double-J Ureteral Stent Placement Research Articles

Comparison of percutaneous antegrade double-J ureteral stent placement: first-hand vs. nephrostomy route approaches.

This study aimed to conduct a comparative analysis of procedural efficacy, safety, and patient outcomes between 2 distinct approaches for percutaneous antegrade double-J ureteral stent (DJS) insertion: the first-hand approach and via a nephrostomy route. Electronic records of patients undergoing percutaneous antegrade ureteral DJS placement from January 2016 to 2023 were reviewed. Patients were categorized into 2 groups based on stent placement technique: the first-hand group, involving a single-stage approach without prior percutaneous nephrostomy catheter insertion, and the nephrostomy group, where stent placement occurred through a percutaneous nephrostomy tube. Clinical data, including patient demographics, primary diagnoses, procedural details, complication rates, stent placement success, and post-procedural outcomes, were collected and analysed. Both approaches demonstrated high technical success rates (93.1%). However, the nephrostomy route group exhibited a comparatively higher fluoroscopy exposure rate (8.2 min) than the first-hand group (6.8 min). Moreover, the complication risk increased by 3.08 times in patients treated with the nephrostomy method (P = .047). Notably, in cases of urinary malignancies, the preference was for placing DJS via nephrostomy. The first-hand approach should be prioritized as the initial choice in suitable cases owing to its reduced fluoroscopy time, lower complication rate, and the single-stage nature of the procedure. With the exception of cases necessitating urgent drainage, such as post-renal acute renal failure and urosepsis, the first-hand method is the primary approach for inserting DJS. This is primarily due to the significantly shorter radiation time and the single-stage nature of the procedure.

Fluorescence guidance during robotic resection of bladder wall endometriosis: case report and technique.

The application of indocyanine green (ICG) has recently been reported to aid in the resection of endometriosis in the bladder wall and/or involving the ureters. A symptomatic 41-year-old patient with dysmenorrhea and pollakisuria was referred to our tertiary center. Imaging revealed a 1.5-2cm intramural endometriotic nodule in the posterior bladder wall. She was planned for robotic resection of the endometriotic nodule, under ICG guidance, together with a hysterectomy. After placement of double-J ureteral stents and clamping the bladder, perforation of the bladder mucosa could be avoided whilst performing a circumferential resection of the nodule. By clamping the bladder catheter after instillation of ICG, both the bladder wall thickness and ureters could be visualized with near-infrared imaging during robotic resection of the endometriotic nodule and hysterectomy. With the surgical approach described here, endometriotic nodules/tissue can be removed precisely with enlarged vision at the robot console, safely, and completely without damaging adjacent tissues.

Surgical Management of Endometriosis of the Bladder and Ureter

<h3>Study Objective</h3> To demonstrate a step-by-step approach for the surgical management of urinary tract endometriosis using conventional laparoscopy for partial cystectomy and robotic-assisted laparoscopy for ureteroneocystostomy. <h3>Design</h3> Surgical video. <h3>Setting</h3> Academic tertiary referral center for endometriosis. <h3>Patients or Participants</h3> The first patient was a 38-year-old G3P3 with a history of hysterectomy presenting with dysuria had an MRI which revealed a T2 hypointense bladder nodule consistent with endometriosis. The second patient was a 25-year-old nulliparous woman with history of stage IV endometriosis with DIE into the bowel and both ureters causing subsequent hydronephrosis requiring bilateral ureteral stents and subsequently bilateral percutaneous nephrostomy tubes. <h3>Interventions</h3> In the first case, a cystoscopy was performed to confirm MRI findings of bladder lesion and to delineate borders and depth of invasion. Conventional laparoscopy was utilized to perform bilateral ureterolysis, bladder mobilization, partial cystectomy for complete excision of the lesion, and two-layered bladder closure. Use of indigo carmine assisted with ureteral orifice identification. In the second case, cystoscopy was performed with injection of ICG to assist with ureteral identification. After ureterolysis, distal ureteric obstruction due to extensive disease was confirmed on laparoscopy and ureteroscopy. Bilateral ureteroneocystostomy with placement of Double-J ureteral stents was performed using a robotic-assisted approach. Each patient had indwelling foley catheter for bladder decompression during recovery. <h3>Measurements and Main Results</h3> Both patients had an uneventful postoperative course. A postoperative retrograde cystogram confirmed adequate repair prior to removal of each foley catheter. Patient two had office stent removal 6 weeks postoperative. <h3>Conclusion</h3> Endometriosis is an increasingly common condition. It is important for gynecological surgeons to have the proper understanding of anatomy, surgical technique, and multidisciplinary care needed with urology for safe and complete excision of bladder and ureter endometriosis.

Live Renal Ultrasonography Facilitates Double-J Ureteral Stent Insertion at the Bedside: A Pilot Study for the COVID-19 Era.

Objectives: To investigate the feasibility and efficacy of live renal ultrasonography to guide Double-J ureteral stent placement at the bedside. Patients and Methods: Between April 12 and June 5, 2020, patients presenting with acute ureteral obstruction requiring decompression were prospectively selected for ultrasound-guided bedside ureteral stent placement. During stent placement, upper tract access confirmed using ultrasound with or without retrograde injection of ultrasound contrast before Double-J stent insertion. A postprocedural abdominal X-ray was obtained for stent position confirmation. Results: Eight patients (four men and four women) were offered bedside ultrasound-guided ureteral stent placement, and all eight consented to proceed. Stents were placed in seven of eight patients. One patient had an impacted ureterovesical junction stone and stricture requiring ureteroscopy and laser lithotripsy in the operating room. All patients tolerated procedures without immediate complications. Conclusion: Live renal ultrasonography can facilitate a high success rate for bedside ureteral stent placement outside the operating room. This approach is an attractive alternative to fluoroscopy-guided stent placement in the operating room and is of particular value in the COVID-19 era when judicious use of these resources is salient.

Double-J stents forgotten for four years: a case report

Placement of double-J ureteral stents after endourologic procedures and some open urological surgeries are practical and safe. However, when neglected in situ, undesired problems may occur, leading to serious medical and legal issues. Complications from ureteral stents with protracted indwelling durations include urosepsis, renal failure, encrustation, and spontaneous fractures which may be retained or voided in the urine (stenturia). We report a 40-year-old woman of forgotten double-J ureteral stents, inserted 4 years prior to this study during a gynecologic operation. The patient had pulled out the double-J stents from her urethra herself and presented with impending sepsis. Then, she underwent ureterorenoscopic lithotripsy, but it failed to remove the remaining encrusted double-J stent. As a result, percutaneous nephrolithotomy was performed successfully and she had symptom-free thereafter.

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.

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.

Endoscopic Management of Primary Obstructive Megaureter: A Systematic Review.

The gold standard treatment for primary obstructive megaureter (POM) with declining renal function, worsening obstruction, or recurrent infections is ureteral reimplantation with or without tapering. In infants, open surgery can be technically demanding and associated with significant morbidity. We conducted a systematic review of the literature with special interest in endoscopic management of POM and its outcomes. A search was conducted of the MEDLINE/Ovid, PubMed, Embase, and Web of Science databases. Only full-text articles written in the English language and involving greater than one reported pediatric case per publication were included. Two authors independently extracted data and assessed strength of evidence for each study. We found 11 retrospective and 1 prospective, single institution case series that met selection criteria, describing 222 patients with 237 obstructed renal units. Mean age at time of surgery was 24.6 months. The most common endoscopic approaches were cystoscopy+high-pressure balloon dilation+Double-J ureteral stent placement (49.5%), cystoscopy+incisional ureterotomy+Double-J ureteral stent placement (27.8%), and cystoscopy+Double-J ureteral stent placement (18.9%). For all approaches and age groups, anatomic and functional success rates were 79.3% (146/184) and 76.7% (132/172), respectively. Anatomic success rates were highest in children ≥12 months of age (82.3%, 117/142). Endoscopic retreatment was performed in 15.1% of cases with a 36.7% overall surgical reintervention rate. Forty-one ureters progressed to ureteral reimplantation. Complications were generally mild (Clavien-Dindo Grades I-II), but 12 ureters did develop vesicoureteral reflux. Mean follow-up period was 3.2 years. Endoscopic management for persistent or progressive POM in children ≥12 months of age is a minimally invasive alternative to ureteral reimplantation with modest success rates. In infants, it may best be utilized as a temporizing procedure. Approximately one-third of patients require surgical reintervention.

A randomized controlled trial comparing antimicrobial (silver sulfadiazine)-coated ureteral stents with non-coated stents

Objective: The aim of this study was to compare the efficacy of antimicrobial [silver sulfadiazine (SSD)]-coated ureteral stents with non-coated stents in the prevention of stent-related bacteriuria.Materials and methods: A randomized controlled trial was conducted between September 2014 and September 2016 after approval from the local ethics committee. Inclusion criteria were adults who underwent unilateral double-J ureteral stent placement after ureteroscopic lithotripsy. All patients underwent placement of the same stent type (Carbothan® with hydrophilic surface) and dimensions (6 F, 26 cm). In the test group, stents were coated with SSD. Patients who used antibiotics during the stenting period or underwent stent removal elsewhere were excluded from the study. Urine and stent cultures were obtained on the day of stent removal. All patients answered the Ureteral Stent Symptom Questionnaire (USSQ).Results: The study included 126 patients. The mean ± SD stent duration was 3.1 ± 1.2 weeks. There were no significant differences between groups in the incidence of bacteriuria and USSQ scores. However, two stents (3.2%) in the SSD group had significant bacterial growth, compared to eight stents (12.5%) in the control group (p = 0.054). The incidence of newly diagnosed bacteriuria was higher in the control group (11%) than the antimicrobial group (6.5%), but the difference was not significant (p = 0.372).Conclusions: This study could not justify the use of antimicrobial (SSD)-coated stents for short stenting periods. The trend towards decreasing stent colonization in the antimicrobial group was not translated to a significantly lower incidence of stent-related bacteriuria or improvement in patients’ quality of life.

Case of fatal air embolism during double-J ureteral stent placement

Air embolism is a severe and fatal complication, but it is very rare during transurethral surgery. This report describes a case of air embolism during double-J ureteral stent placement in a 45-year-old woman. During ureteroscopy, a sudden decrease in oxygen saturation and end-expiratory carbon dioxide pressure and cyanosis of the face were observed. Subsequent echocardiography confirmed an air embolism by detecting bubbles in the heart. Despite resuscitative measures, the patient died rapidly. Detailed autopsy was performed to clarify the cause of death and the route of air entering into the circulatory system. The report presented here reminds urologists and pathologists that air embolism can occur during double-J ureteral stent placement and offers some suggestions regarding identification of air embolism at autopsy.

EFFECT OF TAMSULOSIN ON STENTRELATED SYMPTOMS

Introduction: Cystoscopic intraluminal placement of ureteral stents has become a routine practice in urology. Ureteral stents preserve urine flow from the kidney to the bladder in cases of ureteral obstruction (intrinsic or extrincis). In patients with obvious ureteral obstruction, the placement of a ureteral stent will restart urine transport and protect the kidney from possible risks. Ureteral stents are troublesome in some patients and causes LUTS. Study Design: Prospective randomized controlled trial. Setting: Urology Department, Sheikh Zayed Hospital Lahore. Period: Six month started from August 2015 to December 2015. Material and Methods: 100 patients who were randomly divided into two equal groups. The patients were between 18 to 50 years of age of both gender undergo retrograde double-J ureteral stent placement. Before the double-J stent will be applied, all patients completed an International Prostate Symptom Score (IPSS) questionnaire for evaluation of lower urinary tract symptoms.Patients were divided in two groups on the basis of lottery method tamsolusin group (1) and placebo group (2). Tamsulosin group patients was given tamsulosin post operatively and placebo group was given a placebo postoperatively. Results: There were total 100 patients who were enrolled in this study with a mean age of 42.63±6.24. There were 75(75%) were male while 25(25%) were female. The mean IPSS sore at presentation was 2.47±1.43 and post treatment was 5.20±1.65. There was significant difference in IPSS score in control group with mean 5.28±1.69 versus study as mean 2.22±1.05 group, p-value= 0.010. Conclusion: There is difference in lowering of IPSS score in the patients who are given tamsolusin versus those who were retained on placebo.

Ureteral Obstruction and Hydronephrosis Caused by Postpartum Ovarian Vein Thrombosis

Background: Ovarian vein thrombosis is an uncommon postpartum event that may complicate vaginal or cesarean deliveries. Diagnosis may be delayed, given the nonspecific clinical symptoms. Case: The case of a patient with right flank and abdominal pain 5 days after a cesarean delivery is presented. Despite adequate hydration, antibiotics, and pain medication, the right flank pain persisted. Concomitantly, the patient's serum creatinine levels increased. Computed tomography revealed a thrombosed right ovarian vein causing right ureteral obstruction and hydronephrosis. Results: Subsequently, the patient required double-J ureteral stent placement, intravenous antibiotics, and anticoagulation, after which she felt much better and required only minimal use of oral pain medication. Her serum creatinine level decreased. She was started on therapeutic enoxaparin, tamsulosin, and ceftriaxone and was discharged on hospital day 5. She continued her enoxaparin for 7 more days and reported no problems on follow-up urologic and gynecologic visits 2 weeks later. Conclusions: Ovarian vein thrombosis should be considered in the differential diagnosis of abdominal or flank pain in the postpartum period. Prompt diagnosis and treatment, especially in the setting of ureteral obstruction, is essential to prevent life-threatening complications. (J GYNECOL SURG 29:158)

Ureteral stent placement and BK viremia in kidney transplant recipients

BK virus (BKV) infection is an important cause of kidney transplant dysfunction. A possible association of double-J ureteral stent placement and BK viremia has been suggested in previous studies; however, risk factors for BK are incompletely understood. We aimed to determine if stent placement is an independent risk factor for BK viremia. Data were collected on consecutive kidney-only transplant recipients between December 1, 2006 and June 30, 2010. All patients had at least 12months of follow-up. Of 600 consecutive kidney transplants, BK viremia within the first post-transplant year was detected in 93 patients (15.5%); in 70 of these cases, the peak BKV polymerase chain reaction was ≥10,000 copies/mL. By multivariate analysis, significant risk factors for BK viremia were recipient age (P=0.02) and stent placement (P=0.03). Stents were placed in 49.2% and removed at a median of 46days (range: 11-284) post transplantation; removals occurred within 0-30, 30-60, 60-90, 90-120, 120-150, and >150days post transplantation in 18.4%, 67.2%, 10.5%, 2.4%, 1.0%, and 0.3% of cases, respectively. No association was found of BK viremia with stent duration >46days (P=0.70) or by the 6-level groupings (P=0.92). Although we observed a significant association of BK viremia with stent placement, no dose-dependent effect was seen.

Double-J Ureteral Stent Placement: An Educational Video

OPEN ACCESSAugust 9, 2012Double-J Ureteral Stent Placement: An Educational Video Andrea Crane, MD, Kristy Borawski, MD, Elizabeth Calloway, AnnaMarie Connolly, MD Andrea Crane, MD University of North Carolina at Chapel Hill School of Medicine Google Scholar More articles by this author , Kristy Borawski, MD University of North Carolina at Chapel Hill Google Scholar More articles by this author , Elizabeth Calloway University of North Carolina at Chapel Hill Google Scholar More articles by this author , AnnaMarie Connolly, MD University of North Carolina at Chapel Hill Google Scholar More articles by this author https://doi.org/10.15766/mep_2374-8265.9208 SectionsAbout ToolsDownload Citations ShareFacebookTwitterEmail Abstract Introduction: There are many learners in the surgical profession that go through medical training without specific direction on how to select and properly place a ureteral stent. This video resource file outlines this for the viewer in an organized instructional format and was initially created to facilitate safe and successful stent placement. The original learner target audience consists of urologists, gynecologists, and urogynecologists. Methods: A 7-minute video clip is the single resource file included in this resource. The video is produced as an MPEG-4 movie file. The video contains PowerPoint slides, video footage, and custom animation. Implementation requires streaming video capabilities. Results: This video was successfully presented as a peer-reviewed video oral presentation with a question and answer session at the American Urogynecologic Society 2011 annual meeting in Providence, Rhode Island. This society consists of physicians, nurses, physical therapists, students, researchers, educators, and other health care professionals interested in female pelvic medicine and reconstructive surgery. Feedback from many educators and program directors after the presentation were positive and included comments regarding the utility of this resource for medical education. Discussion: This video has clear educational objectives and is delivered in a concise and generalizable manner. This resource may prove helpful to not only practicing urogynecologists and urogynecologists-in-training, but also to medical students in the obstetrics/gynecology and general surgery/urology clerkships, and residents in the specialties of gynecology, urology, and general surgery. Educational Objectives By the end of this session, learners will be able to: Describe proper ureteral stent selection.Discuss the necessary tools needed for ureteral stent placement.Demonstrate a technique for successful stent placement. Sign up for the latest publications from MedEdPORTAL Add your email below FILES INCLUDEDReferencesRelatedDetails FILES INCLUDED Included in this publication: Ureteral Stent Instructor's Guide.pdf Ureteral Stent.m4v To view all publication components, extract (i.e., unzip) them from the downloaded .zip file. Download editor’s noteThis publication may contain technology or a display format that is no longer in use. CitationCrane A, Borawski K, Calloway E, Connolly AM. Double-J Ureteral Stent Placement: An Educational Video. MedEdPORTAL. 2012;8:9208. https://doi.org/10.15766/mep_2374-8265.9208 Copyright & Permissions© 2012 Crane et al. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-No Derivatives license.KeywordsUreteral Stent PlacementAcknowledgmentsMusic “I Will Celebrate” created by Joshua Tuburan and used with permission. Disclosures None to report. Funding/Support None to report. Prior Presentations Crane AK, Borwaski K, Calloway EH, Connolly A. Ureteral Stent Placement: An Educational Video. Presented at: American Urogynecologic society 32nd Annual Meeting; September 14–17, 2011; Providence, Rhode Island. Loading ...

Alpha-Blockers Impact Stent-Related Symptoms: A Randomized, Double-Blind, Placebo-Controlled Trial

Ureteral stents are indispensable tools in endourology, although they often are associated with bothersome lower urinary tract symptoms. This study was conducted to evaluate the effect of alfuzosin on urinary symptoms, quality of life, and pain in patients after Double-J ureteral stent placement in a randomized, placebo-controlled trial. This study was conducted from July 2008 to May 2009. A total of 130 patients underwent placement of a Double-J stent after retrograde semirigid ureteroscopy for ureteral stones. They were randomized in two groups. Group 1 (n=65) received alfuzosin 10 mg once daily and group 2 (n=65) received placebo for 1 week. Both groups also received standardized analgesia. The stent symptoms were measured and recorded 1 week after the procedure. Statistical analyses were performed using the chi-square test and Student t test with P<0.05 considered significant. The demographic profile including patient and stone-related parameters were comparable. Group 1 had significantly less urinary symptoms (P<0.05). The quality-of-life assessment was better in the alfuzosin arm than in the placebo arm (P<0.001). The mean pain score was 1.15 in group 1 and 3.89 in the placebo group (P<0.001). None of the patients in either of the arms withdrew from treatment; there were minimal adverse effects in the treatment arm. The limitation of the current work includes relatively smaller sample size and use of single type of stent. Alfuzosin 10 mg once daily in patients with a Double-J stent significantly decreases the bothersome urinary symptoms, besides decreasing significantly the pain associated with the stent.

Predictive Factors for Ureteral Double-J-Stent-Related Symptoms: A Prospective, Multivariate Analysis

Whether the length of stent affects stent-related symptoms after urological procedures remains controversial. We aimed to evaluate the predictive factors for stent-related urinary tract symptoms after uncomplicated ureteroscopic lithotripsy (URSL). We prospectively recruited a total of 59 patients who underwent URSL and 6-Fr double-J ureteral stent placement. The demographic and perioperative data and stent characteristics, including the length (22, 24 or 26 cm), position of proximal end (upper calyx or pelvis), position of distal end (crossing midline or not), and configurations of both ends (complete or incomplete curl) were recorded. All patients completed a self-administered questionnaire to evaluate the stent-related urinary symptoms, bladder pain, flank pain and hematuria 1 week after the procedure. All variables were analyzed by a proportional odds logistic regression model. Twenty-two male (37.3%) and 37 (62.7%) female patients were enrolled in this study. Their mean age was 53.7 ± 12.9 years. The mean body height was 161.9 ± 7.9 cm (range, 145.9-178 cm). In multivariate analysis, the 26-cm stent was independently associated with the severity of frequency, urgency, and nocturia symptoms. Crossing the midline of the distal end was significantly associated with urge incontinence. The 24-cm and 26-cm stents were both very strongly associated with the severity of hematuria. Crossing the midline of the distal end was significantly associated with bladder pain. The length of stent and crossing the midline of the distal end were significantly associated with stent-related symptoms after URSL. Selection of the proper length of double-J stent is the most important factor in minimizing stent-related symptoms.

V770 MANAGEMENT ALTERNATIVES FOR URINE LEAK AFTER LAPAROSCOPIC OR ROBOTIC PROSTATECTOMY

You have accessJournal of UrologyOncology (TCC & Adrenal) & Teaching Techniques1 Apr 2010V770 MANAGEMENT ALTERNATIVES FOR URINE LEAK AFTER LAPAROSCOPIC OR ROBOTIC PROSTATECTOMY Camilo Giedelman, Daniel Ramirez, Oswaldo Carmona, Robert De Andrade, Camilo Mejia, David Canes, Ingolf Tuerk, Marcelo Miranda, and Rene Sotelo Camilo GiedelmanCamilo Giedelman Caracas, Venezuela More articles by this author , Daniel RamirezDaniel Ramirez Caracas, Venezuela More articles by this author , Oswaldo CarmonaOswaldo Carmona Caracas, Venezuela More articles by this author , Robert De AndradeRobert De Andrade Caracas, Venezuela More articles by this author , Camilo MejiaCamilo Mejia Caracas, Venezuela More articles by this author , David CanesDavid Canes Burlington, Venezuela More articles by this author , Ingolf TuerkIngolf Tuerk Boston, MA More articles by this author , Marcelo MirandaMarcelo Miranda Caracas, Venezuela More articles by this author , and Rene SoteloRene Sotelo Caracas, Venezuela More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1364AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Anastomotic urinary leaks following minimally invasive prostatectomy are typically immediate and self-limiting with prolonged drainage. Leaks that do not resolve in the first week are unusual. Anastomotic leak after laparoscopic prostatectomy occur in approximately 10% of cases, requiring reoperation in only 0.9-2.5%. Etiology includes anastomotic disruption, misplacement of the foley catheter through the posterior plate, and compression of the surgical drain on the anastomosis. Leaks may present clinically as increased drain output with high creatinine levels, elevated serum creatinine from absorption, or ileus if peritoneal irritation is present. The decision to intervene surgically may be prompted by significant drainage continuing beyond the first week when conservative measures fail to contain the leakage. The goal of this video is to compile surgical footage of intervention techniques in various clinical scenarios of anastomotic disruption, from partial to complete. METHODS The present study is a combination of (1) a literature review on management techniques for anastomotic urine leak was carried out, (2) presentation of a single surgeon experience of 650 patients undergoing laparoscopic or robotic prostatectomy between 2002 and 2009 and (3) a multi-institutional compilation of videos detailing intervention techniques for urine leak. In this series, surgical drains were placed routinely and kept in for 7 days, foley catheters were left in for 10-12 days, and no routine cystograms were performed. RESULTS Out of 650 patients, 12 patients had clinically apparent leaks (1.8%). Of the 12 leaks, 1 anastomosis was done with interrupted sutures, and the other 11 with a running 2-0 monocryl suture. In 3 cases, large abdominal drainage was seen, and this resolved after bilateral double-J ureteral stent placement. Of patients with leaks, 42% had prior prostate surgery, either adenomectomy or TURP. Leaks resolving with conservative maneuvers, JJ stenting, and reoperation are shown. CONCLUSIONS Urine leaks are uncommon and often resolve spontaneously; knowledge of the spectrum of conservative measures is essential to manage these challenging situations. Keys to avoid leaks include lack of tension on the anastomosis, performing a posterior or lateral tennis raquet reconstruction when UO's are known to be close, and placement of JJ stents in those cases up front. Laparoscopic or robotic repair can be safely performed if necessary when these measures fail. © 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e301 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Camilo Giedelman Caracas, Venezuela More articles by this author Daniel Ramirez Caracas, Venezuela More articles by this author Oswaldo Carmona Caracas, Venezuela More articles by this author Robert De Andrade Caracas, Venezuela More articles by this author Camilo Mejia Caracas, Venezuela More articles by this author David Canes Burlington, Venezuela More articles by this author Ingolf Tuerk Boston, MA More articles by this author Marcelo Miranda Caracas, Venezuela More articles by this author Rene Sotelo Caracas, Venezuela More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...

Use of a Holmium Laser to Treat a Forgotten Double-J Stent With Whole Stent Encrustations: A Case Report

Short-term placement of double-J (D-J) ureteral stents after endourologic procedures and some open urological surgery is common. It is rare for a patient to forget about the indwelling D-J ureteral stent, and the major complications associated with that include infection, stone encrustation and multifractured stent. We report a case of a forgotten D-J ureteral stent, which had been placed 24 months previously during ureterorenoscopic lithotripsy, in a 62-year-old man who presented with flank soreness and recurrent urinary tract infection. Radiography of the kidney, ureter and bladder, and computed tomography demonstrated stone encrustation over the whole D-J stent. Cystolithotripsy and ureterorenoscopic lithotripsy with a Holmium laser were performed to remove the D-J. We believe that this is the first case of successful removal of an intact, encrusted stent in one procedure by endoscopic manipulation.

Complications of Laparoscopic Radical Hysterectomy and Pelvic Lymphadenectomy-Experience of 117 Patients

To describe the combined surgical technique of laparoscopic radical hysterectomy and pelvic lymphadenectomy (LRH + LPL) for cervical cancers and summarize our experiences in prevention and treatment of complications, so as to provide strategies to prevent and appropriately manage the complications that may occur during these procedures. A retrospective study was conducted on LRH + LPL in 117 cases of cervical cancer with International Federation of Gynecology and Obstetrics stages Ib (n = 96) and II a (n = 21) from August 1998 to December 2006. The intraoperative and postoperative complications were analyzed. The overall conversion rate was 1.7% (2/117). Four patients had vessel injuries, 3 of which were treated laparoscopically. One patient had a common iliac vein laceration that could not be controlled laparoscopically after failing to deal with the injured branch of common iliac vein. Cystotomy occurred in 5 patients. One case of stage IIa with a bladder laceration longer than 3 cm was converted to laparotomy during the early stages of the learning curve. The remaining 4 were managed laparoscopically. Postoperative complications occurred in 38.5% (n = 45) of the patients, including 38 patients with urinary retention who exhibited complete resolution within 6 months by intermittent training and catheterization, 4 with lymphocyst who underwent conservation treatment, 1 with ureteral fistula that was treated by cystoscopic placement of double-J ureteral stents, 1 with mild adynamic bowel obstruction who received conservative management, and 1 with vesicovaginal fistula that was closed by conservative treatment. With the continuous skilled laparoscopic technology, mastering the tips of prevention, and treatment of complications, LRH + LPL will be widely performed in the future.