Ureteral Stent Insertion Research Articles

Palliative management of bilateral malignant ureteric obstruction

Background Malignant ureteric obstruction is often associated with end-stage cancer arising from the cervix, bladder, prostate and other pelvic organs. We reviewed palliative therapeutic options and outcome of patients with bilateral malignant ureteric obstruction at the Jos University Teaching Hospital (JUTH). Methods This was a retrospective cross-sectional study. Data from patients managed by the Urology division of JUTH for patients with bilateral ureteric obstruction of malignant cause over a period of 10 years were reviewed. Patients’ age, cause of malignant ureteric obstruction and types of interventions carried out were extracted. In addition, mean serum creatinine level at presentation and one-month post intervention were analysed. The overall patient survival over a 6-month period was evaluated. Data were analysed using SPSS version 23. Result 24 patients managed within the period of the study had complete data for analysis. The age range was 43-73years with a median of 49 years. Majority (79.2%) of patients were female. 54.2% of the patients had open nephrostomy. Retrograde ureteric stent insertion (16.6%) and permanent haemodialysis (29.2%) were the other palliative management options. Open nephrostomy offered the most significant improvement in biochemical outcome at one-month post intervention (P = 0.039). 41.6% of patients were alive at 6 months post intervention. None of the treatment options conferred survival advantage over the others. Conclusion Open nephrostomy is the most common palliative management option for patients with bilateral malignant ureteric obstruction at JUTH and achieves the most significant biochemical improvement. No palliative management option conferred superior survival outcome among the patients.

Measuring Individual Ureteral Length Using Computed Tomography Urography to Determine the Appropriate Lengths of Ureteral Stents

Purpose: The purpose of the study was to describe and validate a method for calculating ureteral length using computed tomography (CT) images acquired before ureteral stent placement and to evaluate the appropriateness of fit based on this calculation. Materials and Methods: We analyzed 57 patients who underwent computed tomography urography (CTU). The axial ureteral length (AUL) and coronal ureteral length (CUL) were derived from measurements made on the CTU images, and the length of each patient-specific ureteral stent was chosen based on the calculated ureteral length. Results: Overall, 105 ureters were measured: 54 (51.4%) right side and 51 (48.6%) left side ureters. The mean CUL and AUL of right ureters were 22.5 ± 2.3 cm and 22.5 ± 2.3 cm, respectively, whereas the mean CUL and AUL of left ureters were 23.6 ± 2.2 cm and 23.4 ± 2.1 cm, respectively. Pearson correlation analysis showed that body height was significantly correlated with ureteric length (right CUL and patient height: r =0.441, P= 0.001; right AUL and patient height: R = 0.445, P= 0.001; left CUL: R = 0.341, P= 0.029; left AUL: R = 0.339, P= 0.015). Thirteen of 57 patients underwent ureteral stent insertion; none experienced stent migration (upward or downward) before the removal of the ureteral stent. Comparison of proposed stent size with actual stent size in the 13 patients shows the percentage of size appropriateness (as defined by concordance between proposed and actual stent length) to be 76.9% (10/13). Conclusion: The patient's height was found to correlate significantly with CT-derived measurements of ureteral length. Accordingly, the choice of ureteral stent length can be reliably decided from CT measurements.

Clinical features of hydronephrosis induced by retroperitoneal fibrosis: 17 cases reports

OBJECTIVE To investigate the clinical features and outcome of hydronephrosis induced by retroperitoneal fibrosis (RPF), and to evaluate the effect of corticosteroid based therapy combined with surgical intervention of ureteral obstruction. METHODS A total of 17 RPF patients with hydronephrosis hospitalized in Peking University International Hospital from May 2016 to December 2019 were analyzed retrospectively. RESULTS The median age was 56 (53, 65) years, the male to female ratio was 2.4 : 1, and the disease duration was 4.00 (0.83, 8.00) months. The initial symptoms included back pain (9 cases), abdominal pain (6 cases), oliguria (2 cases) and lower limb edema (3 cases). Eight patients presented left hydronephrosis, 1 right hydronephrosis and 8 bilateral hydronephrosis. C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were both elevated in 13 patients (76.5%, n=17). Immunoglobin (Ig) G4 increased in 5 cases (29.4%, n=17). IgG, IgE and IgA increased in 4 cases (30.8%, n=13), 4 cases (30.8%, n=13) and 1 case (7.7%, n=13), respectively. Among 12 patients who underwent biopsy, 3 patients were diagnosed with IgG4-relate disease. The level of IgG4 in the tissues varied, 6 cases expressed less than 10 per high power field (HPF) or no expression (50.0%). Only 2 cases expressed 10-30/HPF (16.7%), and 4 cases revealed more than 30/HPF (33.3%). Among the 17 patients with ureteral obstruction, no urinary drainage procedure was needed in 4 patients who had mild ureteral obstruction, whereas, ureteral stenting was carried out in the other 13 cases before drug treatment. Time was too short to evaluate the effect of urinary drainage procedures in 4 patients. For the rest, ureterolysis had to be performed in 3 cases after failed ureteral stent insertion. Successful drain removal was accomplished in all of these 9 patients and the mean time to drain removal was (6.7±3.0) months. In addition, 10 patients had complete medical records after an average follow-up time of 5 (3-13) months. Levels of ESR, CRP, IgG4, IgG, IgE, IgA were 54.0 (36.3, 98.5) mm/h, 26.8 (8.7, 53.0) mg/L, 1.34 (0.55, 3.36) g/L, 16.3 (13.0, 21.1) g/L, 40.5 (31.4, 203.0) IU/mL, 2.51 (1.82, 3.25) g/L at baseline, which all decreased predominantly after treatment. ESR, CRP, IgG4, IgG, IgE and IgA dropped by 38.5 (23.5, 54.3) mm/h (P < 0.01), 23.0 (5.5, 52.0) mg/L (P < 0.05), 0.92 (0.40, 2.85) g/L (P < 0.01), 6.5 (1.7, 9.1) g/L (P < 0.05), 23.7 (4.8, 162.0) IU/mL (P < 0.05) and 0.77 (0.32, 1.26) g/L (P < 0.05), respectively. Size of mass measured by CT/MRI imaging became smaller significantly and hydronephrosis relieved. CONCLUSION Onset of RPF is insidious and lack of specific initial symptoms. Corticosteroid based therapy combined with surgical intervention of relieving obstruction is effective.

Huge encrusted ureteral stent forgotten for over 25 years: A case report

BACKGROUNDUreteral stent insertion is a relatively non-invasive procedure commonly used in the field of urology to resolve urinary obstruction. However, they are sometimes forgotten and the risk of complications increases with time.CASE SUMMARYA 43-year-old woman with a history of recurrent urinary tract infections visited our hospital for evaluation of persistent left flank pain, and lower urinary tract symptoms despite anti-biotic treatment. She had received urological surgery in her teens but did not know the details of her surgery. Kidney, ureter, and bladder X-ray and abdominopelvic computed tomography revealed a forgotten left ureteral stent with huge encrustation at both ends and a severely dilated left kidney with parenchymal thinning. In order to remove the ureteral stent, a laparoscopic nephroureterectomy was planned. The ureteral stent was successfully removed, and she was discharged after recovery. The patient was followed up for two years after surgery and did not show any signs of long-term complications. CONCLUSIONLong indwelling stents can cause dire complications requiring radical interventions. Stent registry systems, novel stent material development, and proper patient education is important for complication prevention.

The Modified Prone Jack-knife Position for the Excision of Female Urethral Diverticula

BackgroundFemale urethral diverticula (UD) are an uncommon and often overlooked aetiology in women presenting with lower urinary tract symptoms, urethral pain, and recurrent urinary tract infection. With increasing awareness, appropriate imaging is more commonly undertaken with consideration given to surgical management. ObjectiveThe video presented demonstrates the technique for excising large and/or complex UD using a modified prone jack-knife position—a position that offers excellent surgical access and allows the surgeon to operate in a more ergonomic position. Design, setting, and participantsA retrospective review of the data on patients undergoing excision of UD at a tertiary referral unit was performed. Surgical procedureUrethral and suprapubic catheters (±insertion of ureteric stents) were placed in supine position. UD excised in the modified prone jack-knife position (±placement of a Martius flap). MeasurementsSubjective cure rate, recurrence rate, rates of postoperative urinary incontinence, need for secondary incontinence procedure, and postoperative complications were measured. Results and limitationsA total of 121 patients were operated on in the study period. The mean follow-up time was 10 mo (range 3–40). The most frequent presenting symptoms included a vaginal mass (n = 76, 63%), followed by dysuria (n = 72, 60%) and pelvic pain (n = 71, 59%). An identifiable aetiological factor was present in 45 patients, including traumatic vaginal delivery (18, 15%), prior periurethral surgery (17, 14%), and urethral dilatation (10, 8%). All patients underwent postvoiding magnetic resonance imaging (MRI) to confirm the diagnosis and plan surgery. UD ranged in maximum diameter from 8 to 48 mm, with a mean of 43 mm (standard deviation 9.24). The most common anatomical location was midurethral (55, 46%), followed by distal (36, 30%), proximal (25, 21%), and full length (5, 4%). Most UDs were single in configuration (74%), followed by multiloculated (15%), saddle shaped (7%), and circumferential (5%). On preoperative videourodynamics, 17 (14%) had stress urinary incontinence. UD excision was undertaken in the modified prone jack-knife position in all cases. A Martius flap was utilised in 36 (30%). The median postoperative postvoiding residual was 26 ml (interquartile range 0–40). In total, 88 (73%) patients were continent postoperatively and 16 (13%) experienced de novo stress urinary incontinence. Of the 37 with pre-existing stress incontinence symptoms, 20 (54%) were continent after operation. A total of 14 patients had subsequent autologous fascial sling at 6 mo. In total, five symptomatic recurrences occurred (4%); of these patients, three elected to undergo surgical excision, all of whom had symptom resolution and were continent after operation. A total of 11 patients (9%) experienced a Clavien-Dindo grade I–II complication within 90 d after operation. Five patients complained of dyspareunia, which resolved by 6 mo. ConclusionsThe modified prone jack-knife position facilitates excellent access for excision of both simple and complex UDs. This positioning of the patient is not widely recognised amongst urologists. Using this approach, there were low rates of symptomatic recurrence and de novo stress incontinence at medium-term follow-up. Associated urinary incontinence resolves in over half of patients following UD excision; hence, we advocate deferring any incontinence procedure until after the results of surgery are established. Patient summarySurgical removal of urethral outpouching (diverticula) in women is challenging due to its potential to damage the nearby sphincter muscle, which controls continence, or the urethra tube. Placement of patients on their front, rather than on their back, provides excellent access for the surgical removal of urethral diverticula. With this approach, we achieved excellent rates of cure and low rates of urinary incontinence at an average follow-up of 10 mo.

Urinary Stone Location with Ureteral Stents in Place: Always on the Move, and not Where you Would Expect.

To assess migration of urinary stones with ureteral stents in place. We performed a retrospective analysis of stone characteristics and locations in patients treated with secondary retrograde intrarenal surgery for symptomatic urinary stones at our institution. We analyzed 393 patients with a median age of 53 years and a median stone size of 7 mm. Stone location was assessed at ureteral stent insertion and four weeks later prior to stent removal and retrograde intrarenal surgery (RIRS). Migration of urinary stones was seen in 33.1% of the patients with an indwelling ureteral stent. Stones with caudal migration were smaller for any given initial position. 7.1% of the stones were located at one of the three sites of narrowing at initial presentation, this percentage increased to 18.8% at the time of stone extraction. Stone composition did not affect stone migration. Radiographic imaging prior to retrograde intrarenal surgery is recommended due to the migration of urinary stones with indwelling ureteral stents. The most appropriate surgical approach can be devised depending on stone localization.

Retrograde ureteric stent insertion from percutaneous suprapubic access to the bladder in renal transplant recipients with ureteric stenosis: a novel minimally invasive technique

BackgroundUreteric stricture is a common and salvaging complications after renal transplantation. Two treatment methods are usually used, retrograde ureteral stent placement and percutaneous nephrostomy. The former has a higher failure rate, the latter has a great risk. Therefore, a safe and reliable treatment is needed.Case presentationA technique of retrograde insertion of ureteral stent was established, which was applicable in three transplant recipients with post-transplant ureteral stenosis, and the data was retrospectively recorded. The patients are 2 men and 1 woman, ages 44, 27 and 32 years. These patients underwent a total of five times of retrograde insertion of ureteral stent between 2018 and 2019. None of these patients had any postoperative complication, but all patients had complete recovery from oliguric status within two weeks.ConclusionsThe retrograde ureteric stent insertion by percutaneous suprapubic access to the bladder (RUS-PSAB) was demonstrated feasibility and safety in a case series with short-term follow-up. However, larger prospective studies are needed.

Non-invasive evaluation of obstruction after ureteroscopic stone removal: Role of renal resistive index assessment

The aim of this study is to evaluate prediction of postoperative ureteral obstruction needing ureteral stent insertion by evaluating the resistive index (RI) values and the grade of hydronephrosis. A total of 66 adult patients undergoing stentless endoscopic ureteral stone treatment (URS) between January 2018 and January 2019 were included in this prospective study. Preoperative patient and stone characteristics were noted. All patients were evaluated with renal Doppler ultrasonography study to assess degree of hydronephrosis and RI values. A renal Doppler ultrasonography was repeated at postoperative 1st, 3rd and 7th days. Changes in both RI and hydronephrosis levels before and after the procedures were noted. On the postoperative 7th day, patients were divided into two groups including obstructive and non-obstructive cases according to RI values assessed where a RI value of 0.7 was accepted as the cut-off for obstruction. The preoperative and perioperative characteristics of both groups were evaluated in a comparative manner. The mean patient age was 43.6 ± 1.72 years. Significant improvements were noted in RI and grade of hydronephrosis after the operation. The grade of hydronephrosis and RI values were found to improve more significantly on postoperative 3rd day when compared to the postoperative 7th day (p < 0.01 and p < 0.01). A significant correlation was detected between the grade of hydronephrosis (>grade 2) and obstructive RI values (> 0.7) in each postoperative visits (p: 0.001). RI values (> 0.7) at postoperative seventh days were correlated with larger mean stone size, increased ureteral wall thickness, increased diameter of the ureter proximal to the stone, and longer duration of the operation. Preoperative high-grade hydronephrosis indicated obstructive RI values at postoperative seventh day (p = 0.001) Conclusion: Changes in RI values on Doppler sonography and the grade of hydronephrosis may be a guiding parameter in assessing postoperative ureteral obstruction.

Risk Factors for Anastomosis Leakage After Kidney Transplantation.

PurposeKidney transplantation is one of the best treatment options for end-stage renal disease with an incidence of urologic complications of 2.5 to 30%. One of the most serious and frequent urological complications is urinary leakage from ureteroneocystostomy anastomosis. The purpose of this study was to evaluate risk factors of urinary leakage from ureteroneocystostomy anastomosis after kidney transplantation.Patients and MethodsA retrospective study was performed on patients who received kidney transplantation and were diagnosed with urinary leakage thereafter based on renal scan or drain creatinine per serum creatinine compared with patients in control group. Risk factor assessment was based on inpatient and outpatient information from hospital database.ResultsFrom 459 patients who received kidney transplantation in 2016–2018, there were 20 patients who were diagnosed with urinary leakage after they underwent ureteroneocystostomy anastomosis. The significant risk factors for anastomosis leakage were size of suture materials and duration of ureteral stent insertion. No statistically significant difference in other factors such as underlying disease, surgical technique or duration of urinary catheter was found. About overall urological complication, gender and body mass index significantly affected the outcome.ConclusionThe rate of urinary leakage complications was found to be about 4.36%. The risk factors of overall complication comprised gender and body mass index. Although a lot of previous studies revealed many risk factors that could affect urinary leakage, size of suture materials and duration of ureteral stent insertion were the significant risk factors in our study. Proper consideration should be given to the size of suture materials and optimal duration of ureteral stent.

Feasibility and safety of magnetic-end double-J ureteral stent insertion and removal in children.

The need for surgical removal of a double-J ureteral stent (DJUS) is considered one of its disadvantages. Apart from increased cost, repeated exposure to general anesthesia is a concern in children. Alternative techniques have been described, all failing to become integrated into mainstream practice. Stents with a distal magnetic end, although introduced in the early 1980s, have only recently gained acceptance. We report the feasibility and safety of insertion and removal of a magnetic-end double-J ureteral stent (MEDJUS) in a pediatric population. We retrospectively analyzed the use of the Magnetic Black-Star Urotech® MEDJUS between 11/2016 and 12/2019 in children. Stents were removed in the outpatient clinic using a transurethral catheter with a magnetic tip. MEDJUS insertion was attempted in 100 patients (65 boys). Mean age was 7.8years (0.5-18). The stent was placed in an antegrade procedure (n = 47), by a retrograde route (n = 10), and during open surgery (n = 43). Stent insertion was successful in 84 cases (84%). All 16 failures occurred during the antegrade approach in laparoscopic pyeloplasty, with inability to push the stent and its magnet through the ureterovesical junction in 14. Magnetic removal was attempted in 83 patients, successful in 81 (98%). There was no added morbidity with the MEDJUS. The use of MEDJUS is a safe and effective strategy that obviates the need for additional general anesthesia in children. Its insertion is similar to that with regular DJUS, and its easy and less time-consuming removal benefits both the patient and the hospital and validates its clinical use.

PT242 - Urosepsis post emergency ureteric stent insertion: Can we predict intensive care admission?

PT242 - Urosepsis post emergency ureteric stent insertion: Can we predict intensive care admission?

Urinary tract infection and antibiotic use around ureteral stent insertion for urolithiasis.

Urolithiasis is the main indication for a ureteral JJ stent. Our aim was to determine the incidence of urinary tract infections (UTIs) after a JJ stent for urolithiasis, with an emphasis on antibiotic use. Prospective, multicenter, cohort study over a 4-month period including all of the patients with urolithiasis requiring JJ stent insertion. The clinical and microbiological data and therapeutic information were recorded until removal of the JJ stent. Two hundred twenty-three patients at five French private hospitals were included. A urine culture was performed for 187 patients (84%) prior to insertion of a JJ stent, 36 (19%) of which were positive. One hundred thirty patients (58%) received an antibiotic therapy during surgery: 74 (33%) prophylaxis and 56 (25%) empirical antibiotic therapy, comprising 17 different regimens. The rate of prophylaxis varied according to the center, from 0 to 70%. A total of 208 patients were followed-up until removal of the first stent. The rate of UTIs was 6.3% (13/208); 8.1% of the patients who did not receive a prophylaxis had a UTI versus 1.4% of those who did receive a prophylaxis (p = 0.057). Seven empirical antibiotic regimens were used to treat these 13 patients. Another large panel of antibiotic prescriptions was observed at the time of JJ stent removal. The incidence of a UTI after JJ stent insertion for urolithiasis was 6.3%, in part due to a lack of prophylaxis. An unwarranted diversity of antibiotic use was observed at each step of care.

Effect of two different doses of solifenacin succinate therapy (5mg, 10mg) for the treatment of ureteral stent (Double J) related symptoms in comparison to placebo

Background and objective: Double-J ureteral stent is widely used in endourologic surgery. However, it might cause some annoying side effects. This study aimed to evaluate the effect of two different doses of solifenacin (5mg, 10mg) on double-J stent-related symptoms after uncomplicated ureteroscopic lithotripsy. Methods: This study involved 120 patients. A total of 80 patients undergoing double-J ureteral stent insertion after ureteroscopic lithotripsy were involved in this study and provided with solifenacin postoperatively; 40 patients received 5mg and another 40 patients received 10mg. Another 40 age- and sex-matched patients without solifenacin therapy (received placebo) were enrolled as a placebo group. All patients completed the modified-form of the Ureteral Symptom Score Questionnaire to evaluate the lower urinary tract symptoms, hematuria and stent-related body pain two weeks following the operation. The severity of stent-related symptoms was compared between the three groups. Results: The mean age was 45.4 years in the 5 mg solifenacin group, 48.2 years in the 10 mg solifenacin group, and 46.8 years in the placebo group. Compared to the placebo group, both solifenacin groups had significantly lower total symptom score, urgency, and urge incontinence scores. Solifenacin groups had significantly less urethral, abdominal and flank pain and hematuria scores. There was no statistically significant difference between the two solifenacin groups of 5mg and 10mg. The solifenacin groups versus the placebo group showed significant benefits in lower urinary tract symptoms, hematuria, and stent-related pain in both genders. Ten subjects encountered minor adverse events in solifenacin groups (8 in the 10 mg group and 2 in the 5 mg group), which was mostly dry mouth and constipation. Conclusion: Postoperative solifenacin was effective and well-tolerated in patients undergoing ureteroscopic lithotripsy and double-J stent indwelling irrespective of genders, particularly for the treatment of stent-related body pain, hematuria and the lower urinary tract symptoms.

A 22-Year-Old Retained Ureteral Stent: One of the Oldest Removed Using a Multimodal Endourologic Approach.

Background: Ureteral stent encrustation poses a distinct challenge to urologists. The purpose of our study is to present a patient with one of the oldest retained ureteral stents reported in the literature, effectively treated at our institution with a multimodal endourologic approach. Case Presentation: After IRB approval and patient's consent, we present the case of a 47-year-old man who was referred to our institution for gross hematuria and a right retained ureteral stent, incidentally found on imaging. This patient had a history of traumatic stab wound 22 years prior, requiring an exploratory laparotomy and a ureteral stent insertion. Preoperative CT scan revealed a fragmented and heavily encrusted right ureteral stent. The patient was effectively treated with a multimodal endourologic approach, including a cystolitholapaxy, a right retrograde flexible ureteroscopy (URS), and a prone split-leg right percutaneous nephrolithotomy combined with a right retrograde URS. The patient was rendered stone and stent free. Conclusion: To our knowledge, this 22-year-old retained stent is one of the oldest reported in the literature. As observed in our patient, multimodal endourologic techniques are safe and effective in patients with retained ureteral stents to render then stent and stone free.

Risk factors in the prediction of long-term patency of Resonance metallic ureteric stent in malignant ureteric obstruction.

ObjectivesCancer is the second leading cause of death globally in 2018 with an estimated 9.6 million deaths. The costs of managing malignant ureteric obstruction (MUO) is a significant burden to any healthcare system. However, the management of MUO has long been a challenge for urologists. The standard options of percutaneous nephrostomy or polymer double J stents are fraught with problems. We report a large patient series with long‐term follow‐up in the use of Resonance metallic ureteric stents to relieve MUO, and identification of risk factors associated with stent failure.Patients and methodsAll patients with MUO who were arranged to have Resonance metallic ureteric stent insertion at two university hospitals were included in this cohort study, starting from June 2011 to July 2016. Data were retrieved retrospectively. The primary outcome was the total duration of stent patency before stent failure due to malignant disease progression. Stent failure was defined as ureteric obstruction identified on imaging (functional radioisotope scan or antegrade pyelogram), acute renal failure resolved by subsequent percutaneous nephrostomy, or any other cause requiring stent removal prematurely. Secondary outcomes were identification of factors associated with stent failure, grade III or above complication, and development of a risk‐adopted model to predict metallic ureteric stent patency rates in MUO patients. Median duration of functioning metallic ureteric stent was determined with Kaplan‐Meier survival curve.ResultsA total of 124 renal units in 95 patients with MUO were eligible for the study, with a median follow‐up period of 22.9 months. About 106 (85.5%) renal units had successful metallic stent insertion, of whom 41 (33.1%) renal units ultimately progressed to ureteric obstruction despite the metallic stents, and required subsequent insertion of nephrostomies. Median duration of functioning metallic ureteric stents was 25 months. Female gender (HR 3.0, 95% CI: 1.3‐7.2, P = .014) and suspicious bladder lesion (HR 2.9, 95% CI: 1.4‐6.2, P = .005) were independent risk factors for stent failure, respectively. Stratifying patients into low (0 risk factor), intermediate (1 risk factor), and high (2 risk factors) risk groups, we found that this could predict the duration of stent patency in MUO with the metallic stents. (Low risk: 30.3 months vs intermediate group: 17.8 months vs high risk: 4.9 months, P < .001).ConclusionResonance metallic ureteral stents are able provide a median of 25 months of ureteric drainage in patients with MUO. Determining whether a patient has one or both risks factors (female gender and bladder lesion) will allow one to estimate the duration of metallic stent patency, which in turn may aid in determining cost‐effectiveness in individual patients.

Risk Factors of Infectious Complications after Ureteroscopy: A Systematic Review and Meta-Analysis Based on Adjusted Effect Estimate.

Background: Multiple studies have reported that gender, pre-operative stent insertion, positive pre-operative urine culture results, and diabetes mellitus are associated with infectious complication after ureteroscopy. A previous meta-analysis focused on this topic is based, however, on crude estimate. Further analysis based on adjusted estimates is needed. Methods: PubMed, Web of Science, Embase, and the Cochrane Library database were searched with ureteroscopy, ureteroscopies, ureteroscopic surgical procedures, ureteroscopic surgery, ureteroscopic lithotripsy, flexible ureteroscopic lithotripsy, ureteroscopy (URS), flexible ureterorenoscopy, risk factor, predictor, predicting model, and nomogram until December 15, 2019. The quality of research was evaluated by Newcastle-Ottawa Scale system. Odds ratio (OR) and 95% confidence intervals (CI) of each risk factor were extracted. Meta-analysis was performed with Stata 15.0 software. Heterogeneity was assessed by I2. Publication bias was tested by the Egger test, and funnel plot. Meta-regressions and subgroup analysis were further performed. Results: There were 16 studies; 12,357 patients finally were included in this meta-analysis. The association between gender (OR = 1.82, 95% CI: 1.48-2.23, I2 = 0%, p = 0.701), pre-operative ureteric stent insertion (OR = 1.91, 95% CI: 1.26-2.91, I2 = 40.4%, p = 0.109), diabetes mellitus (OR: 1.40, 95% CI: 1.07-1.85, I2 = 34.1%, p = 0.168), positive urine culture before URS (OR: 2.18, 95% CI: 1.34-3.57, I2 = 47.2%, p = 0.092), operation duration (OR: 1.03, 95% CI: 1.01-1.04, I2 = 70.6%, p = 0.001) and infectious complications was positively significant. All four pooled results were different from results of meta-analysis based on crude estimate. Conclusion: Female gender, pre-operative ureteric stent insertion, diabetes mellitus, positive urine culture results before URS, and operation duration are risk factors for infectious complications after URS. Meta-analysis based on adjusted estimates may be more convincing.

Simplified Stenting Methods during Laparoscopic Pyeloplasty in Children

We are dedicated to evaluate a simplified methods for ureteric stent insertion during laparoscopic pyeloplasty in children. After detect the cause of obstruction, UPJ resection was made. At that stage, we performed antegrade extracorporeal installation of stent by removing the proximal ureter through the lower skin defect after extraction of the trocar. That allowed for successful stenting under precise tactile and visual control. Then the ureter was reintroduced back into abdominal cavity. Dismembered LP by Hynnes-Andersen technique was made using 6/0 absorbable monofilament suture. The second method of ureteric stenting: after the anastomosis of posterior pelvis wall is complete, puncturing with Veress needle between the optics and the upper trocar. The stylet was removed, after that we can introduce a stent through the needle hole with ensure accurate tactile sensations, maximum control over the stent direction. Since January 2017, we have used this method in 32 children with congenital hydronephrosis were operated by LP. The proposed methods of ureteric stenting allowed reducing that stage to 3-10 minutes, with successful outcome in all cases. The children were discharged 5-7 days after surgery. No conversion to open surgery had to be performed. Our experience shows that LP in children with congenital HN reduces the surgical burden on the patient, improves post-surgery quality of life. The proposed methods of antegrade intraoperative stenting significantly reduce the duration of surgery while improving the success rate of this key manipulation.

No evidence for the need of a routine renal transplant ultrasound after elective transplant ureteric stent removal-A retrospective cohort study.

Transplant ureteric stent insertion reduces the incidence of MUCs, but it is not known whether routine PSRGU is needed to detect unmasked MUCs. This study evaluated whether routine PSRGU in the pRTR is a useful tool to identify MUCs before they become clinically apparent. A retrospective analysis was undertaken of the clinical outcomes following elective stent removal from pediatric kidney-only transplant recipients at two London centers between 2012 and 2016. Our policy was to perform PSRGU either routinely or urgently if there were concerning symptoms or biochemical evidence of renal allograft dysfunction. Elective stent removal was performed in 86% (97 of 113 pRTR), and 75 (77%) of whom had routine PSRGU at a median (IQR) of 6 (2-8) days after stent removal. There were changes to management in 3 (4%) of pRTR with PSRGU identifying no MUC. Nineteen patients (25%) had urgent PSRGU, most commonly due to renal allograft dysfunction, at a median (IQR) of 5.5 (2.7-12.3) days after stent removal. Of these, two pRTR required ureteric intervention. For our current practice of removing transplant stents at 4-6weeks post-transplantation, our study has found no evidence to support routine PSRGU after elective stent removal.

PD09-07 RETURNING THE ER: AN ANALYSIS OF EMERGENCY VISITS FOLLOWING UROLOGIC OUTPATIENT PROCEDURES

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Quality Improvement & Patient Safety II (PD09)1 Apr 2020PD09-07 RETURNING THE ER: AN ANALYSIS OF EMERGENCY VISITS FOLLOWING UROLOGIC OUTPATIENT PROCEDURES Luke Witherspoon*, Rodney Breau, Christopher Knee, Ranjeeta Mallick, J. Stuart Oake, and Luke Lavallee Luke Witherspoon*Luke Witherspoon* More articles by this author , Rodney BreauRodney Breau More articles by this author , Christopher KneeChristopher Knee More articles by this author , Ranjeeta MallickRanjeeta Mallick More articles by this author , J. Stuart OakeJ. Stuart Oake More articles by this author , and Luke LavalleeLuke Lavallee More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000836.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Urologic surgeries have been previously identified as having high rates of readmission compared to other surgeries. This study aims to identify risk factors leading to presentation to the emergency department (ED) following urologic outpatient surgery. METHODS: We examined all outpatient surgeries performed by urology, general surgery, thoracic surgery, and gynecology occurring at three hospitals within The Ottawa Hospital system between April 1, 2008, and February 28, 2018. We captured all ED visits within 90 days of the outpatient procedure. Surgical characteristics included hospital campus, procedure end time, and day/month/year of procedure. Patient characteristics assessed included age, sex, marital status, presence of primary care provider, socioeconomic status (SES), American Society of Anesthesiologists (ASA) score, and Elixhauser comorbidity index. RESULTS: 38,377 outpatient procedures were performed by the four services assessed over our time period. 5641 ED visits within 90 days were identified. Urological procedures accounted for 47.5% (n=2681) of the patients returning to the ED, representing a 16.2% rate of return to the emergency room following urologic day surgery. Furthermore, urologic patients were more likely to have several visits to the emergency room within 90 days compared to other surgical services (p<0.05). Univariable analyses of individual variables found that increased age, low SES, unmarried status were all associated with higher rates of ED visits (p<0.05). The median ER visit day post-procedure ranged from 5-17 depending on procedure type. Of the noted reasons for emergency presentation, the top 5 causes were directly related to urology with retention (11% of visits), and hematuria (10% of visits) being the most common. Of urological day surgery procedures ureteroscopy (Relative Risk (RR) 3.69, 95% CI 2.17,6.29), Greenlight Laser Photoselective Vaporization of the prostate (RR 3.6, 95% CI 2.05, 6.34), and ureteric stent insertion (RR 3.83, 95% CI 2.17, 6.76) had the highest rates of return to emergency in 90 days on multivariate analysis. CONCLUSIONS: ED visits following urologic outpatient procedures are common. This study identifies risk factors to identify patients that may benefit from additional education or support after outpatient urologic surgery to reduce ED care needs. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e177-e177 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Luke Witherspoon* More articles by this author Rodney Breau More articles by this author Christopher Knee More articles by this author Ranjeeta Mallick More articles by this author J. Stuart Oake More articles by this author Luke Lavallee More articles by this author Expand All Advertisement PDF downloadLoading ...

The role of preoperative ureteral stenting in retrograde intrarenal surgery in renal stone patients: a propensity score-matched study.

BackgroundThe purpose of this study was to investigate the effect of preoperative ureteral stenting on retrograde intrarenal surgery (RIRS).MethodsWe retrospectively analyzed RIRS cases from October 2014 to June 2017. Patients were divided into two groups according to preoperative ureteral stent insertion. The characteristics of the patients [age, body mass index (BMI), sex, previous disease history, hemoglobin, creatinine, estimated glomerular filtration rate (eGFR)], characters of stone (size, number, density, location), ureteral access sheath (UAS) success rate, perioperative complication, operative time, hospitalization time, period with stent, postoperative urinary tract infection (UTI) rate, stone free rate (SFR), and additional treatment rate were analyzed.ResultsRIRS was performed for 122 patients. Seventy-three patients had preoperative ureteral stents before RIRS, while 49 patients did not have preoperative ureteral stents. The median size of the stone was 14.5 mm. Overall SFR was 87.7%. Preoperative eGFR was relatively high in patients who underwent preoperative stenting (68.18 vs. 79.01 mL/min/1.73 m2, P=0.042). Preoperative stenting led to improvement in the success rate of UAS insertion (97.3% vs. 87.8%, P=0.038) during surgery. Before and after propensity score matching revealed a significant difference in operation time when the diameter of the stone was smaller than 1 cm (P=0.019 and P=0.004). However, there was no significant difference in operation time, postoperative UTI rate, additional treatment rate, or SFR.ConclusionsPreoperative ureteral stenting can facilitate UAS insertion, and reduce operation time in RIRS for stones with a diameter less than 1 cm.