double-J Ureteral Stent Research Articles

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

Forgotten Double-J Ureteral Stents: Prevalence, Risk factors and Complications

Background: Ureteral JJ stents (DJS) are a common part of urological practice and are used for the management of upper urinary tract obstruction and ureteral surgery, despite their advantages; ureteral stents are not without possible morbidity. Objective: This study aimed to record the prevalence and possible reasons behind neglected DJS and its complications. The difficulties associated with their removal and risk factors correlate with these difficulties. Patients and Methods: A cohort study including 517 patients presented with fixed DJS presenting to Department of Urology, Al-Azhar University Hospitals; Cairo; Egypt. With neglected DJS (indwelling for more than 6 months). We noted the complications of neglected stents (urinary tract infection, gross hematuria, encrustation, migration and stent fragmentation), the treatment modalities and risk factors for these complications. Results: From the entire patients, 239 (46.2%) had a neglected stent with mean stenting duration 11.11 ± 8.6 months. A total of 26.8% of patients received urine acidification, 26.4% were stone formers, 32.2% presented with urinary tract infection (UTI) and 33% had gross hematuria. Encrustations on the stent were recorded in 17.2% of patients and fragmented stent in 4.6% and 2.5% migrated stent up. The stent was removed by cystoscopy in 201 cases (84.1%). Other cases needed combined endoscopic and/or open surgical procedures. Lack of urinary acidification was a significant risk factor for UTI and complex interventions for stent removal (P = 0.013 and 0.017, respectively). Stent fragmentation were more likely with longer duration of stenting (P = > 0.001). Conclusion: Neglected DJS are associated with significant morbidity, urine acidifications is protecting against complications.

Forgotten Double-J Ureteral Stents: Prevalence, Risk factors and Complications

Background: Ureteral JJ stents (DJS) are a common part of urological practice and are used for the management of upper urinary tract obstruction and ureteral surgery, despite their advantages; ureteral stents are not without possible morbidity. Objective: This study aimed to record the prevalence and possible reasons behind neglected DJS and its complications. The difficulties associated with their removal and risk factors correlate with these difficulties. Patients and Methods: A cohort study including 517 patients presented with fixed DJS presenting to Department of Urology, Al-Azhar University Hospitals; Cairo; Egypt. With neglected DJS (indwelling for more than 6 months). We noted the complications of neglected stents (urinary tract infection, gross hematuria, encrustation, migration and stent fragmentation), the treatment modalities and risk factors for these complications. Results: From the entire patients, 239 (46.2%) had a neglected stent with mean stenting duration 11.11 ± 8.6 months. A total of 26.8% of patients received urine acidification, 26.4% were stone formers, 32.2% presented with urinary tract infection (UTI) and 33% had gross hematuria. Encrustations on the stent were recorded in 17.2% of patients and fragmented stent in 4.6% and 2.5% migrated stent up. The stent was removed by cystoscopy in 201 cases (84.1%). Other cases needed combined endoscopic and/or open surgical procedures. Lack of urinary acidification was a significant risk factor for UTI and complex interventions for stent removal (P = 0.013 and 0.017, respectively). Stent fragmentation were more likely with longer duration of stenting (P = > 0.001). Conclusion: Neglected DJS are associated with significant morbidity, urine acidifications is protecting against complications.

Bacterial Colonization of Ureteral Double-J Stents in Patients with Negative Urine Culture

Bacterial Colonization of Ureteral Double-J Stents in Patients with Negative Urine Culture

Pyelolithotomy in a Patient with Complete Coraliform Calcification Induced by a Double-J Ureteral Stent

The placement of a double-J ureteral stent enables the treatment of upper urinary tract obstruction. Despite advances, forgetting the stent favors the occurrence of calcification, leading to increased morbidity rates, lawsuits, and a financial burden on the healthcare system. This paper describes a successful pyelolithotomy for the removal of a calcified double-J ureteral stent.

Smartphone-based stent tracking application for prevention of forgotten ureteral double-J stents: a prospective study.

ABSTRACTPurpose:Retained or forgotten ureteral stents (FUS) have a potential to cause significant morbidity as well as medico-legal issues and increased cost. We aimed to evaluate the efficacy and usefulness of smartphone-based Ureteral Stent Tracker (UST) application and compare the results with basic appointment card system to prevent FUS, prospectively.Materials and Methods:A total of 90 patients who underwent ureteroscopic stone treatment procedure with indwelling DJ stents were equally distributed into two groups. In group-1, patients were followed using UST application. In group-2, only appointment cards were given to the patients. Two groups were compared in terms of stent overdue times and complete lost to follow up rates.Results:Forty-four patients in group-1 and 43 patients in group-2 completed the study. Among patients, 22.7% in group-1 and 27.9% in group-2 did not return for the stent removal on the scheduled day. In group-1, these patients were identified using the UST and called for the stent removal on the same day. After 6 weeks of maximal waiting period, mean overdue times in group-1 and group-2 were 3.5 days and 20 days, respectively (p = 0.001). In group-2, 3 patients (6.9%) were lost to follow up, while in group-1, it was none (p = 0.001).Conclusions:We found that the patients who were followed by the smartphone-based UST application has less overdue times and lost to follow up cases compared to the basic appointment card system. The UST application easily follows patients with indwelling ureteral stents and can identify patients when overdue.

Prospective Randomized Controlled Study Evaluating Efficacy of Alpha-Blockers, Antimuscarinics or Combination Therapy in Relieving Ureteral Stent-Related Symptoms

AbstractBackground: Double-J ureteral stent placement is a routine urologic procedure after most of urological interventions. Great efforts are being done to decrease stent symptoms including; improving stent materials, physical properties, and design. Also the application of a combination of alpha-blockers and antimuscarinics are used in our study.Aim of Study: We evaluated the effectiveness and safety of tamsulosin, solifenacin, and combination of both in reducing double-J stent-related lower urinary symptoms.Patients and Methods: A total of 120 patients with double-J ureteral stenting were randomly divided, post-operatively, into 4 groups. In Group A (n=30), tamsulosin 0.4mg was given, Group B (n=30) received solifenacin 10mg daily, Group C (n=30) received solifenacin 10mg and tamsulosin 0.4mg daily, and Group D (n=30) received placebo (control group). Two weeks after discharge was the first time of evaluation (pre-treatment assessment), using an arabic validated version of USSQ. The second visit was after 4 weeks from surgery just before stent removal (post-treatment assessment).Results: There were statistical significance in urinary symptoms, pain, general health and work performance scores in favour of Group III as compared to the tamsulosin group, the solifenacin group, and the control group (p-value <0.001).Conclusion: Combined therapy of tamsulosin and solif-enacin significantly alleviated symptoms associated with double-J stents as compared to either medication alone.

03:36 PM Abstract No. 415 Percutaneous nephrostomy versus double-J ureteral stent: does order matter?

03:36 PM Abstract No. 415 Percutaneous nephrostomy versus double-J ureteral stent: does order matter?

Endoscopic, Single-Session Management of Encrusted, Forgotten Ureteral Stents.

Background and Objectives: Remained or forgotten ureteral double-J stents may cause serious complications. Removing of an encrusted, forgotten stent can be challenging. We present our experience with heavily encrusted ureteral stents and discuss the endourologic treatment options as well as their effectivity. Materials and Methods: Eleven men and six women (mean 48.58 ± 14.48 years of age) with 18 encrusted forgotten stents (mean 16.4 ± 13.25 months of indwelling) were treated at our clinic. All patients underwent the operation after negative urine cultures were obtained. Their medical records were retrospectively reviewed and analyzed in terms of number of interventions required to remove the stent, operation time, complications, hospital stay and stone-free rate. Results: According to the Forgotten-Encrusted-Calcified (FECal) classification, the most common form of stent encrustation was grade III (64.7%) and 17.6% of the stents were fragmented. Four of 17 patients were initially treated with extracorporeal shock-wave lithotripsy. The patients required a mean of two endoscopic interventions for removing the encrusted stent and all stents were removed endoscopically in a single session. The mean operating time was 63.3 ± 41.8 minutes. Cystolithotripsy followed by ureteroscopy was the most common intervention (41.1%). Of the 17 patients, peroperative and postoperative complications were Clavien grade I in two, grade II in two and grade IIIb in one. The mean hospital stay was 1.3 ± 0.99 days. All patients were stone-free after a month of stent removal. Conclusions: The endourological removal of the encrusted forgotten stents in a single session is feasible and effective with a minimal morbidity. The treatment strategy should be to minimize the number of interventions.

Treatment of retained encrusted ureteral Double-J stent.

We conducted this study to evaluate patients with retained encrusted ureteral stents, identify the predisposing factors and present our experience in the management of such challenging problem. This prospective study was carried out in the period from May 2007 to February 2011 at the Urology and Nephrology Center, Al-Thawra General Hospital, Sana'a, Yemen. 40 patients with retained encrusted ureteric stents were treated at our center. All patients were initially evaluated with a radiographic imaging for assessment of stent encrustation and stone burden. Treatment decisions were based on the site and severity of encrustations in the renal pelvis, ureter and bladder and on our technical situation and availability of instrumentations. Multi-modal approaches ranging from extracorporeal shock wave lithotripsy (ESWL) to endourological and open urologic procedures were used to achieve stent removal. A total of 90 urological procedures were performed to render all 40 patients stent and stone free. The average duration of stent remained indwelling was 24.2 months (range 4 months -16 years). All patients were managed either by minimally or more invasive multi-modal endourological approaches. For upper coil encrustation percutaneous nephrolithotripsy was performed in eight patients, pyelolithotomy in two patients and ESWL in three patients. Encrustation of the body was treated initially by ESWL, followed by retrograde ureteroscopic manipulation in 12 patients. Lower coil encrustation was successfully managed by cystolitholapaxy in seven patients and one patient required cystolithotomy. Cystolithotomy, pyelolithotomy and ureterolithotomy were carried out in two patients. Two patients who had large burden bladder and kidney stones with loss of kidney function underwent nephrectomy and cystolithotomy. The retrieval of severely encrusted retained ureteral stent and its associated stone burden poses a real management challenge for urologists due to the need for multimodal procedures and the lack of standardized treatment plan.

Effect of tamsulosin on lower urinary tract symptoms related to double-J ureteral stent: a randomised, double-blinded, placebo controlled trial

Objective: To evaluate the effect of tamsulosin on stent-related symptoms in patients undergoing double-J ureteral stenting. Methods: and materials Seventy patients (47 men and 23 women; mean age 42.5 years) who underwent double-J stent placement in adjunct to urological surgery were prospectively randomised into two groups. Group 1 included 35 patients who received 0.4 mg of tamsulosin once daily for 4 weeks; group 2 included 35 patients who received a placebo for the same protocol. All patients were interviewed by the same physician about the frequency of stent-related symptoms at 4 weeks after stent insertion. Results: Patients in group 1 showed a lower score for suprapubic pain during the filling phase and lower pain during sexual activity than group 2, although the overall pain score was not significantly different between two groups. The mean urinary urgency score was less in group 1 in comparison to the placebo group (p=0.030). No statistically significant differences were found between two groups concerning haematuria, urinary incontinence, frequency nor dysuria. Conclusion: Tamsulosin improves symptoms associated with double-J ureteral stents, especially body pain during sexual activity.

Percutaneous Nephrolithotomy in the supine flank free modified position for the removal of a 3 year Double-J ureteral stent in a horseshoe kidney

Horseshoe kidney is one of the most common congenital renal abnormalities with increased incidence of stone formation. We present a case of an HIV seropositive patient with a both-ends encrustated 3 year forgotten DJ stent and a staghorn stone in the left moiety of a horseshoe kidney. He was treated with percutaneous nephrolithotomy in the supine flank free modified position and simultaneous cystolitholapaxy. Supine percutaneous nephrolithotomy is safe and feasible in horseshoe kidney and facilitates simultaneous thansurethral access for cystolitholapaxy.

Spectrum of asymptomatic bacteriuria in renal allograft recipients and its short-term effect on graft outcome: Experience of a Tertiary Care Center from Northwest India

Introduction: Asymptomatic bacteriuria (AB) is not uncommon after renal transplantation with limited data from developing countries; we did this study to assess the microbiological spectrum and its short-term graft outcome in our tertiary care center. Materials and Methods: It is a prospective observational study. We included all the patients who underwent renal transplantation over a period of 18 months, from January 2016 to June 2017. Patients who had indwelling urinary catheter beyond 5 days posttransplant and those with persistent graft dysfunction within 6 months of transplant were excluded from the study. Results: A total of 67 patients were included in the study with a mean age of 33.78 ± 8.91 years and a male-to-female ratio of 7:1; live-related donors were 36 (53.73%), live unrelated were 19 (28.35%), and 12 (17.91%) were cadaveric renal allograft recipients (RARs). Twenty-eight (41.79%) patients had 42 episodes of AB over 6 months of follow-up. The maximum episodes occurred within 1 month of postrenal transplantation, and 42 out of 67 (62.68%) RARs had bacterial growth in their double-J ureteral stents (USs). The most frequently isolated pathogen from urine was Escherichia coli (n = 14, 33.33%), whereas Pseudomonas aeruginosa (n = 10, 23.80%) was in US culture (USC). The prevalence of AB was higher in cadaveric RARs compared to live RARs (83.33% vs. 32.72%, P = 0.001) and with bacterial growth in the USC compared to those who did not show any growth in USs (57.14% vs. 16.0%, P = 0.001). However, the estimated glomerular filtration rate between those with AB and those without at 6 months of follow-up (66.36 ± 14.98 vs. 66.10 ± 13.83 ml/min/1.73 m2, P = 0.943) was not different. Conclusion: AB is not uncommon in RARs and it is more common in cadaveric RARs and those with growth in US culture without compromise in allograft function at 6 months postrenal transplant.

Uretero-arterial Fistula by a Double-J Ureteric Stent in a Stented Internal Iliac Artery Aneurysm

We represent a-65-year-old male patient presented with indwelling left JJ stent for obstructed solitary kidney drainage. The obstruction was due to internal iliac artery aneurysm, had been managed by trans-femoral self-expandable coated endovascular stenting. This patient readmitted with recurrent attacks of hematuria with displaced JJ stent and rising serum creatinine twice. In the first admission, the patient was managed by JJ stent readjustment and Percutaneous Nephrostomy tube (PCN) and was discharged safely. Again, he presented with UAF associated with aggressive hematuria mostly due to vascular endoleak rupture. The patient developed severe sepsis and multiple organ dysfunction syndrome.

Transperitoneal laparoscopic ureteroureterostomy with excision of the compressed ureter for retrocaval ureter and review of literature.

PurposeWe present surgical techniques and operative results of laparoscopic reconstruction for patients with retrocaval ureter (RCU) and review similar papers.Materials and MethodsTen patients with RCU were enrolled in this study from April 2005 to January 2017. The mean age of 7 males and 3 females was 40.5 years old. The chief complaint was flank pain in 6 patients; the remaining patients were detected incidentally. All patients showed hydronephrosis and typical S-shaped deformity of the ureter on imaging studies. Five patients showed obstructed patterns on the renal scans. Two surgeons performed laparoscopic ureteroureterostomies with transperitoneal approaches including excision of the compressed ureter. Double-J ureteral stents were inserted intraoperatively. The operative and follow-up results were checked and compared with published papers.ResultsAll laparoscopic reconstructions were successfully completed without conversion to open surgery. The mean operative time was 199.6 minutes. The estimated blood loss was 154.4 mL. No operative complications were encountered. There were no obstruction and symptom after the mean follow-up of 40.7 months. We found 7 papers from PubMed, which had more than five cases of laparoscopic reconstruction of RCU. We reviewed and summarized the clinical and operative parameters.ConclusionsOur results show that transperitoneal laparoscopic ureteroureterostomy with excision of the compressed ureter is a safe and effective treatment for RCU. Data from published papers and ours summarize clinical parameters of RCU, and suggest that the laparoscopic reconstruction can be considered as the standard treatment for it.

To compare the efficacy of tamsulosin and tolterodine in double-J stent-related symptoms: A prospective randomized trial

Background: Stent-related symptoms affect nearly 80% of patients with indwelling ureteral stents. Alpha blockers relieve flank pain by blocking alpha-adrenergic receptors and relaxing the smooth muscles of ureter, trigone, and prostatic urethra, thus reducing bladder outlet resistance and voiding pressure, whereas mechanism of anticholinergic drugs involves relief of involuntary bladder contractions that are mediated by muscarinic receptors. We have compared alpha blocker and anticholinergic drugs in reducing stent discomfort. Materials and Methods: The study was conducted from March 2017 to February 2018. A total of 100 patients with unilateral double-J ureteral stenting were randomized, postoperatively into two groups: tamsulosin 0.4mg daily (Group I) and tolterodine 4mg daily (Group II). Results: The mean age was 39.1 years in Group I and 38.0 years in Group II. The male:female ratio in Group I and Group II was 1.38:1 and 1:1, respectively. There was statistically significant difference in urinary symptom score, pain score, and general health score between the two groups in favor of Group I (tamsulosin 0.4mg) at 1week post-stenting and 4 weeks (at stent removal). Conclusion: Oral medication, with uroselective alpha blockers, in patients with indwelling stents reduces stent-related symptoms and negative impact on quality of life.

Spontaneous ureteral rupture caused by iliac aneurysm: a case report

BackgroundRupture of the ureter with extravasation resulting from an iliac aneurysm is extremely rare. Herein, we report a case of ureteric rupture with urinary extravasation secondary to an iliac aneurysm.Case presentationAn 80-year-old man was admitted to our hospital for sudden onset of severe abdominal pain. Contrast-enhanced computed tomography demonstrated a large left internal iliac aneurysm (6.5 cm in diameter) and a ureteric rupture with leakage of contrast media from the left ureter, indicating a spontaneous ureteral rupture. The patient was treated with placement of a ureteral double-J stent under endoscopic and X-ray fluoroscopic guidance and endovascular aortic repair. His postoperative course was uneventful and he was discharged on postoperative day 20. A computed tomography scan at 2 weeks after surgery showed no contrast extravasation from the ureter or end leak.ConclusionCombination treatment with ureteral and endovascular stenting is effective in avoiding aneurysmal rupture and the serious consequences of a ureteral rupture, which include a perinephric or retroperitoneal collection, abscess formation, subsequent urosepsis, and graft infection.

Urinary neutrophil gelatinase-associated lipocalin as a biomarker to monitor renal function in patients with obstructive ureteral calculi.

Our study aimed to investigate the clinical significance of urinary neutrophil gelatinase-associated lipocalin (NGAL) as an effective real-time monitoring biomarker of renal function in patients with obstructive ureteral calculi presenting renal colic. A cohort of 89 first-visit patients with renal colic caused by unilateral ureteral calculi were retrospectively reviewed. 46 of which received double-J ureteral stent placement (group 1) and the remaining 43 treated conservatively with analgesics and hydration (group 2) when diagnosed. Urinary NGAL (uNGAL) values in the baseline, 2h and 1day after treatments were recorded. The variation of this parameter over time and the association with patients' characteristics were analyzed. uNGAL levels decreased as time went by for patients receiving double-J ureteral stent placement (47.23 ± 28.32ng/mL for baseline, 40.73 ± 21.86ng/mL for 2h and 34.67 ± 18.00ng/mL for 1day after operation; p = 0.0363). Nevertheless, for those treating conservatively, the levels emerged a mild increase (50.63 ± 32.30ng/mL, 56.00 ± 32.01ng/mL and 60.63 ± 34.08ng/mL, correspondingly; p = 0.3708). By analyzing the association between uNGAL variation and patients' characteristics of group 1, operation duration showed the best correlation coefficient (Pearson r = 0.6106, r2 = 0.3728, p < 0.0001). uNGAL can be used as a biomarker to monitor the renal function effectively when serum creatinine (sCr) was within normal limits. And double-J ureteral stent can be considered as a protective factor to renal function in patients with obstructive ureteral calculi presenting renal colic.

Cystoscopic ureteral stent placement: techniques and tips

We present a video demonstrating technical considerations and tips for cystoscopic placement of external, lighted, and internal ureteral stents. Cystoscopic ureteral stent placement is useful in cases where difficult pelvic periureter dissection is expected or encountered. In this video, we review cystoscopy basics, our approach to various types of retrograde stent placement, and performing retrograde pyelograms. Traditional external ureteral stent and lighted stent placement for prophylactic purposes are discussed, with attention to understanding stent markings, appropriate resistance, and steps for externalization. Internal, double-J ureteral stent placement with the use of fluoroscopy is initiated with placement of a guidewire. An open-ended ureteral catheter is advanced over the wire in the pelvic portion of the ureter, and a retrograde pyelogram is performed. The wire is reintroduced and the stent advanced to the renal pelvis under fluoroscopy. The proximal curl is confirmed to be in the appropriate position with fluoroscopy. The string attached to the stent is then cut and removed, the guidewire is removed, and the stent is deployed with the distal curl in the bladder. This video reviews key steps for cystoscopic ureteral stent placement in a prophylactic setting, cases of challenging anatomy, or ureteral injury.

How bothersome double-J ureteral stents are after semirigid and flexible ureteroscopy: a prospective single-institution observational study.

To evaluate in details the actual extent of double-J stent-related symptoms after semirigid (URS) and flexible (RIRS) ureteroscopy using a validated questionnaire. We asked to complete the Ureteric Stent Symptoms Questionnaire (USSQ) to all stone patients undergoing URS or RIRS with stent placement from 2010 to 2015. Stent-related symptoms' prevalence, severity, and impact on daily life were analyzed using descriptive statistics and five-order Likert scales. Subgroups analyses were performed. 232 patients completed the USSQ. Stents had a deep impact on urinary symptoms (daily frequency ≥ 1 per hour 59.1%, ≥ 1 nocturnal micturition 90.1%, urgency 86.6%, burning 82.3%) that represented a problem for 88.4% of patients. 83.2% complained of pain, mostly in the kidney (67.9%) or in the bladder area (31.3%), particularly during physical activity (72.9%) and micturition (77.0%). Pain interfered with everyday life in 92.2%. General health, working, and sexual activity were also affected. 62.0% of patients would be dissatisfied (51.6% unhappy or terrible) if further ureteral stenting was proposed in future. Younger patients and females were more affected. Limitations include observational design and lack of baseline evaluation. Ureteral stents are responsible for significant urinary symptoms and pain after semirigid and flexible ureteroscopy. They also considerably affect general health, working and sexual activity. Urologists should consider it carefully before stenting, inform patients about stent-related symptoms, and minimize stent indwelling time.