double-J Stent Insertion Research Articles

Is double-J stent mandatory in complete supine percutaneous nephrolithotomy for adult patients with staghorn renal stones?

It is controversial whether double-J (DJ) stent insertion is necessary in tubeless percutaneous nephrolithotomy (PCNL) for patients with staghorn stones. We compared the outcomes of using ureteral catheters and double-J stents in tubeless complete supine PCNL (csPCNL) of staghorn stones. In this analytical cross-sectional study, from May 2008 to August 2022, 123 patients who underwent tubeless csPCNL were assessed. Patients were divided into two groups by either tubeless csPCNL with DJ stent (Group I; n = 23) or totally tubeless just with perioperative ureteral stent (Group II; n = 100). Demographic characteristics, stone-related factors, perioperative and postoperative parameters were compared in groups. Baseline characteristics were comparable in groups. The operative time in group I was significantly longer than group II (68.26 vs. 55.25min, P = 0.05). However, the duration of hospitalization in Group I was shorter than the other group (1.81 vs. 2.37 days, P = 0.03). Stone free rate was notably higher in Group I (90.5% vs. 79.8.0%) with no statistically significant difference. No significant differences were found in major complications. Patients in Group II had a significantly shorter time to return to normal life (6.48 vs. 7.91day; P = 0.043). Multivariable linear regression showed the preoperative creatinine level and stone size can affect the operative time (P = 0.02). In addition, stone number and underlying disease can affect the length of hospital stay (P = 0.007 & 0.030, respectively). Although not inserting a double J stent after csPCNL has acceptable results, because of higher residual rate in staghorn stone which cause more incidence of renal colic, longer time of hospital stay and return to normal life, inserting DJ stent is recommended.

Comparative Approaches in Treating Double-J Stent Syndrome: Monotherapy or Combination Therapy?

Introduction: The application of double-J ureteral stents in urology is widespread, but their use is often accompanied by complications and bothersome symptoms, affecting patients' quality of life (QoL). While various medications have been tested for alleviating the symptoms associated with double-J stents, consensus on their effectiveness remains elusive. This study aims to investigate the effectiveness of tamsulosin, solifenacin, mirabegron, desloratadine, and combination therapy using a Romanian-adapted version of the Ureteral Stent Symptom Questionnaire (USSQ). Materials and Methods: A prospective, observational, randomised trial was conducted at the Urology and Renal Transplant Clinic of Dr. "C.I. Parhon" Clinical Hospital in Iasi between 1 January 2022 and 1 August 2023. Three hundred twenty seven patients who underwent their first double-J stent insertion were evaluated with the Romanian-adapted USSQ at baseline and 30 days post-insertion. Patients were randomly divided into six groups based on the prescribed medications: control, tamsulosin, mirabegron, solifenacin, desloratadine, and combination therapy. Results: The data suggest a significant reduction in symptoms in patients who received medication compared with the control group. Furthermore, the combined medication of solifenacin 10 mg and tamsulosin 0.4 mg was particularly effective in reducing pain with statistical significance compared to the control group (p = 0.001). The highest mean scores for urinary symptom severity were observed in the control group (12.37 ± 6.82), and the lowest was in the mirabegron group (9.94 ± 5.82). The individuals who received a daily dose of 50 mg of mirabegron saw the most notable influence on their job. Conclusions: While no single medication emerged as a "miracle drug" for managing symptoms related to double-J stent insertion, the combination therapy of solifenacin and tamsulosin is the most promising option for improving symptoms related to double-J stent insertion and QoL. Additional extensive research is required to validate these initial results.

Effect of theophylline on stent-related symptoms in patients undergoing Double-J ureteral stent insertion: a randomized controlled trial.

To investigate the effect of oral theophylline on stent-related syndrome (SRS) after Double-J insertion. Double-J stent is widely using in many urological procedures. Infection, hematuria, and discomfort are some of common complication after stenting. Theophylline is a dimethylated xanthine that inhibits phosphodiesterase and blocks adenosine receptors. To relaxing effect of theophylline on smooth muscles and its effects on the urinary system, it seems it could reduce complications after inserting Double-J stent especially ureteral stent syndrome. In this double-blind placebo-controlled randomized clinical trial, 67 patients were enrolled. Mean (SD) age of control and theophylline group was 51.8 (12.5) and 43.9 (10.4) years old, respectively. Patients were randomized into two groups of control and theophylline. All patients were stenting with silicon Double J. Theophylline group received 100mg of theophylline, twice daily for 30days, while control group received placebo. Stent symptoms were assessed by questionnaire and urine culture was performed before stent removal at removal day. Statistical analysis was performed using Chi-squared test and t test with P < 0.05 considered significant. Logistic regression models were fitted, crudely and adjusted for age and sex. Of 67 eligible patients, 60 completed the study. Theophylline significantly decreased percentages of gross hematuria (P < 0.001), dysuria (P < 0.001), and urinary frequency (P < 0.001). Microscopic hematuria (P = 0.042) and chills (P = 0.042) also decreased after theophylline. Theophylline could be an effective and safe choice for reducing SRS among patients undergoing Double-J stent insertion.

Predictive Factors of Successful Double J Stent Insertion Among Advanced Cervical Cancer Patients.

Cervical cancer remains the most lethal and prevalent cancer among women. Obstructive uropathy is a common complication of advanced cervical cancer, caused by the expanding tumor. One of the recommended treatments for this condition is the implantation of a double J (DJ) stent. However, this procedure is challenging due to the unique characteristics of the patient. The objective of this study was to identify the variables that influence the successful insertion of a DJ stent in women with advanced cervical cancer. This retrospective study included women who attempted to have a DJ stent implanted at the General Hospital of Adam Malik in Medan, Indonesia, between January 2020 and December 2022, and were diagnosed with advanced cervical cancer. The inclusion criteria were limited to cervical cancer patients in stages III-IV, according to the International Federation of Gynecology and Obstetrics (FIGO) staging standard, who underwent an attempt at DJ stent insertion. Patients who underwent a nephrostomy and received a DJ stent were excluded from the study. The participants were divided into two groups based on the success of the DJ stent implantation. The analysis was conducted using the logistic regression test and the Chi-square test. The study included 88 patients with advanced-stage cervical cancer, of whom 45 underwent nephrostomy and 43 received a DJ stent. The analysis revealed that lower levels of hydronephrosis (odds ratio (OR): 18.203, P = 0.001), urea (OR: 4.207, P = 0.037), and creatinine (OR: 6.923, P = 0.004), higher levels of urine output (OR: 8.26, P = 0.003), and lower cervical cancer stage (OR: 4.125, P = 0.022) were all predictors of successful DJ stent insertion. For women with advanced cervical cancer, lower degrees of hydronephrosis, urea, and creatinine levels, higher urine output, and lower cervical cancer stage were all predictive factors for successful DJ stent implantation.

Efficacy and safety of extracorporeal shock wave lithotripsy (ESWL) in pielic stones and infected hydronephrosis after double-J stent insertion

Efficacy and safety of extracorporeal shock wave lithotripsy (ESWL) in pielic stones and infected hydronephrosis after double-J stent insertion

Assessment of the incidence and risk factors of postoperative urosepsis in patients undergoing ureteroscopic lithotripsy.

Ureteroscopic lithotripsy (URSL) is an approved, minimally invasive, low-risk procedure for urolithiasis treatment. However, some patients may develop urinary tract infection (UTI) post-procedure, eventually leading to urosepsis. Determining the predictors of infection after URSL would help identify patients at a high risk of urosepsis, thereby enabling the early implementation of effective treatment. Therefore, we aimed to establish the incidence and predictors of urosepsis after URSL. We assessed 231 patients who underwent URSL using a holmium laser. The incidence of urosepsis during the 30-day post-treatment period was analysed, and potential predictors of urosepsis, including patient characteristics and individual clinical factors, were examined. Statistical analysis revealed that 16.88% of patients had a confirmed positive urine culture before the procedure. Post-procedure urosepsis occurred in 4.76% of patients. Univariable analysis revealed that 3 factors were significantly associated with the risk of postoperative urosepsis: double-J stent insertion before URSL, pre-operative positive urine culture, and MDR pathogen found preoperatively. In multivariable analysis, only positive urine culture remained significantly associated with the risk of urosepsis after URSL. Patients with positive urine culture before URSL are at significantly higher risk of urosepsis in the postoperative period. Hence, urine culture should be routinely performed before planned endoscopic urolithiasis treatment.

Which position is more advantageous for percutaneous nephrolithotomy: supine or prone?

Percutaneous nephrolithotomy (PNL) can be performed in a number of different positions. Our aim was to evaluate the convenience and advantages of the supine position following the transition from the prone to the supine position. 94 patients undergoing supine PNL (Group-1) and 93 patients undergoing prone PNL (Group-2) were retrospectively reviewed and included in the study. Patients who underwent mini-PNL (mPNL) were selected from Group-1 and Group-2 and divided into Group-1A supine mPNL patients (77) and Group-2A prone mPNL patients (53). Demographic characteristics, operative data and post-operative parameters were compared between these groups. The operation time was 74.4 ± 21.9min in Group-1A and 79.2 ± 19.8min in Group-2A (p= 0.076). The median value of fluoroscopy time was 30s in Group-1A and 40s in Group-2A (p= 0.003). In Group-1A, 59 patients had no intraoperative double-J stent (DJS) insertion and 18 patients had DJS insertion, while in Group-2A, 24 patients had no DJS insertion and 29 patients had DJS insertion (p < 0.001). MPNL was performed in 81.9% of patients in the supine position and 57% in the prone position. This difference was statistically significant (p < 0.001). No significant difference was found with regard to the success rate and the complications of mPNL. Fluoroscopy time is shorter in the supine position. Moreover, the insertion rates of DJS are low. With increasing experience, we have found that our standard PNL (sPNL) rate is gradually decreasing and more mPNL is being performed.

Safety and effectiveness of magnetic ureteric stent removal under ultrasound control: a randomized single center trial.

To assess the safety and effectiveness of magnetic ureteric stent removal with a special magnet retriever under ultrasound guidance. A total of 60 male patients, who underwent ureteroscopy from October 2020 to March 2022, were prospectively enrolled and randomized into two groups. Group A patients underwent conventional double-J (DJ) stent insertion and subsequent stent removal via flexible cystoscopy. Group B patients underwent stent insertion using magnetic ureteric stent [Blackstar, Urotech (Achenmühle, Germany)] and stents were removed using a special magnet retriever under ultrasound guidance. Stents were left in situ for 30days in both groups. All patients had follow-ups with a ureter stent symptoms questionnaire at 3- and 30-days post stent insertion. Visual analog scale (VAS) was assessed immediately after stent removal. Stent removal time (142.5s vs 142.5s, group A vs group B, p < 0.0001) and VAS scores (4 vs 1, group A vs group B, p = 0.0008) were significantly lower in Group B. There were no statistically significant differences between both groups in the "urinary symptoms" (p = 0.3471) and "sexual matters" (p = 0.6126) in the USSQ domains. There was marginal statistical significance favoring Group A in the "body pain" (p = 0.0303), "general health score" (p = 0.0072), "additional problems" (p = 0.0142), and "work performance" (p < 0.0001) domains. Magnetic ureteric stent can be considered as a safe and efficient alternative to conventional DJ stent. This approach avoids the need for cystoscopy, saving resources while minimizing patient discomfort.

The Comparison of Clinical Outcomes Between DJ Stent Insertion and Percutaneous Nephrostomy in Patients with Obstructive Uropathy due to Cervical Cancer

Background: Metastatic cervical cancer into the ureter may lead to obstructive uropathy due to mechanical ureteral blockage. The insertion of a double J (DJ) stent and percutaneous nephrostomy (PCN) are some options that can be offered to the patients, but until now the comparison between these two procedures is still debated. Aim: The aim of the study is to compare the clinical outcomes of DJ stent insertion and PCN in the management of uropathy obstructive secondary to cervical cancer. Materials and Methods: This study is an analytical observation with a retrospective cohort design. We analyzed the difference in clinical outcomes between the two procedures such as 24-hour renal function, the number of visits due to procedure or device related complications, quality of life and overall survival in patients with stage 3B cervical cancer. Results: We collected 108 patients with uropathy obstructive secondary to stage 3B cervical cancer from January 2019 to July 2021, of which 54 underwent DJ stents insertion and 54 underwent PCN. There was no difference in the improvement of renal function between the two procedures (p=0.184), as well as on the parameters of quality of life (p=0,909) and overall survival (p=0,582). We found a significant difference in patient visits to the hospital due to procedure related complications. Patients who have a DJ stent inserted are more often come to the hospital because of fever and pain compared to patients who have PCN procedures (p=0,027). Conclusion: Percutaneous nephrostomy is superior to DJ stent insertion in terms of procedure related complications. However, an individualized approach regarding the most appropriate procedure in palliative care patients should be recommended.

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

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 (&gt;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.

Minimally invasive ureteral reimplantation or endoscopic management for primary obstructive megaureter: a narrative review of technical modifications and clinical outcomes.

Primary obstructive megaureter (POM) has various courses in different age populations. Although open ureteral reimplantation (OUR) remains the standard treatment for symptomatic POM, it is highly invasive with potential complications. In recent years, minimally invasive ureteral reimplantation (MIUR), including laparoscopic ureteral reimplantation (LUR) and robotic-assisted laparoscopic ureteral reimplantation (RALUR), and endoscopic management, such as double-J stent insertion, endoureterotomy and endoscopic balloon dilatation (EBD), have been utilized for POM in selected patients. However, few comparable studies between MIUR and endoscopic management have been published to date, and it remains unclear which surgical management is the optimal choice for POM in different age groups. This review provides a comprehensive perspective on technical development and clinical outcomes of MIUR and endoscopic management for POM in pediatric and adult populations. The PubMed and Web of Science databases were used to comprehensively search English language articles related to MIUR and endoscopic management for POM in pediatric and adult populations up to March 2022. The technical modifications and the relevant clinical outcomes were reviewed. MIUR with various technical modifications related to intracorporeal suturing and ureteroneocystostomy with anti-reflux techniques appears to be as safe and effective for POM in different age groups as the open procedure. Double-J stent insertion should be regarded as a temporary option for infants by achieving internal urinary drainage, as it may present limited success rates and various complications. Endoureterotomy using pure cutting current or laser appears to be a safer, easier, and less invasive alternative to open surgical management. While EBD has emerged as a definite treatment for POM in the pediatric population, it is debatable whether EBD can substitute for MIUR in adult patients. The safety and feasibility of MIUR and endoscopic management in patients from all age groups still need further investigation.

Impact of drainage technique on surgical treatment of ureteropelvic junction obstruction in adults

Introduction. Urinary drainage is a key part of ureteropelvic junction obstruction treatment. Both external and internal drainage methods have been widely used for many years, but there is now relevant research comparing these methods and their impact on surgical outcomes in adults. The aim of the current research was to assess the efficacy and safety of two different types of urinary drainage on adult pyeloplasty. Material and methods. We conducted a retrospective and prospective clinical controlled study in the Department of Urology at the Republican Clinical Hospital from Chisinau. We reviewed 118 consecutive adult pyeloplasties for ureteropelvic junction obstruction. In 62 (52.54%) patients, we used double-J ureteral stent insertion (DJ); in another 56 (47.46%) patients, we used different types of external drainage (ED): uretero-pyelo-nephrostomy, nephrostomy, or a combination of both. Operative time, hospital stay, use of analgesics, overall complications, type of complications, and success rates were compared between the two groups. Results. The mean operative time in the DJ group was 93.52±18.10 min. vs. 95.77±20.48 min. in the ED group (p = 0.001). The average postoperative hospital stay in the DJ group was 8.45±2.02 days vs. 14.71±3.45 days in the ED group (p=0.000). The DJ group used 7.77±3.48 analgesics on average, while the ED group used 9.86±4.64 (p = 0.006). Overall complication rate was 9.68% in the DJ group and 32.14% in the ED group (p = 0.002). The most frequent complication for all patients was acute pyelonephritis (12.71%): 4.84% in the DJ group vs. 21.43% in the ED group (p = 0.007). The success rate was 96.77% in the DJ group and 92.86% in the ED group. Conclusions. Both urinary drainage methods appear equivalent concerning overall success rates, but double-J ureteral stents are associated with a shorter operating time, fewer postoperative pain medications, a shorter postoperative hospital stay, and a lower number of postoperative complications compared with external urinary drainage methods.

Outcomes of ureteroscopy and internal ureteral stent for pregnancy with urolithiasis: a systematic review and meta-analysis

ObjectivesTo investigate the outcomes of internal ureteral stents in comparison with ureteroscopy (URS) for pregnant women with urolithiasis.Data sourcesRelevant studies published from January 1980 to June 2022 were identified through systematic literature searches of MEDLINE, EMBASE, Web of Science and the Cochrane Library.Methods of study selectionA total of 499 studies were initially identified. We included pregnant women in any stages of gestation who underwent double-J (D-J) stent insertion only or ureteroscopy for the treatment of urolithiasis; for a study to be included, the number of participants needed to exceed 10. This systematic review was registered on the PROSPERO website (Reference: CRD42020195607).ResultsA total of 25 studies were identified with 131 cases undergoing serial stenting and 789 cases undergoing URS. The pooled operative success rate was 97% for D-J stent insertion and 99% for URS. Only a few patients passed stones spontaneously after serial D-J stenting. The pooled stone free rate (SFR) in URS operations was about 91%. For internal ureteral stent therapy, the rate of normal fertility outcomes was 99%, although the pooled incidence of complications was approximately 45%. For group receiving URS treatment, the rate of normal fertility outcome was 99% and the pooled incidence of complications was approximately 1%. However, the pooled rate of premature birth and abortion were the similar between the two groups (< 1%); the rate of serious complications was also similar between the two groups.ConclusionsAlthough internal ureteral stents may cause more minor complications, both ureteroscopy and internal ureteral stents showed had low rates of adverse effects on fertility outcomes when used to treat pregnant women with symptomatic urolithiasis. Evidence suggests that URS may have a greater advantage for pregnant patients with urinary stones when conditions permit. Since, it has been proven to be safe and effective, internal ureteral stents could be considered in emergency or other special situations.

Primary versus delayed ureteroscopy for ureteric stones: A systematic review and meta-analysis

Background: Ureteric colic is a major clinical and economic burden on the National Health Service. There has been a recent paradigm shift to consider definitive surgery as the primary intervention at the time of initial presentation. Objective: To systematically evaluate the outcomes of primary/emergency ureteroscopy versus delayed/elective ureteroscopy. Methods: We performed a critical review of MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials–CENTRAL, CINAHL, Clinicaltrials.gov, Google Scholar and individual urological journals in April 2020. A robust database search was performed using a combination of the terms ‘primary ureteroscopy’, ‘immediate ureteroscopy’, ‘delayed ureteroscopy’ and ‘emergency ureteroscopy’. Adult patients (&gt; 16 years) with ureteric stones presenting as an emergency were included. Results: Twelve studies met the inclusion criteria, with 4 studies directly comparing primary/emergency to delayed/elective ureteroscopy for an acute presentation of ureteric colic. Across the studies, 1708 patients underwent primary/emergency ureteroscopy for ureteric calculi and 990 underwent delayed ureteroscopy. No significant differences in stone-free rates were found between both groups with primary/emergency achieving 85% and delayed/elective 91% ( p = 0.68). The majority of stones treated were located in the distal ureter in both groups. Overall, there were no differences in complications between the groups ( p = 0.42) or major complications (0.17). However, there were fewer minor complications in the primary URS group ( p = 0.02). Ureteral catheter or double-J stent insertion was used in 71% of delayed/elective ureteroscopy cases, compared to 46.8% of primary/emergency cases (p = 0.001). For patients undergoing primary/emergency ureteroscopy, 6.4% patients required auxiliary procedures. In the delayed/elective group, 7.6% required further definitive treatment (NS). Conclusion: Primary ureteroscopy is a safe and feasible procedure, when performed in suitable patients in the acute setting. It is associated with significantly lower stent usage, equivalent stone clearance, no increase in overall or major complications including sepsis, and fewer minor complications when compared to delayed/elective ureteroscopy. Prospective studies will do well to explore this area further but on current evidence, primary ureteroscopy is the safe procedure. Level of evidence: Not applicable

Neutrophil to lymphocyte ratio as an early indicator for ureteral catheterization in patients with renal colic due to upper urinary tract lithiasis.

To evaluate whether the neutrophil-to-lymphocyte ratio (NLR) can predict the need for ureteral catheterization in patients with renal colic. We retrospectively studied 15,887 patients with renal colic between 2005 and 2019. Patients with prior antibiotics treatment (156), with hematological diseases (15), with negative computerized tomography scan (CTS) for stone disease (473) or with no available laboratory findings (1750) were excluded. A ureteral double J stent (DJS) was inserted in case of ongoing pain, fever, sepsis, single kidney and elevated blood creatinine levels concomitant with hydronephrosis. A cut-off value of 2.1 NLR was determined to stratify and to compare patients using multivariable logistic regression models. A locally weighted scatterplot smoothing (LOWESS) plot was also applied to show the relationship between NLR and predicted probability for DJS insertion. Thirteen-thousand and 493 patients with a mean age of 42.7 years (30% females and 70% males) were included in the study. Five-hundred and 57 patients (4.1%) underwent early DJS insertion: 5.3% vs. 1.5% of patients with high vs. low NLR, respectively, (p<0.001). High NLR was significantly associated with longer hospitalization time, admission to the intensive care unit and overall mortality within a month from admission (p<0.05). LOWESS plot showed that NLR value >2.1 escalates progressively the probability for DJS insertion. A high NLR is associated with the need for early internal DJS insertion due to urolithiasis. The NLR is easily calculated from simple blood tests and based on our results can be used for clinical decision making in patients with renal colic needing renal decompression.

Sheathed flexible retrograde intrarenal surgery without safety guide wire for upper urinary tract stones.

To assess the success rate and intraoperative complications of flexible ureterorenoscopy (f-URS) in patients with upper urinary tract (UUT) stones using a ureteral access sheath (UAS) without a safety guide wire (SGW). Between April 2010 and March 2022, 464 renal units in patients with renal stones with and without concomitant ureteral stones (UUT), underwent ureterorenoscopy by one surgeon, and UAS was used in all of them. The primary endpoint was the stone-free rate (SFR). SFR was defined as no residual fragments at all. The following characteristics were examined: age, sex, laterality, renal/ureteral stones, stone diameter, SFR, Hounsfield unit, auxiliary procedures, double-J stent insertion, and intraoperative complications. This study was retrospective, with all the data recorded prospectively. Patients with residual stones were scheduled for the 2nd RIRS. The Clavien-Dindo classification was used to report complications. The mean patient age was 52.9 years. The mean stone size was 13.1 mm. Lower pole, upper and middle calyces, renal pelvis and ureteral stones were found in 51.5% (239), 34.9% (162), 18.3% (85) and 46.9% (218) of cases, respectively. The mean diameter was 8.1 mm, 8 mm, 12.5 mm and 8.1 mm for the lower pole, upper and middle calyces, renal pelvis and ureteral stones, respectively. The single- and second-session SFRs were 90% and 100%, respectively. The mean number of procedures per renal unit was 1.1. Ureteral double-J stents were inserted in 45.7% (212) of patients. In 96 cases, a stent was placed before surgery. Postoperative complications were minor, with no avulsion or perforation of the ureters; readmission and insertion of a DJ stent occurred in one patient. Ureteral stricture developed in one patient (0.2%) and needed treatment with laser ureterotomy. f-URS is a safe and effective mode of surgical management of renal and simultaneous renal and ureteral calculi using the ureteral access sheath without a safety guide wire. A guide wire should not be routinely used in these cases.

A descriptive study of experience of laparoscopic repair of retrocaval ureter in a tertiary care institute in Eastern India

Background: Retrocaval ureter (RCU) is a rare congenital anomaly. It occurs due to anomalous development of inferior vena cava (IVC) and not ureter. Here, we describe our experience in surgical techniques and operative results of laparoscopic reconstruction for patients with RCU. Aims and Objectives: The aims of this study were to obtain information regarding clinical presentation, demographic profiles, investigations, indications for intervention, postoperative complications of laparoscopic repair of retrocaval repair, and also to develop laparoscopic surgical skill without causing any untoward effects to the patients. Materials and Methods: Twelve patients with RCU were enrolled in this study. The mean age was 32.4-years-old (23–37 years). All patients were preoperatively evaluated with different relevant imaging modalities. Laparoscopic surgery with transperitoneal approach with insertion of double-j stent was performed to all patients by same surgeon without excision of compressed ureter. Post-operative follow-up was done with ultrasonography every 3 months and repeat DTPA renogram every 6 months for 2.4 years. Results: All operations were completed laparoscopically without conversion to open surgery. There was no obstruction or symptom after the mean follow-up of 2.4 years. Conclusion: Transperitoneal laparoscopic repair is a feasible, safe, and effective modality of The treatment for RCU. Careful dissection along the planes with good respect to tissue and proper hemostasis during each step is the key to success for laparoscopic repair of RCU.

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.

ХИРУРГИЧЕСКОЕ ЛЕЧЕНИЕ ПОВРЕЖДЕНИЙ МОЧЕТОЧНИКА В АКУШЕРСКОЙ И ГИНЕКОЛОГИЧЕСКОЙ ПРАКТИКЕ

Introduction. Ureteral injury (UI) during obstetric and gynecological surgical procedures is one of the most serious and severe complications. Objective. To improve the outcomes of management of UI identified after obstetric and gynecological surgical procedures. Material and methods. A study of long-term outcomes of surgical management of 47 women aged 19 to 62 (median 48.5) years with ureteral injury (UI) was carried out in wards of the department of urology. All women underwent prior surgical procedures in gynecological (n=40) and obstetric (n=7) departments. Results. On the day of admission to the urological hospital, optical uretheroscopy and retrograde ureteropyelography were conducted on all women, and an attempt to insert double J-stent was made. The results of these procedures show that 6 women underwent reconstructive surgical repair, 33 had double J-stent insertion, and 8 had a percutaneous nephrostomy. On average, after 3 months, all patients underwent follow-up examinations, which showed that complete restoration of urodynamics on the side of the injury did not occur in 20 patients; they were reoperated. The final distribution of the procedures carried out is as follows: open access reconstructive surgical repair - in 15 patients, double J- stent insertion - in 23, ureteral bougienage and stent placement - in 6, laser dissection and endoureteroplasty - in 3. Good outcomes were observed in 38 (80.9%) patients, and satisfactory outcomes - in 9 (19.1%). Conclusions. The most significant investigations in the diagnosis of UI and options of the management plans were identified. The analysis of the outcomes of the use of X-ray endoscopic methods in the management of UI identified after obstetric and gynecological surgeries shows that their use in most cases help to restore urodynamics in the ureter avoiding more difficult reconstructive surgical repair procedures.

Emphysematous Pyelonephritis Disparities observed in the use of percutaneous drainage techniques.

ObjectivesThe recent drop in the mortality rates of emphysematous pyelonephritis, a serious medical condition, is attributable to renal percutaneous drainage (PCD) techniques that have also reduced the necessity for surgery. Since the difference in the objectives of the two specific techniques, i.e. PCD and percutaneous nephrostomy (PCN), is often overlooked, this study aimed to highlight the inconsistencies in the use of these two techniques.MethodsA retrospective study of 17 patients was conducted over a 10-year period from January 2008 to December 2017 at The Royal Hospital, Muscat, Oman. All patients had undergone abdominal computerised tomography. The obtained images were reviewed and categorised based on Huang and Tseng’s classification.ResultsFrom the sample, 13 patients (76%) were categorised as class I and II, three (17%) as class IIIA and one (6%) as class IIIB. Five patients from the class I and II categories underwent drainage of the pelvicalyceal system, four by PCN and one by a double-J stent insertion. PCN was performed on all the class IIIA and IIIB patients. One class IIIB patient required PCD for localised gas and fluid collection but later underwent emergency nephrectomy. There were no mortalities.ConclusionThe favourable outcome of this study was in keeping with those of the more recent studies. However, despite the present classifications and guidelines, wide variations were reported in the use of percutaneous drains with PCD, ranging from 2.5–91%. The lack of precise guidelines may be a cause of these disparities in clinical management.