Internal Ureteral Stents Research Articles

"Early" removal of the internal ureteral stent after kidney transplantation

Background. Urological complications are currently one of the main causes of the renal graft loss and the death of the recipient in the early and late periods after surgery. Objective. To reduce the risk of developing infectious complications after kidney transplantation by early removal of the internal ureteral stent. Material and methods. From June 2018 to March 2020, the Department of Organ and/or Tissue Transplantation of the City Clinical Hospital n.a. S.P. Botkin performed 89 deseased-donor kidney transplantations with the placement of an internal ureteral stent. Depending on the timing of stent removal, the patients were divided into 2 groups: the first group included 54 patients who had the stent removed on day 21, and the second group included 35 patients who had the stent removed on day 14. Results. No urological complications were recorded in both groups. Urinary tract infection was recorded in 8 patients (15%) in the first group, and in 1 patient (3%) in the second group (p = 0.01). Conclusion. Removal of the internal ureteral stent on the 14th day after kidney transplantation safely and reliably reduces the risk of a urinary tract infection development, improving the immediate results of the operation.

When the Good Old X Ray Saved the Day

Internal ureteral stents have become an integral part of urologic practice to relieve intrinsic as well as extrinsic upper urinary tract obstruction. Missed internal ureteral stents is a serious potential complication that is associated with increased patient morbidity and is especially a problem in developing countries due to poor patient compliance, lack of understanding, and poor administration of stent registry. Diagnosis of forgotten ureteral stents is usually straight forward on usual imaging. Here, we report a case where the forgotten stent was missed on ultrasound and computed tomography and was picked up on plain radiograph thereby, emphasizing the still relevant role of plain radiograph in evaluation of stone disease.

Clinical outcomes and prognostic factors associated with internal ureteral stent placement for malignant extrinsic ureteral obstruction.

The optimal management of malignant extrinsic ureteral obstruction (MUO) remains unclear. It is necessary to assess the patient prognosis in deciding the adaptation of drainage of renal pelvis. In this study, we investigated the clinical outcomes after ureteral stenting for MUO and the predictive factors for overall survival in order to create a risk-stratification model. We retrospectively analyzed the clinical and laboratory data of 93 patients with radiologically significant hydronephrosis associated with MUO who underwent successful stent placement between May 2005 and May 2018. The median survival duration after the initial stent insertion was 266days. Of the 93 patients, 70 died, and the median interval from the first stent insertion to death was 160days. Multivariate analysis showed that gastric cancer as the primary disease, poor performance status before stenting, and treatment after stent insertion were significant predictors of survival. According to these three factors, we stratified patients into the following four prognostic groups: no-factor (43 patients), one-factor (23 patients), two-factor (23 patients), and three-factor (4 patients) groups. This classification was effective for predicting survival, and the median survival durations in these groups were 807, 269, 44, and 12days, respectively (p < 0.001). Our stratification model of patients with a poor prognosis after ureteral stent placement for MUO may allow urologists and clinicians to identify patients who will benefit from ureteral stenting.

Urinary Tract Drainage Selection in Case of Pyelonephritis in Pregnant Women

The article presents an analysis of the treatment results of 1122 patients with pyelonephritis in pregnancy at different gestational periods (from 6 to 39-40 weeks of pregnancy). The age of the patients was from 16 to 41 years, the average age was 26.15 ± 7 years. The indications and methods of urinary tract drainage in pregnant women were analyzed depending on the causes of urodynamic disturbances (kidney stone disease, decreased urinary tract tone, ureters compression by the uterus, vesico-urethral reflux) pregnancy term; pyelonephritis in pregnancy stage (serous/ purulent). Errors in the patients’ management after purulent pyelonephritis in pregnancy are considered. The expediency of examining and treating patients with risk factors for urinary tract infections during pregnancy were indicated at the stage of preparing a woman for pregnancy. Antegrade draining of the urinary tract is indicated for pregnant women from the 31st pregnancy week (and even shorter periods with a pronounced violation of urodynamics) with the presence of knee-shaped deviation in the ureter`s upper third and with suspected purulent process. Therefore, nephrostomy draining provides a more adequate outflow of urine from the affected kidney and makes it possible to control daily diuresis. It is necessary to conduct active monitoring of pregnant women with the presence of internal ureteral stents and their timely replacement. It is advisable to remove the drainage 3-4 weeks after birth, depending on the causes of the urodynamics` disorders. Symptom build-up dynamics, severity of intoxication, multi-organ lesion, the possibility of antenatal death of the fetus require urgent choice of the method of urinary tract drainage and the early initiation of intensive therapy in patients with suspected purulent process. Antimicrobial therapy should be carried out in accordance with the Russian guidelines on Urinary tract infections.TThe study did not have sponsorship. The authors have declared no conflicts of interest.

Renal trauma: a 6-year retrospective review from a level 1 trauma center in Denmark

Background: Management of renal trauma injuries is shifting towards more conservative approaches in hemodynamically stable adult patients, even for high grade and/or penetrating trauma. The objective of this study was to analyze the patterns of injury, management and complications in renal trauma patients at a Danish university hospital with a level 1 trauma center.Method: Patients diagnosed with renal trauma at Rigshospitalet, Copenhagen, Denmark, between January 2010 and December 2015 were identified retrospectively by the ICD-10 code. Data were collected from electronic patient records. Imaging was classified by radiologists.Results: Out of 107 patients identified, blunt injuries comprised 93%. Median age was 28. The distribution of injury grade according to AAST was 20% grade I, 4% grade II, 33% grade III, 33% grade IV and 10% grade V. All patients with grade I–III were managed conservatively. Two patients were treated with angioembolization (1 with grade IV and 1 with grade V). Five patients with grade IV were treated with an internal ureteral stent and one patient with grade IV blunt trauma had an emergency nephrectomy performed. Overall complication rate was 7%. No patient died due to their renal injury. Renal function was normal in all patients at discharge, assessed by eGFR measurement. Of the 50% of patients who were followed up with a renography, none developed obstruction due to the renal trauma.Conclusion: The vast majority of renal injuries were due to blunt trauma. Hemodynamically stable patients, even with penetrating and/or high-grade blunt trauma, were managed non-operatively and there was a low rate of complications.

MP17-13 CHOICE OF THE OPTIMAL METHOD OF UPPER URINARY TRACT DRAINAGE IN PATIENTS WITH ACUTE OBSTRUCTIVE PYELONEPHRITIS

INTRODUCTION AND OBJECTIVES:Emergency drainage of the upper urinary tract may be undertaken by either the placement of an internal ureteric stent or percutaneous nephrostomy and is a standard treat...

323 - Outcomes of externalized pyeloureteral versus internal ureteral stent in pediatric pyeloplasty: Single center experience

323 - Outcomes of externalized pyeloureteral versus internal ureteral stent in pediatric pyeloplasty: Single center experience

The Effect of Treatment Timing and Urinary Drainage on the Outcome of Urinary Tuberculosis

Background: Urinary tuberculosis (TB) has a variety of clinical manifestations and is a diagnostic challenge for urologists. Delayed treatment can lead to loss of renal function and structural destruction. In this study, we analyzed the relationship between the timing of treatment and outcomes in patients with urinary TB. Methods: We performed a retrospective chart review of all patients with urinary TB from 1978 to 2016 at our hospital and analyzed the patients' symptoms, diagnostic methods, imaging studies, time to diagnosis, treatment methods, and follow-up. Results: Twenty-one patients (median age: 49 years) had urinary TB, of whom 18 had hydronephrosis and hydroureter. No bilateral renal involvement was noted. The median duration from symptom onset to anti-TB treatment was 78.5 days. There was no significant relationship between symptom-to-treatment time and posttreatment changes in renal function (Pearson's r = 0.103, P &gt; 0.05); however, the symptom-to-treatment time was linearly associated with pre- and posttreatment hydronephrosis grade (Pearson's r = 0.667, P= 0.03, and r = 0.710, P= 0.007, respectively). In multivariate analysis, the symptom-to-treatment time was found to be an independent predictor of improvements in hydronephrosis but was not associated with renal function change. Of nine patients with upper urinary tract drainage, hydronephrosis improved in three and was stable in five patients. Of 12 patients without drainage, four experienced renal loss. Conclusion: Urinary TB has vague clinical manifestations and is prone to a delayed diagnosis. Early diagnosis and prompt internal ureteral stenting may prevent renal loss in certain patients.

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.

Outcomes of externalized pyeloureteral versus internal ureteral stent in pediatric robotic-assisted laparoscopic pyeloplasty

After pyeloplasty, urinary drainage options include internal double-J (DJ) ureteral stents or externalized pyeloureteral (EPU) stents, which can avoid bladder symptoms and additional anesthetic exposure from stent removal. Comparative outcome studies, however, are lacking following primary pediatric robotic-assisted laparoscopic pyeloplasty (RALP). To compare operative success, operative time, hospitalization, and postoperative complications of EPU versus DJ stents following RALP. Consecutive children undergoing primary RALP from 10/2013 to 9/2015 were retrospectively identified. Data collected included patient demographics, stent type and duration, postoperative complications, and operative success. To control for confounding by indication for EPU stent, propensity score weighting was used to balance baseline covariates. Weighted regression analyses compared between-group differences in study outcomes. At median follow-up of 12.3 months, 44 and 17 patients underwent DJ and EPU stenting, respectively. At baseline, DJ stent patients were older than EPU stent patients (median 7.7 vs 1.2 years, P=0.01) and were less likely to be on postoperative antibiotic prophylaxis (25 vs 76%, P<0.001). After weighting, these differences disappeared. All EPU stents were removed in the outpatient clinic; all DJ stents were removed under anesthesia. On weighted regression analyses (Summary Fig.), EPU stents had no different associations than DJ stents with operative success (95 vs 94%, between-group difference 1%, 95% CI -11, 13; P=0.86), complications, or operative time, but did have 0.6 of a day more hospitalization (95% CI 0.04, 1.2; P=0.04). Patients receiving EPU stents were different at baseline from those receiving DJ stents. After propensity score weighting balanced these covariates, EPU stents were associated with similar operative success, complications, and operative time to DJ stents. Further study is warranted in larger prospective cohorts. Use of EPU stents provided a viable alternative, particularly in younger patients, to DJ stenting with comparable success and complications, while avoiding the need for an additional anesthetic.

Efficacy and safety of the use of infant feeding tubes as internal ureteral stents at Muhimbili National Hospital, Tanzania

Background: Infant feeding tubes are inexpensive, readily available, and have been used as urinary tract stents with some uncertainty about their effectiveness and safety. Double J ureteral stents are available on the market, but among other factors, availability and affordability limit their use in developing countries, including in our hospital. We aimed to compare the efficacy of infant feeding tubes compared to standard double J ureteral stents in patients undergoing open ureteral stenting at Muhimbili National Hospital in Dar es Salaam, Tanzania. Methods: We conducted a hospital-based cross-sectional analytical study over 12 months. Patients included in the study required open ureteral stenting for different indications and were divided into 2 groups: those for whom infant feeding tubes were inserted during surgery (study group) and those whose surgery used double J stents (control group). After surgery, patients were recruited and observed to ascertain the duration of hospital stay, as well as the presence of haematuria, dysuria, urinary frequency, flank and suprapubic pain, stent migration, and stent encrustation. Observations continued until the day of discharge, after which patients were followed up to the day of stent removal. Results: A total of 44 patients were enrolled in the study. The mean age of participants was 40 years (range 1 to 75). The majority of participants were female (n = 26; 60%). Among the 44 operations, 19 (43.2%) used the infant feeding tube as a stent whereas the remainder (n = 25; 56.8%) used the standard double J ureteral stent. The mean hospital stay among patients who underwent surgery with the infant feeding tube as a stent was 9.6 days, whereas those who used the standard double J stent stayed for 8.8 days (P = 0.37). Postoperatively, haematuria was observed in 19 (43.2%) of the patients; among these, 15 (79%) of them received infant feeding tube stents and 4 (4.3%) received standard double J stents (Χ2 = 17.4; P = 0.001). The postoperative prevalences of dysuria, flank pain, and suprapubic pain were 6.8%, 20.4%, and 9.1%, respectively. These outcomes did not show association with the type of surgical stent used. None of our study patients experienced postoperative urinary frequency. Imaging studies showed that 57.8% of the infant feeding tube stents were in the normal position postsurgery, whereas all of the standard double J stents were in the normal position (Χ2 = 12.86; P = 0.005). Further, we found that among the 44 patients, only 1 patient (who underwent surgery that used double J stenting) had postoperative stent encrustation (Χ2 = 0.7; P = 0.4). Conclusions: Despite producing significantly higher incidences of haematuria and malposition, infant feeding tube as ureteral stents were comparable to double J stents in terms of hospital stay post-stenting, dysuria, flank pain, suprapubic pain and encrustation. Future larger prospective studies are needed to confirm these findings. https://dx.doi.org/10.4314/ecajs.v22i3.5 This work is licensed under a Creative Commons Attribution 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source (including a link to the formal publication), provide a link to the Creative Commons license, and indicate if changes were made.

Abstract No. 575 A retrospective analysis of a single-center experience with percutaneous nephrostomy during pregnancy

Percutaneous nephrostomy has been used to treat symptomatic renal obstruction. Although there have been small published series describing safety and efficacy, this study assesses our experience over 12 years placing PCNs in pregnant women in a tertiary care academic medical center. In this IRB approved study, all patients undergoing percutaneous nephrostomy (PCN) from 7/1/2005 through 7/1/2017 were identified through a Hi-IQ database search. Only patients who were pregnant at the time of PCN placement were included. A retrospective review was performed to include demographics, gestational age, clinical indications, technical success, maternal outcome, fetal outcome, and complications. Twenty-one subjects were included with a median age of 28 (range, 19-38). The median gestational age at the time of intervention was 26 weeks (range, 8-38). Of the 21 patients undergoing percutaneous nephrostomy 7 (33%) had hydronephrosis secondary to calculi, 7 (33%) due to congenital ureteral dysfunction and childhood ureteral re-implantation, 2 (10%) had failed internal ureteral stenting, 2 (10%) had urosepsis. There was one case each of the following: gravid uterus with ureteral compression, ureteral trauma in the setting of surgery for presumed ovarian torsion, and hydronephrosis with associated flank pain. Eleven (52%) patients had moderate hydronephrosis, 8 (38%) had severe hydronephrosis, and 2 (10%) had mild hydronephrosis. Technical success was 100% (21/21). 91.5% of pregnancies continued to term. One fetus in the cohort was delivered prematurely at 31 weeks (4.7% preterm delivery). One pregnancy was terminated as it was undesired. There were no major or minor complications related to the procedure. Percutaneous nephrostomy during pregnancy has excellent technical success and good maternal and fetal outcomes.

The Predictive Factors of Stent Failure in the Treatment of Malignant Extrinsc Ureteral Obstruction Using Internal Ureteral Stents

In this study, we retrospectively reviewed the experiences at our single institute in the treatment of malignant extrinsic ureteral obstruction (MUO) using ureteral stents to investigate the clinical outcomes and the predictive factors of stent failure. In 52 ureters of 38 patients who had radiologically significant hydronephrosis due to MUO, internal ureteral stents (The BARD(R) INLAY(TM) ureteral stent set) were inserted. The median follow-up interval after the initial stent insertion was 124.5 days (4-1,120). Stent failure occurred in 8 ureters (15.4%) of the 7 patients. The median interval from the first stent insertion to stent failure was 88 days (1-468). A Cox regression multivariate analysis showed that the significant predictors of stent failure were bladder invasion. Based on the possibility of stent failure, the adaptation of the internal ureteral stent placement should be considered especially in a patient with MUO combined with bladder invasion.

Efficacy of commercialised extracorporeal shock wave lithotripsy service: a review of 589 renal stones

BackgroundExtracorporeal shockwave lithotripsy (ESWL) is the management of choice for renal stones 20 mm or smaller, with a stone clearance rate of up to 89%. The purpose of the present is to investigate the efficacy of a commercialised ESWL service, being performed as an outsourced treatment using a mobile lithotripsy system on an outpatient basis. Furthermore, the study aims to evaluate the risk of needing treatment with an internal ureteral double-J stent (JJ) after ESWL treatment.MethodsDuring an eight-year period, 461 patients with a total of 589 renal stones were treated using a mobile lithotripsy system at a single Danish institution. A commercial company performed all treatments using a Storz Modulith SLK® system. Each stone was prospectively registered according to size, intra renal location and the presence of a JJ at the time of treatment. The number of required ESWL treatments and auxiliary procedures were retrospectively evaluated.ResultsThe success rate after the initial ESWL procedure was 69%, which increased to an overall success rate of 93% after repeated treatment. A negative correlation was found between stone size and the overall success rate (r = −0.2, p < 0.01). The upper calyx was associated with a significantly better success rate, but otherwise intra renal stone location was not predictive for treatment success. A total of 17 patients (2.9%) required treatment with a JJ after the ESWL procedure. No significant difference was observed between the stone size or intra renal location and the risk of needing treatment with JJ after ESWL.ConclusionsCommercialised ESWL treatment can achieve an overall success rate of more than 90% using a mobile lithotripsy system. As expected, an inverse relation between stone size and success rate was found. Patients who do not require treatment with a JJ prior to ESWL will only rarely need treatment with a JJ after ESWL, irrespective of stone size and intra renal stone location.

Prevention and treatment of symptoms associated with indwelling ureteral stents: A systematic review.

Temporary drainage of the upper urinary tract by internal ureteral stents is a routine procedure in endourology. However, it is associated with a clear side-effect profile. Our aim was to evaluate prevention and treatment options of stent-related symptoms. We carried out a systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines using MEDLINE and SCOPUS, and identified 107 appropriate records. A high number of these studies showed clear methodological limitations. Available data clearly support the use of α1 -blockers in patients suffering from stent-related symptoms. It seems that antimuscarinic monotherapy or combination with α1 -blockers might also play an important role, whereas the use of classical analgesics in the treatment of stent-related symptoms has not been assessed systematically within clinical trials so far. Improvements in stent design and material seem to have the potential to reduce stent-related symptoms. However, so far there is no type of stent with outstanding characteristics and clear evidence suggesting fundamental advantages compared with a standard double pigtail stent. Although stent diameter does not seem to influence patients' comfort, it seems to be beneficial to choose a proper stent-length. Coated and drug-eluting stents, as well as intravesical drug application, seem to be promising concepts to prevent stent-related symptoms, but still have to be considered as experimental approaches. Furthermore, thorough patient education has the potential to reduce the morbidity associated with ureteral stenting. Further research in the field seems to be mandatory.

V7-11 PEDIATRIC ROBOT-ASSISTED LAPAROSCOPIC EXCISION OF ECTOPIC DISTAL URETERAL STUMP

RESULTS: Surgery was uneventful. Identification of the distal ureter was somewhat challenging, but landmarks, such as the iliac bifurcation allowed for localization. The placement of both robotic ports along the midclavicular line provided maximum access to the distal and proximal segments of the ureter, aiding in our dissection. The ureter was transected proximally and distally to the stenotic segment. The retrocaval portion of the ureter was left in place though in discontinuity. The anastomosis was performed using a 5-0 PDS continuous suture. Operative time was 159 minutes, and EBL was 20mL. A 6x28 JJ internal ureteral stent was left in place for one month. The patient awaits further follow-up. CONCLUSIONS: A robotic-assisted approach to repair of a retrocaval ureter is a safe alternative to the conventional open approach. Identification of the distal ureter can be challenging, but the use of landmarks, such as the iliac bifurcation, as well as selective port placement can assist the dissection.

After urgent drainage of an obstructed kidney by internal ureteric stenting; is ureteroscopic stone extraction always needed?

ObjectivesTo assess the probability of spontaneous stone passage and its predictors after drainage of obstructed kidney by JJ stent, as insertion of an internal ureteric stent is often used for renal drainage in cases of calcular ureteric obstruction. Patients and methodsBetween January 2011 and June 2013, patients for whom emergent drainage by ureteric stents were identified. The patients’ demographics, presentation, and stone characteristics were reviewed. The primary endpoint for this study was stone-free status at the time of stent removal, where all patients underwent non-contrast spiral computed tomography (NCCT) before stent removal. Ureteroscopic stone extraction was performed for CT detectable ureteric stones at the time of stent removal. Potential factors affecting the need for ureteroscopic stone extraction at the time of stent removal were assessed using univariate and multivariate statistical analyses. ResultsEmergent ureteric stents were undertaken in 196 patients (112 males, 84 females) with a mean (SD) age of 53.7 (16.2) years, for renal obstruction drainage. At the time of stent removal, 83 patients (42.3%) were stone free; with the remaining 113 patients (57.7%) undergoing ureteroscopic stone extraction. On multivariate analysis, stone width [odds ratio (OR) 15.849, 95% confidence interval (CI) 2.83; P=0.002) and radio-opaque stones (OR 12.035, 95% CI 4.65; P<0.001) were independent predictors of the need for ureteroscopic stone extraction at the time of stent removal. ConclusionSpontaneous ureteric stone passage is possible after emergent drainage of an obstructed kidney by ureteric stenting. Stone opacity, larger stone width, and positive preoperative urine culture are associated with a greater probability of requiring ureteroscopic stone extraction after emergent drainage by ureteric stenting.

Studying the Morbidity and Renal Function Outcome of Missed Internal Ureteral Stents: A Matched Pair Analysis.

To investigate the effect of missed internal ureteral stents (IUS) on renal function and to describe different modalities of management and associated morbidity. A retrospective study included patients with missed IUS (>1 year). The complications of missed IUS were categorized according to the forgotten, encrusted, calcified (FECal) grading system. The estimated glomerular filtration rate (eGFR) was calculated using the Modification of Diet in Renal Disease (MDRD) equation at time of initial stent placement and time of stent removal. An age- and sex-matched group of patients who had IUS and had available follow-up for the same duration of the study group were used as a control. A total of 46 missed IUS in 46 patients were included. Complicated stents were reported in 34 (73.9%) patients. FECal grade 1 was reported in 16 (57.2%) patients followed by grade 2 and 4 in 5 (17.8%) patients each. Retrograde removal, visual cystolitholapaxy, ureteroscopy with laser disintegration of encrustations and combined retrograde and antegrade approach have been used in 21, 5, 10, and 9 patients, respectively. In the missed IUS group, the mean±standard deviation (SD) eGFR has declined from 65.5±26.3 mL/min/1.73m(2) to 54.3±30 mL/min/1.73m(2) (P=0.001). While in the control group, the mean±SD eGFR has increased from 57.5±30 mL/min/1.73 m(2) to 66.7±27 mL/min/1.73 m(2) (P=0.001). Missed IUS were associated with significant complications that necessitated more invasive intervention. In addition, IUS had a negative impact on renal function at time of removal.

Is intravesical stent position a predictor of associated morbidity?

Temporary drainage of the upper urinary tract by use of internal ureteral stents is a common procedure that is often associated with a variety of symptoms. The role of intravesical stent position in associated morbidity is controversial. The German version of the ureteral stent symptom questionnaire (USSQ) was completed by 73 patients with an indwelling ureteral stent the day before stent removal. Intravesical stent position was classified into 3 categories by x-ray before stent removal. The influence of intravesical stent position on USSQ score was analyzed, including subscores and single items. Intravesical stent position showed no significant influence on associated morbidity. The median USSQ total score in all patients was 77.5 (range, 30-147). Patients with ipsilateral stents (69.0; range, 30-122) tended to have lower total scores than did those with tangential (86.5; range, 30-122) or contralateral (77.0; range, 31-147) stents, but the differences were not statistically significant (p=0.35). The USSQ subscores for urinary symptoms (p=0.80), body pain (p=0.80), general health (p=0.16), work performance (p=0.07), additional problems (p=0.81), and all of the USSQ single items of interest in the context of stent length also did not differ significantly between the three groups. Intravesical stent position did not significantly influence associated morbidity in our study. An appropriate stent length should be chosen to avoid dislocation. However, complex calculations of optimum stent length, time-consuming manipulations, and costly stock holding of various stent sizes to obtain the perfect stent position do not seem worthwhile.

Nonoperative treatment of blunt renal trauma with urinary extravasation in a child

The goal of renal trauma management is preservation of functional renalparenchyma with minimal morbidity. In children with grade IV renal injury, therole and timing of surgical or endourologic intervention is less established andremains controversial. We report a case of a urinary extravasation after bluntrenal trauma treated by internal ureteral stenting.