficult DJ stent removal.

PT108 - What are the organizational impacts of the new single use solution for the DJ stent removal procedures?

PT108 - What are the organizational impacts of the new single use solution for the DJ stent removal procedures?

P1736FIRST PROSPECTIVE CLINICAL STUDY OF A SINGLE-USE STERILE CYSTOSCOPE DESIGNED FOR DOUBLE J (DJ) STENT REMOVAL IN AN ITALIAN TRANSPLANT CENTER

Abstract Background and Aims A DJ is routinely placed during kidney transplantation then post-operatively removed, usually within the first month after transplantation. The removal is mainly performed in urology unit, through reusable rigid scope in an operating theatre with anesthesiologist assistance. Such removal procedure requires a complex environment with reprocessing, periodic maintenance and repairs of scopes, leading to delays and postponed stent removals. Hematuria, pain or dysuria due to the local trauma, and urinary infection are the most common complications of the DJ removal procedure. To overcome these issues, we introduced in April 2018 in our unit the single use sterile cystoscope ready to use with integrated grasper designed for DJ removals. Method We hereby report our experience with single-use flexible cystoscope (Isiris® – Coloplast). We prospectively collected data of any DJ stent removal operation from April 2018 to December 2019 (92 procedures). Urine culture at the removal day and usually 1 week after, at the first outpatient control was performed. All complications (related or not to the procedure) were recorded. All removals were performed in our unit by the nephrologist. 87 patients were treated, from which 82 as outpatients, and 5 as in-patients. Results 86 out of 87 patients stent removals were effectively done with Isiris®. In a single case, we could not remove the stent with the single-use instrument and resorted to traditional rigid cystoscopy under general anaesthesia. This happened with the sixth patient of our series and we think that this failure happened in the learning curve phase. In 4 cases stent removal wasn’t possible at first attempt due to likely interference of the internal stitches of the anastomosis: our policy is NOT to force stent removal if any resistance is felt to light pulling. Indeed, in all 4 cases a second procedure performed one month later was completely successful with smooth withdrawal of the device. In one case, a removal procedure was not possible because of urethral stricture and stent removal was postponed after its treatment. Taking into account these five patients the success rate of using Isiris® is 98.9% during this period. No patient was admitted for complications related to the removal procedure, namely for symptomatic urinary tract infection requiring antibiotics. Two patients were admitted for obstructive nephropathy (namely ureteral stenosis) which became evident after stent removal. 16 patients had an asymptomatic positive urine culture for a multi-resistant microbe before the stent removal and maintained positivity after the procedure. 11 patients were negative on the day of the stent removal and resulted positive in the control done at the first control. Again, none developed symptoms, and none required treatment. 9 patients were positive before stent removal and were negative on the first control. The rest of the patients were negative both at baseline and thereafter. Conclusion Due to the simplicity of the procedure by the single use solution (with 98.9% removal success, no operating theatre, no anaesthesiologist) and the fact that it is entirely managed by the transplantation clinic staff, the timing of the stent removal always respected physician’s indication, with no procedure delayed for organizational reasons. Knowing the infection risk associated with longest ureteral stent dwell durations, and the vulnerability of these immunosuppressed patients, it is important to remove the DJ as safely as possible and in defined time. In our study, no patient had to be admitted for urinary tract infection after the procedure nor developed symptomatic urinary tract infection to be treated with antibiotics.

The course of alterations in ureteral jet dynamics following kidney transplantation: a prospective observational cohort study.

To prospectively investigate the alterations and normal ranges of ureteral jet dynamics after double-J-stent (DJS) removal in patients who underwent renal transplantation (RTx). Patients who underwent RTx were prospectively evaluated between November 2017 and June 2018. After RTx, Doppler ultrasonography (D-US) was performed on all patients after DJS removal. Renal artery resistive index (RA-Ri), renal pelvis anterior-posterior diameter (RP-APD), pelvicalyceal system dilation (PCSD), and ureteral jet flow dynamics (maximum and average velocity; JETmax and JETave) were measured by D-US. Also, patients' demographics, estimated glomerular filtration rate (eGFR) levels, and acute rejection were investigated in the study. Patients were assessed two different times by D-US, about 6 and 12 weeks after DJS removal, and the two different measurements were compared with the Wilcoxon test and Chi-square test. A total of 25 patients were evaluated in the study. Nonobstructive PCSD rate (12% vs 8%), JETave (18.8 vs 12.9 cm/sec), and JETmax (29.2 vs 20 cm/sec) levels were significantly decreased (p values are 0.01, 0.010 and 0.014, respectively). In addition, monophasic and square pattern rates were significantly observed to increase over time (p=0.035); however, ureteral jet patterns were correlated between the two different D-US measurements (R=0.225, p=0.032). After RTx, dilation rate and ureteral jet flow velocities were significantly decreased, and monophasic and square JETpattern rates were significantly increased over time. Ureteral jet dynamics can provide useful information about the follow-up of peristaltic activity in the pelvic-ureteric system.

P094 - The use of a virtual reality device (HypnoVR®) during outpatient DJ stent removal procedures: Initial results from a feasibility study

P094 - The use of a virtual reality device (HypnoVR®) during outpatient DJ stent removal procedures: Initial results from a feasibility study

Double J stent removal in paediatric patients by Vellore Catheter Snare technique: a randomised control trial

Double J (DJ) stents placed at the end of paediatric urological procedures require another cystoscopy under general anaesthesia for removal. The second author developed a reproducible technique for snaring the DJ stent using an infant feeding tube (6-Fr or 8-Fr) and a 3-0 polypropylene suture per urethra. Having demonstrated the proof of concept, ethical clearance was obtained for an institutional randomised controlled trial. The aim of the study was (1) to describe the Vellore Catheter Snare (VeCS) technique for DJ stent removal, (2) to study the efficacy of the technique and (3) to compare the costs of VeCS technique with cystoscopy on an intention-to-treat basis. The study design was that of a randomised control trial with parallel groups as a non-inferiority study. Forty children with unilateral indwelling DJ stents were enrolled from January to August 2018. They were randomised by unequal allocation (1:3) to cystoscopic and VeCS technique removal arms. The VeCS technique and cystoscopy were successful in 86.67% (26/30) and in 100% (10/10) cases, respectively, with no statistically significant difference in the outcome (p=0.223). The average cost for cystoscopic removal of the stent was INR 14,579and was INR 5636.5for the VeCS technique (on an intention-to-treat basis). While per-urethral catheterisation is an outpatient/ward procedure in children, cystoscopy is not. Other techniques such as extraction strings and magnetic stents with their extraction device were found to have certain disadvantages. The VeCS technique, using common disposables, circumvented the need for inpatient admission, disinfected equipment usage and operation theatre time in 87% children, thereby reducing the costs incurred by the patient. The VeCStechnique for DJ stent removal is a practical low-cost safe alternative to cystoscopic removal of DJ stents in children. Although the technique has a high success rate, it still needs the backup option of cystoscopy under general anaesthesia.

Clinical Utility of the Modified Snare Technique for Percutaneous Antegrade Removal of Double J Ureteral Stents.

Although a snare is the commonly used device for antegrade double J (DJ) stent removal, there are some cases in which DJ stent removal using only a snare is particularly difficult. In the present study, an unfavorable positioning of the proximal DJ stent tip and tip embeddedness were significantly associated with a simple snare technique failure; thus, present the modified snare technique to overcome the simple snare technique failure. By applying these 2 techniques together, we can increase the overall technical success rate up to 97% (196/202). The modified snare technique is safe and effective in cases of simple snare technique failure.

Prospective trial of single-use, flexible cystoscope for ureteric double-J stent removal: Cost and utility analysis

Objective: The objective of this study is to evaluate the costs and benefits of Isiris (Coloplast, Denmark), a mobile, single-use, flexible cystoscope with a built-in stent grasper. Methods: A prospectively collected database was reviewed to define procedural outcomes for Isiris ureteric stent removal. Variables assessed included stent duration and location of removal. A cost assessment was performed evaluating the impact on costs, funding and facility use. Results: Seventy-five procedures were performed using Isiris between April and September 2017. There were no complications. Two procedures failed because of encrustation and poor visibility secondary to haematuria. The mean (SD), median (interquartile range) and range of delay were 2.1 (0–5.3), 0 (0–2) and 0–40 days, respectively. Only one patient was delayed more than two weeks; this occurred because he was placed on a theatre waiting list, which resulted in the 40-day delay. Overall, the cost benefit for our department with the introduction of the Isiris system has been a surplus of $104,434, with an extra 65 elective spaces free for diagnostic flexible cystoscopy cases. Conclusion: Isiris flexible stent removal offers our patients a rapid stent-removal service with low rates of removal delay. Savings have been made in scope repair costs, sterilisation and scope maintenance, as well as optimisation of theatre and procedure room space. Level of evidence: 1c

Extrarenal calyces mimicking retroperitoneal cystic mass with concomitant ureteropelvic junction obstruction: renal pelvis reconstruction using calyx unification.

Extrarenal calyces (ERCs) are a very rare urological anomaly, especially when concomitantly presenting with ureteropelvic junction obstruction (UPJO). Surgical intervention is often necessary in ERCs associated with UPJO, with dismembered pyeloplasty being the most commonly utilized technique. We present a case of UPJO-associated ERCs in which renal pelvis reconstruction using calyx unification was selected as the treatment technique. An 11-year-old boy was referred to our center due to bilateral hydronephrosis and left multicystic kidney disease. Magnetic resonance imaging showed severe left hydronephrosis with concomitant left cystic mass and left UPJO. A 99mTc diethylenetriaminepentaacetic diuretic renal scan showed residual renal function of 25.9% split function and 26.8 mL/minute glomerular filtration rate. Intraoperatively, we found ERCs with severely dilated renal pelvis. The renal pelvis was excised. Major calyces protruding from the kidney were unified using side-to-side anastomosis to form a new structure resembling a renal pelvis, which was further anastomosed to the ureter. Temporary urinary drainage from the affected kidney was achieved using a double-J (DJ) stent and nephrostomy. Pathological examination revealed atrophic transitional epithelial cells. There was no intra- or postoperative complication reported. The nephrostomy tube and DJ stent were removed 2 weeks and 3 months after surgery, respectively. Ultrasonography examination performed at 1 and 9 months after DJ-stent removal showed no hydronephrosis. We conclude that renal pelvis reconstruction using calyx unification can be performed safely and is effective in treating patients with ERCs associated with PUJO. This technique should be considered especially in cases where excision of the renal pelvis cannot be avoided.

THE EFFECT OF SILODOSIN AND SODIUM DICLOFENAC TO REDUCE PAIN AFTER DJ STENT REMOVAL IN SOETOMO HOSPITAL: DOUBLE-BLINDED RANDOMIZED-CONTROLLED TRIAL

Objective: To analyze, measure, compare, prove, and evaluate effectiveness of silodosin, diclofenac sodium, and the combination of both drugs in pain management after stent removal. Materials & Methods: Thirty-three patients were divided into three groups. Group I was given diclofenac Sodium 50 mg, group II was given silodosin 8 mg and group III was given the combination of diclofenac sodium 50 mg and silodosin 8 mg. The Wong Baker Pain Scale (WBPS) was assessed serially: two hours before the DJ stent removal, during DJ stent removal, and after the DJ stent removal (2 hours and 24 hours after). The data was analyzed by ANOVA and Kruskal-Wallis test. Results: In this study, 33 patients who underwent DJ stent removal were obtained. Wong Baker was presented in median (min-max) form. The WBPS study in each group did not differ statistically significant. Lowest WBPS during DJ stent removal was found in group III. Group III was better and statistically significant in reducing pain compared to group I and group II (p<0.05). WBPS two hours after removal in each group decreased and group III was better and statistically significant in reducing pain compared to group II, whereas group III compared to group I had an equivalent effectiveness. While the WBPS 24 hours after removal had the same value and did not differ significantly. No side effects or adverse events were found in the use of diclofenac sodium, silodosin, and their combinations. Conclusion: Single oral dose of diclofenac sodium combined with silodosin is effective to reduce pain after DJ stent removal.

Tamsulosin in Lowering Double J Related Symptoms

Background: Indwelling double J ureteral stents are used routinely in the resolution of ureteral obstruction caused by different etiologies. Evaluation of urinary symptoms related to double-J stent indicate that these affect 73-90% of patients. Aim of this study is to evaluate the effect of tamsulosin on the DJ related complications to improve the quality of life and render symptom free life. Material and Methods: Quasi experimental study was carried out in the department of urology in College of Medical Science, teaching hospital Chitwan, Nepal from 15th March 2017 to 15th March 2018. A total of 80 post operative patients were included in this study and were randomized into Group A and B with 40 patient in each group. Stent related symptoms, quality of life and IPSS (International prostate symptom score) were evaluated at the time of discharge and at the time of DJ removal. Pain was evaluated with the help of VAS at the time of discharge and at the time of DJ removal. Data were entered in MS-Excel and were imported to EZR software Version 3.4.1 for analysis. A p-value of less than 0.05 was considered significant. Results: Median age was 30.5 in Tamsulosingroup and24years in placebo group. (p=0.68).At the time of discharge significant difference was noted in IPSS (p<0.001), butno significant difference wasnoted with QoL index (p=0.932) and VAS (p=0.68). At the time of DJ stent removal, significant difference was noted with IPSS (p<0.001), QoL index (p<0.001), VAS (p=0.004) in Tamsulosin group than in Placebo group.
 Conclusion: Tamsulosin lowers stent related symptoms, pain and improves quality of life in patientswith indwelling DJ stent.
 Key words: DJ stent; IPSS; Tamsulosin; VAS.

Timing of Double-J Stent Removal and Occurrence of Urological Complications

Timing of Double-J Stent Removal and Occurrence of Urological Complications

Fluoroscopically Guided Retrograde Double-J Stent Removal in Renal Transplant Patients

Fluoroscopically Guided Retrograde Double-J Stent Removal in Renal Transplant Patients

Externalized Ureteral Catheter Versus Double-J Stent in Tubeless Percutaneous Nephrolithotomy for Upper Urinary Stones: A Systematic Review and Meta-Analysis.

The objective of this meta-analysis was to compare the efficacy and safety of externalized ureteral catheter (EUC) and Double-J stent (DJS) in tubeless percutaneous nephrolithotomy (PCNL) for patients with upper urinary stones based on published literature. A comprehensive literature search using Pubmed, Embase, and Cochrane Library was performed to find studies comparing outcomes of EUC and DJS for treating patients with upper urinary stones up to December 2017. Seven studies, which included 863 patients from 5 randomized controlled trials (RCTs) and 2 non-RCTs published between 2009 and 2017, met our inclusion criteria and were included in this systematic review and meta-analysis. Between-studies heterogeneity was assessed and sensitivity analysis was conducted based on RCTs. The stent-related symptoms were higher for DJS compared with EUC (odds ratio [OR]: 0.09; confidence interval [95% CI]: 0.01-0.61; p = 0.01). No significant differences were found in minor (Clavien I-II) complications (OR: 1.37; 95% CI: 0.93-2.01; p = 0.11), major (Clavien III-V) complications (OR: 1.38; 95% CI: 0.73-2.60; p = 0.32), hemoglobin drop (weighted mean difference [WMD]: -1.43 g/L; 95% CI: -3.65 to 0.78; p = 0.2), pain score (VAS) (WMD: 0.01; 95% CI: -0.28 to 0.29; p = 0.95), analgesic required (OR: 1.02; 95% CI: 0.77-1.34; p = 0.91), stone-free rate (risk ratio: 0.98; 95% CI: 0.9-1.07; p = 0.67), duration of hospitalization (WMD: -0.21 days; 95% CI: -0.86 to 0.44; p = 0.53), and operative times (WMD: -7.59 minutes; 95% CI: -18.81 to 3.64; p = 0.19). We concluded that compared with DJS, EUC is also an effective alternative for patients with upper urinary stones in tubeless PCNL and could help patients by reducing stent-related discomfort and avoiding cystoscopy for DJS removal. However, the inherent limitations of the included studies should be considered, and well-designed RCTs with further large sample size should be performed to validate our findings.