double-J Ureteral Stent Research Articles

Forgotten Double-J ureteral stent: An analysis of 25 cases in a tertiary hospital

IntroductionDouble-J (DJ) ureteral stents are considered basic and common in daily urological practice. We aim to share our experience of managing 25 cases of forgotten double-J (DJ) stents in our tertiary care center. Methods and materialsWe did a retrospective analysis of cases with forgotten DJ stent for a period of one year spanning from February 2021 to February 2022. Detailed information like age, sex, the indication for insertion of the double-J, the period of insertion, presenting symptoms, and the definite procedure performed to remove the double-J. ResultsThe total number of cases was 25. We had 60% of patients underwent previous procedure in our hospital and the rest 40% were in other centers. The mean age was 38.44 years. The mean duration of the indwelling stent was 20.36 months, and the duration ranged from 13 months to 33 months.Most common indications for stenting were URS (64%). Presenting complaints were dysuria (n = 19; 76%), hematuria (n = 13, 52%), flank pain (n = 9; 36%), storage lower urinary tract symptoms (n = 8; 32%), and recurrent urinary tract infection (n = 5; 20%).Several complications were noted during or after forgotten stent removal like stent fragmentation (20%), fever (16%), sepsis (8%), and hematuria requiring transfusion (4%). ConclusionForgotten double-J ureteral stents are a source for morbidity. Patients should be educated about the complications of the forgotten double-J. Creating a scheduled program for notifying patients with double-J stent is another good way.

Complete intraureteral stent placement reduces stent-related symptoms: Systemic review and meta-analysis

The distal coil of a double-J ureteral stent is considered the major cause of stent-related symptoms. We noticed that some recent studies investigated whether complete intraureteral stent placement (CIU-SP) reduced these symptoms. The current systemic review and meta-analysis aimed to evaluate the safety and the effectiveness of CIU-SP, as compared to conventional stent placement (C-SP). We retrieved relevant trials published before December 2021 from three databases, including PubMED, Embase, and Web of Science. The following medical subject heading were used ((complete intraureteral stent) OR (suture stent)) AND (symptom OR pain) AND (randomized OR randomised). The above search was limited to English language publication. We identified six prospective randomized trials, all of which investigated a short-term (1-2 weeks) stent placement following uncomplicated ureteroscopic lithotripsy. The meta-analysis revealed that CIU-SP significantly reduced stent-related symptoms: CIU-SP had lower USSQ (Ureteral Stent Symptom Questionnaire) Urinary Symptom Index score (MD -5.13; 95%CI [-5.82,-4.44]; P<0.00001), lower USSQ Pain Index score (MD -4.21; 95%CI [-5.25,-3.17]; P<0.00001), and lower VAS pain scale (MD -1.93; 95%CI [-2.17,-1.69]; p<0.00001). Besides, patients with CIU-SP were less likely to have pain (RR 0.78; 95%CI [0.67,0.91]; p=0.001). There was no significant difference regarding the USSQ General Health and Work Performance. Both CIU-SP and C-SP had similarly few complications of Clavien-Dindo grade ≥2. This meta-analysis reveals that CIU-SP significantly decreases stent-related urinary symptoms and pain. Based on the current evidence, CIU-SP is ready to be applied in clinical practice, at least in those requiring short-term stent placement following uncomplicated ureteroscopic lithotripsy.

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.

Bacterial Colonization Incidence before and after Indwelling Double-J Ureteral Stents.

The upper urinary tract stenting allows to restore the ureteral patency in various situations. However, one of the main disadvantages of stenting is bacterial contamination, which can be a source of persistent infections that hardly respond to antibiotic therapy. The aim of this study was to investigate the local spectrum of bacterial pathogens and their susceptibility to antibiotics in order to optimize antibacterial therapy after upper urinary tract stenting. A prospective observational study was conducted in which 140 urine samples were examined (70 before stenting and 70 after stenting). Bacterial growth was detected in 37 patients (52.8%) before stenting and in 43 patients (61.4%) after stenting. E. coli (13 (28.8%)) and Streptococcus spp. (8 (17.6%)) strains were more commonly detected before stenting; P. aeruginosa (15 (31.2%)) and E. coli (8 (16.6%)) were usually revealed after stenting. The proportion of P. aeruginosa strains after stenting grew from 4.4% up to 31.2%. E. coli strains were resistant to ampicillin (92.3% before and 100% after stenting). Three strains of E. coli (23.1%) and six strains of P. aeruginosa (40%) were multidrug-resistant. Determination of the bacterial sensitivity to antibiotics and identification of antibiotic-resistant forms of bacteria is a factor in reducing the risk of complications and optimizing antibiotic therapy during the upper urinary tract stenting.

Fluoroscopy-guided trans-urethral exchange of double-J ureteral stents

BackgroundFor patients with malignant ureteral obstruction or stricture who require long-term internal drainage, plastic double-J stents (DJ stents) represent the mainstay of therapeutic strategies. DJ stents should be replaced at least once every 6 months to avoid infection or obstruction. Although DJ stents are generally replaced under cystoscopy, successful fluoroscopy-guided retrograde replacement of DJ stents in the interventional suite has been described in the literature.MethodsBetween April 2004 and May 2020, we exchanged 143 DJ stents in 19 male and 22 female patients under fluoroscopic guidance using Nelaton catheters, snare catheters, and 8F DJ stents. All procedures were performed with patients under sedation and local anesthesia. There were 39 patients with malignant ureteral obstruction and two patients with benign ureteral strictures. This study was approved by the Institutional Review Board. Technical success, clinical success, complications, procedure time, and mean interval between two procedures were retrospectively reviewed, and the factors affecting the success rate of the procedure were analyzed.ResultsObstruction was detected at the abdominal ureter in 4 patients, pelvic ureter in 29 patients, and intravesical ureter in 8 patients. Twenty-six patients underwent two or more sessions of the procedures, whereas 15 patients underwent single-session procedures. Total 34 outpatient-based procedures and 109 inpatient-based procedures were performed. Technical success and clinical success were achieved in 94.4% (135/143) and 93.3% (126/135) procedures, respectively. Mean procedure time was 21.5 min (range 9–192 min). Mean procedure interval was 101.8 days (range 5–306 days). Technical success was negatively affected by male sex and obstruction at the pelvic ureter and was positively affected by previous successful exchange. Left-sided ureteral stent placement and old age negatively influenced clinical success. Septic shock occurred in one patient and was treated with antibiotics.ConclusionFluoroscopy-guided trans-urethral exchange of DJ stents is an effective and less painful procedure.

Cystoscopic-guided Robotic Resection of Bladder Trigone Endometriosis Nodule with Ureteral Preservation

To demonstrate tips and tricks for the successful execution of robotic-assisted resection of a large bladder trigone endometriosis nodule while preserving the ureters. Stepwise demonstration with narrated video footage. An academic tertiary care hospital. Our patient is a 36-year-old G0P0 with a symptomatic full-thickness ill-defined nodule located in the posterior wall and trigone of the urinary bladder with anterior cul-de-sac endometriosis. Urinary tract endometriosis is a rare entity occurring in 1% of women with endometriosis and may involve the bladder and/or the ureters [1]. Bladder endometriosis (BE) frequently coexists with endometriosis in other locations such as the ovaries or peritoneum. Frequently seen lower urinary tract symptoms of BE include hematuria, frequency, and dysuria [2]. Previous literature has demonstrated the feasibility of a laparoscopic approach to BE in the trigone. However, there has yet to be any publications investigating the feasibility of robotic resection of bladder trigone endometriosis [3]. Cystoscopy was first performed, and the large mid-trigonal endometriosis nodule was noted to be extending within millimeters of the ureteral orifices. Bilateral ureteral orifices were identified, and double-J ureteral stents were sequentially guided up to the kidneys. The peritoneum lateral to the bladder bilaterally was incised to better define the edges of the bladder. Next, bilateral distal ureters were dissected out circumferentially, and the dissection was carried distally to the posterior bladder wall. Flexible cystoscopy with Firefly technology was then utilized to define the precise location and extent of the trigonal nodule to minimize removal of uninvolved bladder tissue and preserve the ureters. Using cystoscopic guidance, the dissection was first carried through the serosal and muscular layers, and once the circumference of the nodule had been clearly defined, we proceeded with the mucosal layer. The bladder lumen was entered, and the nodule was meticulously excised to avoid injury to the intramural ureters as the dissection was carried distally. We were able to preserve bilateral ureters despite the close proximity to ureteral orifices and also maintain enough bladder tissue for bladder closure. Once the resection of the trigonal nodule was completed, running 3-0 V-loc sutures were utilized in a 2-layer closure. The patient was discharged in 1 day with a Foley catheter and ureteral stents with reports of minimal pain. A cystogram at 10 days after the surgery was negative for leak, and the Foley catheter was removed. The ureteral stents were subsequently removed at 6 weeks after the surgery, and follow-up renal ultrasound demonstrated no hydronephrosis. Tips and tricks: (1) Utilizing robotic assistance in conjunction with cystoscopy aids the surgeon in precisely defining the boundaries of an endometriosis nodule and ureteral identification. (2) The precise dissection permitted by robotic-assisted surgery leads to greater tissue preservation of the bladder with complete endometriosis resection [4-6]. (3) Three-dimensional visualization provides depth of tissue analysis, which allows the surgeon to delicately dissect several centimeters of intramural ureter in the bladder wall and trigone. (4) Cystoscopy with Firefly technology guidance permits more precise localization compared with white light during dissection of the bladder nodule [7,8]. (5) The articulating instrumentation in the robotic surgical platform enables fine suturing technique [9,10]. Robotic-assisted resection of bladder trigone endometriosis with cystoscopic guidance may offer a precise and delicate dissection of large bladder trigone endometriomas, thus possibly providing optimal bladder trigone and ureteral preservation.

Outcomes of Mini-Percutaneous Nephrolithotomy in Children and Adolescents: A 10-Year Single-Centre Experience From Kuwait.

The current study retrospectively reviewed data for all children and adolescents who underwent mini-percutaneous nephrolithotomy (PCNL) at Ibn Sina Hospital and Sabah Al Ahmad Urology Centre in Kuwait over 10 years. Accordingly, the 40 patients underwent mini-PCNL. Among them, 21 patients (52.5%) had varying degrees of hydronephrosis, with mild to moderate severity accounting for nearly half of them, whereas six (15%) had multiple stones. The median operative time was 54.5 (43.3-64) minutes. Moreover, 11 patients needed flexible ureteroscopy (URS) and double-J (DJ) ureteric stent, and one patient required DJ ureteric stent only. None of the cases developed intraoperative bleeding. The median hospital stay of the included patients was three (2.3-4) days. Residual stone was observed in 11 patients (27.5%), with a median size of 3 (2 to 7) mm. The incidence of postoperative complications was 27.5% (n = 11 patients), with three patients experiencing postoperative bleeding (7.5%) and eight patients developing a fever (20%). All patients had mild postoperative pain. However, no leakage, sepsis, or pelvic injury occurred. None of the patients required revision. In conclusion, mini-PCNL was a safe and effective procedure in children and adolescents with renal stones.

Severe calcification of forgotten Double-J ureteral stent in a patient with undiagnosed hyperparathyroidism

Background Double J stent (DJ) is widely used in urological practice in patients with renal stones. However, its application is related to the risk of incrustation. We present a case of severe calcification of forgotten DJ in a patient with previously undiagnosed hyperparathyroidism (HPT). Case presentation A 30-year-old female was admitted to the Urology Department with renal colic. An initial kidney, ureter, and bladder X-ray revealed a completely calcified DJ catheter placed twelve months earlier. Unfortunately, the patient did not show up for a follow-up visit, and stent removal was not performed. Due to the extent of the disease, the patient was qualified for multistage endoscopic treatment. Total treatment lasted six months and consisted of five urereroscopies and one hybrid procedure. Simultaneously, diagnostics of a metabolic cause of the advanced stone disease suggested primary hyperparathyroidism, confirmed during parathyroid scintigraphy. After urological treatment had been completed, parathyroidectomy was performed. During a further 7-year follow-up, only one episode of renal colic occurred within the first year after treatment. The patient is stone-free until the present day. Conclusions Stents are designed to last usually up to six months, but they should be removed as quickly as possible after finishing treatment. Also, other causes such as a metabolic or hormonal imbalance should be considered. In our patient combination of forgotten DJ and HPT was the reason for excessive stone formation. Selective removal of the parathyroid gland was effective in the presented patient, with no stone recurrence observed.

MP048 - Double-J ureteral stents incrustation pattern characterization on scanning electron microscope.

MP048 - Double-J ureteral stents incrustation pattern characterization on scanning electron microscope.

Comparison of Percutaneous Nephrostomy and Ureteral DJ Stent in Patients with Obstructive Pyelonephritis: A Retrospective Cohort Study

Purpose Comparing the two different drainage methods of percutaneous nephrostomy (PCN) versus retrograde ureteral double – J (DJ) stent insertion in patients with obstructive pyelonephritis cases. Material and methods In this retrospective study, patients with obstructive pyelonephritis secondary to urolithiasis who underwent PCN or DJ insertion were included in the study. Patients were divided into two groups according to drainage method. After exclusion criteria, the study included 105 patients. The groups were compared for intraoperative outcomes, duration of fluoroscopy usage, the time needed for normalization of infection parameters (white blood cells (WBC), C – reactive protein (CRP), procalcitonin), and complications were observed. Results From 105 patients, 56 patients were in DJ stent group and 49 patients were in PCN group. According to intraoperative data, operative time and fluoroscopy duration were significantly shorter in the DJ ureteral stent group (P < .001). WBC returned to normal range in mean 3.5 ± 1.3 days in the DJ stent group and 3.2 ± 1.1 days in the PCN group (95% CI: −0.76–0.21, P = .268). There were no statistically significant differences identified for the duration for CRP, PCT and fever to return to normal range between the drainage methods. The complication rates was 51.8% for DJ stent group and, 30.6% in PCN group (P = .028). Conclusion Both methods are effective and safe in obstructive pyelonephritis. Despite the higher complication rate in DJ stent group, these complications were minor.

Characteristics of Bacterial Colonization and Urinary Tract Infection after Indwelling of Double-J ureteral Stent and Percutaneous Nephrostomy Tube.

Introduction:Infections associated with catheter in the upper urinary tract (CUUT), which include the double-J stent and the percutaneous nephrostomy (PCN) tube, get particularly infected in patients with specific risk factors for developing an infection.Methods:A retrospective observational study was carried out by compiling data from the hospital information system of a tertiary care center from 2019 to 2021 to evaluate infections in patients with catheter in the upper urinary tract.Result:A total of 200 pus samples of double-J stent (96 pus samples) and PCN tube (104 pus samples) were included in our study. Among patients with nephrostomy tube, the most frequently isolated microorganisms were Escherichia coli, followed by Pseudomonas spp. In those with a double-J stent, Pseudomonas aeruginosa, followed by E. coli were the most commonly isolated microorganisms. We found 55.72% of cases of Enterobacteriaceae-producing carbapenemases in patients with a percutaneous catheter. 66.07% of Enterobacteriaceae in patients with double-J and nephrostomy stents are extended-spectrum beta-lactamase-producing bacteria. The percentage of cultures with multiple-drug resistance (MDR) microorganisms was 38.54% in patients with double-J stents and 37.75% in nephrostomy tubes. The presence of prior urinary tract infection (P = 0.010), presence of urinary catheter before admission (P = 0.005), increased time with single urinary catheter in-situ (P < 0.001), and increased length of hospital stay (P = 0.036) were risk factors for isolation of MDR microorganisms.Conclusion:Pseudomonas spp. and Pseudomonas aeruginosa are commonly infecting both the CUUT. E. coli infections are more commonly infecting the nephrostomy tubes. MDR microorganisms are frequent, mainly in patients with prior urinary tract infection, presence of urinary catheter before admission, and prolonged use of a single catheter.

Colonic perforation during percutaneous nephrolithotomy: can we predict it

Background: Colonic perforation though rare but is one of the most dangerous complications of Percutaneous nephrolithotomy (PCNL) which may lead to increase significant post operative morbidity in worldwide, therefore, the aim of this study was to explore colonic perforation during percutaneous nephrolithotomy- Can we predict it.Methods: We reviewed retrospectively the data of 1270 PCNL procedures performed between April 2013 and April 2019 at Ayushyaman kidney hospital, Palanpur, North Gujarat, India. All parameters including demography, history, stone parameters, site of skin puncture and punctured calyx, were reviewed in all these patients.Results: Colonic perforation was found in 10 patients (7 males and 3 females) and the mean age was 40.5±20.0. The left side was affected in 4 patients and the right side was injured in 6 cases. Conservative administration was the treatment planned for all patients. It included withdrawal of the nephrostomy tube outside the kidney to the colon as a percutaneous colostomy, insertion of a double-J ureteral stent, intravenous broad-spectrum antibiotics, bowel rest and total parenteral nutrition. Under this conservative management, entire healing of the colon was achieved in all cases.Conclusions: Colonic perforation is rare complication in PCNL. High degree of suspicion, early diagnosis and timely management can prevent sepsis and peritonitis and minimize patient morbidity and mortality.

Quantitative Evaluation of Encrustations in Double-J Ureteral Stents With Micro-Computed Tomography and Semantic Segmentation

Accurate evaluation of stent encrustation patterns, such as volume distribution, from different patient groups are valuable for clinical management and the development of better stents. This study quantitatively compares stent encrustation patterns from stone and kidney transplant patients. Twenty-seven double-J ureteral stents were collected from patients with stone disease or who underwent kidney transplantation. Encrustations on stent samples were quantified by means of micro−Computed Tomography and semantic segmentation using a Convolutional Neural Network model. Luminal encrustation volume per stent unit was derived to represent encrustation level, which did not differ between patient groups in the first six weeks. However, stone patients showed higher encrustation levels over prolonged indwelling times (p = 0.02). Along the stent shaft body, the stone group showed higher encrustation levels near the ureteropelvic junction compared to the ureterovesical junction (p = 0.013), whereas the transplant group showed no such difference. Possible explanations were discussed regarding vesicoureteral reflux. In both patient groups, stent pigtails were more susceptible to encrustations, and no difference between renal and bladder pigtail was identified. The segmentation method presented in this study is also applicable to other image analysis tasks in urology.

Encrustation of the ureteral double-J Stents made of styrene/ethylene/butylene and polyurethane before and after implantation

Purpose: The aim of this study was to determine the affinity to crystal, calculi and biofilm deposition on ureteral double-J stents (DJ stents) after ureterorenoscopic–lithotripsy procedure (URS-L). The analysis was performed in two aspects: to determine which material used for fabricating ureteral stents promotes encrustation and which part of the DJ stents is the most vulnerable for blockage. Methods: One hundred and twenty patients with an indwelling DJ stent duration between 7 and 78 days were included in this study. The encrustation of DJ stents was characterized by scanning electron microscopy (SEM), and the mechanical properties of DJ stents were examined using the standard MTS Micro Bionix tensile test. Results: This study showed that polyurethane catheters have a much higher affinity for encrustation than styrene/ethylene/butylene block copolymer. Obtained results indicated the proximal (renal pelvis) and distal (urinary bladder) part is the most susceptible to post-URS-L fragments and urea salt deposition. Both the DJ ureteral stents’ outer and inner surfaces were completely covered even after 7 days of implantation. Conclusions: Performed analysis pointed out that polyurethane DJ stents have a much higher affinity for encrustation of calculi and NaCl crystals compared to the silicone-based copolymer. The surface of the ureteral stents needs improvement to minimize salt and kidney stone deposition, causing pre-biofilm formation and the occurrence of defects and cracks.

The Function Improved of the Newly Designed Magnetic-End Ureteric Stenting Retrieval Device: A Clinical Prospective Randomized and Control Trial in a Multicenter Study.

Objective To demonstrate the advantage of our newly designed magnetic ureteric stenting retrieval device over traditional nonmagnetic ureteric stents and other retrieval devices without cystoscopy intervention on clinical application and cost-related outcomes. Patients and Methods. A total of 333 patients were recruited into two study groups: magnetic-end ureteral stent (Group A) and conventional ureteral stent (Group B). The effects were evaluated by Ureteral Stent Symptom Questionnaire (USSQ) scores, complications of the indwelling stent, visual analog scale (VAS) pain scores at stent removal, and cost-analysis outcomes between the magnetic ureteric stenting retrieval device and traditional double-J ureteral stent (DJUS) removed by cystoscopy. Results The VAS of the pain score of patients undergoing magnetic stent removal with the retrieval device was 2 ± 0.97, whereas that of patients undergoing conventional ureteral stent removal with cystoscopy was 5.76 ± 1.53 (p < 0.001). The removal of magnetic stents by a retrieval device proved to be less painful than cystoscopy-mediated stent removal (p < 0.001). Obviously, the total cost for the magnetic stent removal was much lower than the conventional ureteral stent removal, although the magnetic stent costs more than the conventional ureteral stent. The improved magnetic stent used in our study showed a remarkable cost saving of 705/111 USD Chinese Yuan (CNY) per patient when compared with the conventional ureteral stent. Conclusion We reported the integrated design features of the improved magnetic stent in the world, which was granted a patent in China. USSQ scores and rate of complications in the magnetic stent were as equally acceptable as a conventional stent. Furthermore, successful stent insertion rate reached 100% by both the antegrade and retrograde approaches, and no failure case of magnetic stent removal was reported in our study.

Robotic ureteroplasty with appendiceal onlay flap: an update on the outcomes of 18-month follow-up.

BackgroundTo describe our technical experience of robotic appendiceal onlay flap ureteroplasty (RAUP) for complex ureteral stricture disease and report the updated analysis of 18-month follow-up outcomes.MethodsSince May 2019, nine patients with right ureteral strictures have undergone RAUP in our medical centre. Patients’ perioperative data and follow-up information were collected prospectively. Patients were excluded in present study if the postoperative follow-up time was less than 6 months.ResultsEight patients were recruited. Proximal ureteric strictures were present in 5 patients, and 3 patients had middle ureteric strictures. The mean stricture length was 4.3 cm (range, 3.0–6.0 cm). Nephrostomy was performed in 4 patients, and 4 patients had indwelling double-J ureteral stents before they were admitted to our hospital. All operations were implemented successfully without intraoperative complications. The mean operation time was 162 minutes (range, 135–211 minutes), and the mean estimated blood loss was 78 mL (range, 30–200 mL). The mean postoperative hospital stay was 8 days (range, 4–12 days). No patients had high-grade postoperative complications (Clavien-Dindo III and IV) 30 days after surgery. At a mean follow-up of 18 months (range, 6–28 months), all patients were not needed further surgical intervention and could be considered successful. But 2 cases still have stable mild hydronephrosis without symptoms such as flank pain or fever.ConclusionsRAUP is a workable option for managing long-segment (3–6 cm) proximal and middle ureteral strictures of the right side. The outcomes of 18-month follow-up are satisfactory.

Urine Bacteriology in Post-Kidney Transplant Patients with Double-J Stents

Background: Kidney transplantation is the gold standard treatment modality for patients with end-stage renal disease. Ureteric stenting is commonly used during kidney transplantation to reduce the incidence of ureteric complications post-transplantation. The presence of ureteric stents could be complicated by bacterial colonisation and urinary tract infections.&#x0D; Objective: To identify the urinary flora in patients with double-J stents following kidney transplantation and establish bacteria colonisation and their antimicrobial susceptibility.&#x0D; Methods: Over one-year, single urine samples of consecutive 100 post-renal transplant patients were subjected to bacteriologic analysis. Early morning midstream urine was obtained into a sterile bottle from all the participants for laboratory analysis.&#x0D; Results: The mean age of post kidney transplantation patients was 47.6 ±12.3 years. Hypertension and diabetes were the commonest co-morbidities associated with End-Stage-Renal-Disease (ESRD), accounting for 61% and 28%, respectively. E. coli was the commonest isolate (70.4%). Microbiological evidence of Urinary Tract Infection (UTI) revealed by pyuria (pus cells &gt;4/HPF) was found in 40.9%. Tigecycline, nitrofurantoin and tetracycline showed the highest sensitivity pattern in 9%, 8% and 8%, respectively, with significant resistance against cephalosporins and fluoroquinolones.&#x0D; Conclusion: The fourth week of double-J ureteric stent insertion in kidney transplant recipients showed a high incidence of urinary bacterial colonisation.

Urosepsis secondary to ureterosciatic hernia corrected with ureteral stent placement: a case report and literature review

BackgroundUreterosciatic hernia is a rare type of pelvic floor herniation that occurs through the sciatic foramen. The resulting ureteral obstruction may lead to hydronephrosis and to further complications including urinary tract infection and urosepsis. There have been 30 reported cases of ureterosciatic hernia. Ureteral stenting and surgical repair have been used as treatment options.Case presentationWe report the case of an 86-year-old woman who was transferred to Tokyo Metropolitan Bokutoh Hospital with symptoms of fever and septic shock. Her computed tomography scan revealed left hydronephrosis and deviation of the left ureter into the sciatic foramen; she was therefore diagnosed with a left ureteral sciatic hernia and admitted in our intensive care unit for further treatment with resuscitative fluids, vasopressors, and antibiotics. Following a retrograde insertion ureteral catheter insertion, ureteral incarceration was relieved, and a double-J ureteral stent was placed in situ. Antibiotic treatment was initiated, and the patient’s hemodynamic status gradually improved.ConclusionsAlthough ureterosciatic hernia is a rare disorder, it is associated with serious complications including urinary tract infection with sepsis, which may warrant urgent corrective procedure to relieve the structural obstruction. Treatment may be conservative or surgical, though treatment with ureteral stent placement may be a favorable approach in elderly patients with multiple comorbidities presenting with urosepsis.

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.

Effects of silodosin, darifenacin, and combination therapy for the treatment of ureteral stent related discomforts

Background: To evaluate the effect of silodosin, darifenacin and combination therapy of two agents in improving the lower urinary tract symptoms of patients with indwelling double-J ureteral stents.Methods: A total of 150 patients underwent placement of a double-J ureteral stent after retrograde ureteroscopy for urinary stone disease. All patients received polyurethane double-J ureteral stents (4 Fr and length 26 cm), which were removed at a mean of around 14 days postoperatively. A total of 40 patients were given no medication (group 1), 39 patients were given silodosin 4 mg once daily (group 2), 40 patients were given darifenacin 7.5 mg once daily (group 3), and 31 patients were given a combination of two agents postoperatively (group 4). International prostate symptom score (IPSS) and visual analogue pain scale (VAPS) questionnaires were completed by each patient at 1st day postoperatively and on the day of stent removal.Results: In the total group of patients, the mean age was 50.24±12.90 years. There was a significant difference in the IPSS total score between group 1 and groups 3 and 4. Group 4 also differed significantly from group 1 in the irritative subscore. The obstructive subscore differed between groups 2 and 4 and group 1. There was a statistically significant difference between group 1 and group 4 in the quality of life (QoL) score.Conclusions: Combination therapy with silodosin and darifenacin improved both irritative and obstructive symptoms more than in the other groups. Combination therapy should be strongly considered for patients who complain of stent-related symptoms.