Successful Stent Insertion Research Articles

The safety and effectiveness of the treatment of refractory post-intubation subglottic stenosis using short bronchial Dumon stent: a pilot study.

Post-intubation subglottic stenosis (PI-SGS) is a fatal disease which could result in partial or complete narrowing of the airway. Although airway stenting is commonly used as an alternative treatment for PI-SGS patients unsuitable for surgery, complications including stent migration and excessive granulation tissue formation are frequently encountered. Additionally, tracheotomy is necessary in patients undergoing T-tube placement. Therefore, it is necessary to further enhance the effectiveness of airway stenting in refractory PI-SGS. In this study, we aimed to evaluate the safety and effectiveness of utilizing short bronchial Dumon (BD) stents in managing refractory PI-SGS. PI-SGS patients who were not suitable for surgery and in whom previous interventional treatments had proven ineffective were enrolled. Short BD stents were inserted via rigid bronchoscopy under general anesthesia. Complications and outcomes were assessed by follow-ups. Fourteen patients were included and successful stent insertion was achieved in all cases. The median diameter and length of stents was 12 (0.25) and 33.5 (5) mm, respectively. During the 6-month follow-up period, complications were reported in five patients. Granulation tissue formation was the most frequently observed complication (4 in 14 patients, 28.57%), followed by stent migration (2 in 14 patients, 14.29%). Out of the total participants, 11 patients (78.57%) demonstrated good tolerance to the stent, while 3 (21.43%) required stent removal. Among these three patients, two finally underwent subsequent T-tube insertion after the removal. Twelve patients (85.71%) avoided the tracheotomy and T-tube insertion. The utilization of short BD stents appears to be a safe and effective approach for managing refractory PI-SGS. The complications and tolerability are acceptable.

Safety and efficacy of trans-afferent loop endoscopic ultrasound-guided pancreaticojejunostomy for post pancreaticoduodenectomy anastomotic stricture using the forward-viewing echoendoscope: a retrospective study from Japan.

Endoscopic ultrasound (EUS)-guided pancreatic duct drainage is a well-established procedure for managing pancreaticojejunostomy anastomotic strictures (PJAS) post-Whipple surgery. In this study, we examined the effectiveness and safety of EUS-guided pancreaticojejunostomy (EUS-PJS). This retrospective, single-arm study was performed at Aichi Cancer Center Hospital on 10 patients who underwent EUS-guided pancreaticojejunostomy through the afferent jejunal loop using a forward-viewing echoendoscope when endoscopic retrograde pancreatography failed. Our primary endpoint was technical success rate, defined as successful stent insertion. The secondary endpoints were early and late adverse events. A total of 10 patients underwent EUS-PJS between February 2019 and October 2023. The technical success rate was 100%. The median procedure time was 23.5 minutes. No remarkable early or late adverse events related to the procedure, except for fever, occurred in two patients. The median follow-up duration was 9.5 months, and the median number of stent exchanges was two. A stent-free state was achieved in three patients. EUS-PJS for PJAS management after pancreaticoduodenectomy appears to be an effective and safe procedure with the potential advantages of fewer reinterventions and the creation of a permanent drainage fistula.

Safety and efficacy of endoscopic ultrasound-guided pancreatic duct drainage using a drill dilator: a retrospective study in Japan.

Dilation of the tract before stent deployment is a challenging step in endoscopic ultrasound-guided pancreatic duct drainage (EUS-PDD). In this study, we examined the effectiveness and safety of a novel spiral dilator, Tornus ES (Asahi Intec), for EUS-PDD. This was a retrospective, single-arm, observational study at Aichi Cancer Center Hospital. The punctured tract was dilated using a Tornus ES dilator in all EUS-PDD cases. Our primary endpoint was the technical success rate of initial tract dilation. Technical success was defined as successful fistula dilation using a Tornus ES followed by successful stent insertion. Secondary endpoints were procedure times and early adverse events. A total of 12 patients were included between December 2021 and March 2023. EUS-PDD was performed in 11 patients for post-pancreaticoduodenectomy anastomotic strictures and one patient with pancreatitis with duodenal perforation. The technical success rates of stent insertion and fistula dilation using a Tornus ES dilator was 100%. The median procedure time was 24 minutes. No remarkable adverse events related to the procedure were observed, apart from fever, which occurred in 2 patients. Tract dilation in EUS-PDD using a Tornus ES is effective and safe.

The optimal stent pusher position to achieve successful ureteral stent insertion under fluoroscopic guidance

To examine factors to predict the optimal stent pusher position when inserting ureteral stents under fluoroscopy. We retrospectively reviewed 327 patients who underwent ureteral stent insertion. We considered the pubic bone as a useful anatomical landmark to insert ureteral stents under fluoroscopic guidance. Thus, we categorized patients into three groups (proximal, middle, and distal groups) according to the position of the radiopaque tip of the push catheter when inserting the ureteral stent. Success was defined as a completely curled ureteral stent tail. We compared stent insertion success rates among the three groups. A multivariate analysis was performed to identify the factors affecting stent insertion success. In men, 36 (63.2%) cases were deemed successful in the proximal group compared with 40 (80.0%) cases in the middle group and 12 (20.7%) cases in the distal group (p<0.001). In women, 26 (45.6%) cases were deemed successful in the proximal group compared with 54 (98.2%) cases in the middle group and 38 (76.0%) cases in the distal group (p<0.001). With the multivariate analysis, the stent pusher position was the most significant factor influencing successful stent insertion (men: odds ratio 6.00, 95% confidence interval 2.66-13.51, p<0.001; women: odds ratio 37.80, 95% confidence interval 4.94-289.22, p<0.001). The position of the stent pusher affects stent insertion success. The middle of the pubic symphysis is the optimal position for the radiopaque tip of the pusher when inserting ureteral stents under fluoroscopic guidance.

FTP7.8 Has Endoscopic retrograde cholangiopancreatography (ERCP) management of acute biliary obstruction due to gallstones been affected during the Covid-19 pandemic? – A single unit experience

Abstract Introduction British Society of Gastroenterology (BSG) guidelines advised for ERCP procedures to be continued for emergency biliary pathologies during the Covid pandemic. We aim to compare the performance and outcomes of ERCP for acute gallstone biliary obstruction before, during, and post first and second covid waves at our unit. Methods Retrospective study of all patients with acute biliary obstruction secondary to gallstones who underwent ERCP from January to December 2020 (covid), compared with those between January to December 2019 (pre-covid), and between January to December 2021 (post-covid). Results 65 patients underwent ERCP for obstructed gallstones in the covid group, compared to 64 in pre-covid and 64 in post-covid group. Higher proportion of patients presented with severe jaundice (bilirubin &amp;gt;100) in the covid group, compared to pre-covid (P=0.031) and post-covid (P=0.028) groups. Proportion of patients with biliary sepsis requiring antibiotics was higher in covid group compared to pre-covid (P=0.031) and post-covid groups (P=0.047). The median waiting time for ERCP was 3 days in covid group, 4 days in pre-covid, and 5 days in post-covid. Compared to both pre-covid and post-covid groups respectively, there was no statistically significant reduction in the covid group in any of: proportion of complete CBD clearance (P=0.26 P=0.40), sphincterotomies performed (P=0.22, P=0.49), or successful CBD stent insertion (P=085. P=0.52). There was no statistical difference in post-ERCP complication rates comparing Covid with pre-covid (P=0.47), or post-covid (P=0.24) groups. Conclusions Quality of ERCP management of acute gallstone biliary obstruction has been maintained throughout the covid pandemic at our unit.

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

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

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.

Role of endoscopic colonic stent insertion in patients with colonic obstructing malignancy: a single-center study

BackgroundLeft-sided colonic malignant lesions have the potential of acute bowel obstruction. Emergency surgery with stoma construction is considered the standard of management. Insertion of colonic stent to allow bowel decompression, primary resection, and re-anastomosis, avoiding the need of colostomy formation, can be an alternative. We describe our experience with the use of colonic stent in left-sided malignant obstruction as a step to relieve the obstruction before definitive surgical intervention.Patients and methodsA total of 30 patients with left-sided colonic malignant obstruction were included; 15 patients were offered colonic self-expandable metal stent insertion, and the other fifteen patients were offered emergent surgery.ResultsOf the 15 patients, 10 (66.6%) had successful stent insertion (technical and clinical). We failed to insert stent in four (26%) patients, and one (6.6%) patient had colonic perforation. All patients with successful colonic stent insertion underwent one-step resection and primary anastomosis.ConclusionColonic stent for left-sided colonic malignant obstruction represents a valuable procedure for one-step resection and primary anastomosis without the need for colostomy.

Predictive factor for successful retrograde ureteral stent insertion in obstructive uropathy due to advanced cervical cancer

Cervical cancer is the 3rd most common cancer in women. Some of the patients came with kidney failure due to malignant ureteral obstruction. Retrograde ureteral stent insertion as palliative urinary diversion often performed on these patients, but it has high failure rate and often has to be converted to nephrostomy, giving the patient unnecessary burden due to failed procedure. In this study, we evaluate factors that may predict successful ureteral stenting in cervical cancer patients to avoid unnecessary burden to the patient. Data were collected from 2014-2017. We evaluate the clinical, ultrasound and laboratory findings before stent insertion of the patient with successful compared to failed insertion. Comparative study was done using independent T-test and Mann-Whitney U test for nonparametric data. Odds ratio (OR) were calculated using contingency table and P value calculated using Fisher exact test. There were 41 patients diagnosed with cervical cancer performed retrograde ureteral stenting. From 41 patients, 20 (48.7%) were successful and 21 (51.3%) failed. Low hydronephrosis grade (OR=85.8; P&lt;0.0001), low stage (OR=6.0; P=0.0098), radiotherapy (OR=3.7; P=0.04) were strong predictor for successful stent insertion. In bilateral hydronephrosis, more daily urine output (OR=29.2; P=0.002) and normal creatinine level (OR=6.3; P=0.03) were strong predictors for successful retrograde stenting, while bladder infiltration was strong predictor for stent failure (OR=0.0684; P=0.0021). Low hydronephrosis grade, no bladder infiltration, normal creatinine level, more daily urine output, low clinical staging and radiotherapy are predictive factors to predict a successful ureteral stenting in cervical cancer patients.

Thermo-expandable prostatic stents for bladder outlet obstruction in the frail and elderly population: An underutilized procedure?

PurposeTo report our outcomes with the use of a thermo-expandable metallic intraprostatic stent (Memokath) for patients with bladder outlet obstruction (BOO) secondary to prostatic obstruction, and to assess it is a feasible option for many frail and elderly men unsuitable for surgery.Materials and MethodsWe reviewed patients who underwent insertion of a Memokath stent for BOO over 17 years (January 1999 to December 2015) at one regional center over a long follow-up period (median, 7 years). Patients were selected if they had obstructive urinary symptoms or urinary retention with an indwelling catheter in situ, and were ineligible for transurethral resection of the prostate (TURP) under general or spinal anesthesia. Primary outcomes assessed were the improvement in urinary symptoms and voiding parameters, as well as the ability to void spontaneously if catheterized, along with complications.ResultsOne hundred forty-four patients who presented with BOO or urinary retention had a Memokath stent inserted. Ninety patients (62.5%) had a successful stent insertion with a significant difference between the median preoperative (550 mL) and postoperative residual volume (80 mL, p<0.0001). Nearly two-thirds of men (64%) returned to unassisted voiding with no increased risk of complications over time. Fifty-four patients (37.5%) experienced stent failure. Main complications requiring stent removal or repositioning were migration, occlusion, refractory urinary retention and irritative voiding symptoms.ConclusionsIn elderly and frail men with BOO deemed unsuitable to undergo TURP, prostatic stent is a safe and practical alternative to long-term catheterization.

Stenting in malignant colonic obstruction--is it a real therapeutic option?

Malignant colonic obstruction is commonly treated surgically. Colonic stents are a therapeutic option for palliation or used as a bridge to surgery or chemotherapy. The aim of the study was to evaluate the clinical success rate of stenting as a bridge to one-step surgery, chemotherapy, or as a palliative measure. This was a retrospective observational study. The study was conducted at a university-affiliated tertiary referral center. From 2007 to 2014, 45 patients with malignant colonic obstruction were referred for stent insertion. Patients were grouped according to three pre-defined treatment goals: group 1: restorative one-step procedure without an ostomy, group 2: completion of scheduled chemotherapy before surgery, and group 3: palliation without surgical intervention. Group 1 included 11 patients. Three patients (27.3 %) met the treatment goal of one-step surgery. Eight patients (72.7 %) did not reach the primary goal due to stent insertion failure (four patients), stent-related complications (two patients), and failure to perform a one-step surgery after successful stent insertion (two patients). Group 2 included 12 patients. Chemotherapy was successfully completed prior to surgery in six patients (50 %). Six patients (50 %) did not achieve treatment goal due to stent insertion failure (two patients), stent migration (two patients), stent-related perforation (one patient), and mortality (one patient). Group 3 included 20 patients. Long-term palliation without surgical intervention was achieved in eight patients (40 %). Stent insertion failed in seven patients (35 %). Five patients (25 %) needed urgent surgery due to stent complications (three migrations and two perforations). The study was limited by its retrospective nature and small sample size. This study demonstrates only a modest success rate of colonic stents in the treatment of malignant colonic obstruction. Although colonic stenting seems to be an effective method of relieving colonic obstruction, high failure rates limits its applicability.

The role of palliative colorectal stents in gynaecologic malignancy

ObjectiveThe objectives of this study were to determine the clinical success of colorectal stenting in patients with large bowel obstruction secondary to gynaecologic malignancy and to determine whether there are any predictors of outcome. MethodsThis was a retrospective cohort study of all patients with a gynaecologic malignancy and large bowel obstruction referred for colorectal stenting at Vancouver General Hospital between January 2006 and February 2013. All stents were placed using image guidance with the exception of one placed endoscopically. Information was extracted from the medical record. Data were analysed using descriptive statistics. Chi-square and Fisher's exact tests were used to compare stent outcomes and clinical variables. ResultsThere were 32 patients in the study. The median age was 66 (range 40–78). The median follow-up was 28.9months (range 0.8–481). The primary tumour was ovarian in 75% and uterine in 18.8%. Seventy-five percent of patients had a technically successful stent insertion. Of these, 37.5% had a complication requiring intervention. The rate of clinical success was 47%. There were no statistically significant associations between any clinical variables and failed stent insertion or complications. ConclusionColorectal stenting in patients with a large bowel obstruction secondary to gynaecologic malignancy is associated with a high rate of technical success but a low rate of clinical success. There were no clinical predictors of outcome identified in this study. If patients are offered this procedure, they should be counselled about the anticipated benefit and associated risks.

Biliary stenting with or without sphincterotomy for malignant biliary obstruction: a meta-analysis.

To investigate the benefits of endoscopic sphincterotomy (EST) before stent placement by meta-analysis of randomized controlled trials (RCTs). PubMed, EMBASE, Cochrane Library, and Science Citation Index databases up to March 2014 were searched. The primary outcome was incidence of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) and successful stent insertion rate. The secondary outcomes were the incidence of post-ERCP bleeding, stent migration and occlusion. The free software Review Manager was used to perform the meta-analysis. Three studies (n = 338 patients, 170 in the EST group and 168 in the non-EST group) were included. All three studies described a comparison of baseline patient characteristics and showed that there were no statistically significant differences between the two groups. Three RCTs, including 338 patients, were included in this meta-analysis. Most of the analyzed outcomes were similar between the groups. Although EST reduced the incidence of PEP, it also led to a higher incidence of post-ERCP bleeding (OR = 0.34, 95%CI: 0.12-0.93, P = 0.04; OR = 9.70, 95%CI: 1.21-77.75, P = 0.03, respectively). EST before stent placement may be useful in reducing the incidence of PEP. However, EST-related complications, such as bleeding and perforation, may offset this effect.

PTH-063 Establishing Audit Standards for Colonic Stent Insertion will Facilitate Service Evaluation and Planning for a Rapidly Growing Service

IntroductionSelf-expandable metal stent (SEM) placement is the recommended treatment option by the National Institute for Clinical Excellence (NICE) for acute colorectal obstruction in the palliative management of inoperable colorectal cancer...

Colorectal Resection After Stent Insertion for Obstructing Cancer

To evaluate surgical outcomes after stent insertion for obstructing colorectal malignancy and to compare between laparoscopic and open approach. Surgical resection was performed after stent insertion for malignant colorectal obstruction in 36 patients with a median age of 73 years. Eighteen patients were treated with open resection, whereas 18 underwent a laparoscopic resection. The outcomes were evaluated and comparison was made between patients with laparoscopic and open resection. The mean interval between stent insertion and surgery was 11 days. One patient died within 30 days (2.8%). The overall incidence of postoperative morbidity was 22% and reoperation was required in 3 patients (8.8%). The median postoperative hospital stay was 8.5 days for the open surgery group and 5.5 days for the laparoscopic group (P = 0.004). The postoperative morbidity rates for the open and laparoscopic groups were 33.3% and 11.1%, respectively (P = 0.228). In those patients with nonmetastatic disease, with the median follow-up of 20 months, the 5-year survival rate was 49.5%. Our experience showed that after successful endoscopic stent insertion for malignant colorectal obstruction, elective surgical resection could be performed safely. The combined endoscopic and laparoscopic procedure provides a less invasive alternative to the multistage open operations and is feasible for patients with obstructing colon cancer.

Effect of a Temporary Thermo-Expandable Stent on Urethral Patency After Dilation or Internal Urethrotomy for Recurrent Bulbar Urethral Stricture: Results from a 1-Year Randomized Trial

The long-term success rate of dilation and/or internal urethrotomy is low in cases of recurrent urethral stricture. We investigated the ability of the Memokath™ 044TW stent to maintain urethral patency after dilation or internal urethrotomy for recurrent urethral stricture. A total of 92 patients with recurrent bulbar urethral strictures (mean length 2.7 cm) were treated with dilation or internal urethrotomy and randomized to short-term urethral catheter diversion (29) or insertion of a Memokath 044TW stent (63). The primary end point was urethral patency, as assessed by passage of a calibrated endoscope. Secondary end points included urinary symptoms and uroflowmetry parameters. Stents were scheduled to remain in situ for 12 months. The rate of successful stent insertion was 93.6% (59 of 63 patients). In stented patients patency was maintained significantly longer than controls (median 292 vs 84 days, p <0.001). Patency was reflected in significantly improved uroflowmetry and symptom scores. The stent was removed in 100% of patients. The most frequently noted side effects in stented patients were bacteriuria, hematuria and penile pain, which were usually mild and transient. There was no difference in sexual function between stented and control patients. Stent dislocation and occlusion were observed in 8 and 3 patients, respectively. Patients with recurrent bulbar urethral strictures treated with dilation or urethrotomy and a Memokath 044TW stent maintained urethral patency significantly longer than those treated with dilation or urethrotomy alone. The stent side effect profile was favorable. The stent was straightforward to insert and it was removed without difficulty even after long-term placement.

Endoscopic Self-Expanding Metal Stents for Acute Colonic Obstruction

The current study presents our experience with the introduction of self-expanding metal stents (SEMS) and assesses success rate, clinical outcomes, and complications. We conducted a historical cohort study reviewing endoscopic SEMS insertions between 2000 and 2010. Overall, 51 patients underwent stent insertion: 38 with an emergent procedure and 13 with a semielective procedure. SEMS was inserted in 27 men and 24 women with a mean age of 68.9 years. Colonic malignancy was the cause of obstruction in all patients. The tumors were localized in the rectosigmoid in 33 (64.7%), in the left colon in 16 (31.4%), and in the right colon in two cases (3.9%). Endoscopic SEMS insertion was technically successful in 68.4 per cent of patients in an emergency and in 84.6 per cent of patients in a semielective setting. Successful stent insertion allowed a "bridge to surgery" in 23 and palliative care in 14 patients. Stent migration occurred in three, obstruction in two, and bowel perforation in three cases. Nineteen patients in the emergent group underwent a subsequent successful semielective colonic resection within 8.1 days (range, 2 to 30 days) of stent insertion. There were two cases (11.1%) of major and four cases (22.2%) of minor postoperative complications in this series. No anastomotic leaks were observed. Mean postoperative hospitalization was 10.1 days (range, 5 to 45 days). Endoscopic stent insertion is a relatively simple procedure providing an effective first-line treatment for relief of symptoms of acute malignant colorectal obstruction, preventing acute perforation, and serving either as a preoperative procedure (allowing lower morbidity semielective surgery) or as palliative care.

Multi‐length or 24 cm ureteric stent? A multicentre randomised comparison of stent‐related symptoms using a validated questionnaire

WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: One of the suggested factors for stent-related symptoms is that excess distal intravesical stent mass may cause bladder irritation. There is a lack of studies investigating this in a randomised controlled fashion using a validated questionnaire. This study compared two of the most commonly used length of stents (a 30 cm multi-length vs a 24 cm long stent) and showed no significance difference in stent-related symptoms in patients with either of these stents. To investigate whether excessive redundant intravesical stent component contributes to the severity of stent-related symptoms in patients with a ureteric stent. We compared stent-related symptoms in patients who had either a standard 24 cm or multi-length ureteric stent. In all, 162 patients with upper urinary tract calculi requiring ureteric stent insertion were randomised to receive either a 6 F × 24 cm Contour(TM) or multi-length 6 F × 22-30 cm Contour VL(TM) stent. Patients were requested to complete the validated Bristol Ureteric Stent Symptom Questionnaire (USSQ) at 1 and 4 weeks after stent insertion and 4 weeks after removal. The mean scores for each domain of the USSQ for both groups were compared using the Student's t-test. Any adverse events, e.g. stent migration, early removal of stent due to stent-related symptoms and failure of stent insertion, were also recorded. In all, 153 patients who had successful stent insertion were requested to complete the USSQ and 74% of patients returned at least the week 1 questionnaire. At 1 and 4 weeks with the stent in situ, comparison of the mean scores showed no significant difference in urinary symptoms, pain, general health, work performance, sexual dysfunction and number of days patients stayed in bed or reduced their routine activities. Three (2%) patients had their stent removed early due to stent-related symptoms and five (3%) had failed stent insertion. This study did not find any difference in symptoms between the 24 cm or multi-length Contour stents. However, the study was not powered to detect small differences particularly for the pain symptom domain. Stents should only be used sparingly and the stent dwell-time should be minimised.

633 A MULTI-CENTRE RANDOMIZED CONTROLLED STUDY TO COMPARE THE IMPACT OF DIFFERENT URETERAL STENT LENGTHS ON PATIENTS' QUALITY OF LIFE USING A VALIDATED QUESTIONNAIRE

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Quality of Life1 Apr 2011633 A MULTI-CENTRE RANDOMIZED CONTROLLED STUDY TO COMPARE THE IMPACT OF DIFFERENT URETERAL STENT LENGTHS ON PATIENTS' QUALITY OF LIFE USING A VALIDATED QUESTIONNAIRE Robert Calvert, Kee Wong, Sudhanshu Chitale, Stuart Irving, Muthuswamy Nagarajan, Chandra Biyani, Anthony Browning, James Young, Anthony Timoney, Francis Keeley, and Neil Burgess Robert CalvertRobert Calvert Liverpool, United Kingdom More articles by this author , Kee WongKee Wong Liverpool, United Kingdom More articles by this author , Sudhanshu ChitaleSudhanshu Chitale Norwich, United Kingdom More articles by this author , Stuart IrvingStuart Irving Norwich, United Kingdom More articles by this author , Muthuswamy NagarajanMuthuswamy Nagarajan Wakefield, United Kingdom More articles by this author , Chandra BiyaniChandra Biyani Wakefield, United Kingdom More articles by this author , Anthony BrowningAnthony Browning Wakefield, United Kingdom More articles by this author , James YoungJames Young Bristol, United Kingdom More articles by this author , Anthony TimoneyAnthony Timoney Bristol, United Kingdom More articles by this author , Francis KeeleyFrancis Keeley Bristol, United Kingdom More articles by this author , and Neil BurgessNeil Burgess Norwich, United Kingdom More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1509AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Insertion of ureteral stent is a common urological procedure in both elective and emergency settings. However, indwelling ureteral stent is often associated with significant pain and urinary symptoms. One suggested factor for this is bladder irritation secondary to a long redundant distal end of ureteral stent. The objective of this study is to compare the impact of multi-length 30cm and single length 24cm ureteral stents on patients' quality of life. METHODS 162 patients with upper urinary tract calculi requiring ureteral stent insertion were randomized into group 1 (6Fr x 24cm, Contour™) or group 2 (6Fr x 22–30cm, Contour VL™). Both stents were different in length but were otherwise identical and manufactured by the same company. Patients were requested to complete the validated Bristol ureteric stent symptom questionnaire (USSQ) at 1 and 4 weeks after stent insertion and 4 weeks after removal. Mean scores for each domain of the USSQ in both groups were compared using 2-tailed unpaired t test. Any adverse events such as stent migration, early removal of stent due to stent-related symptoms and failure of stent insertion were also recorded. RESULTS 153 patients who had successful ureteral stent insertion were requested to complete the USSQ. The response rate was 74% (62 and 51 patients in group 1 and 2 respectively). There were no significant difference in both groups in terms of age (p=0.47) or sex (p=0.22). At 1 and 4 weeks with the stent in situ, comparison of the mean domain scores demonstrated no significant difference in urinary symptoms (p=0.42 and p=0.19), pain (p=0.84 and p=0.39) and general health (p=0.48 and p=0.98). This is also similar for work performance (p=0.87 and p=0.78), sexual dysfunction (p=0.71 and p=0.41) and number of days patients stayed in bed (p=0.11 and 0.65) or reduced their routine activities (p=0.10and p=0.63). There were 3 (2%) patients who had stent removed earlier due to severe stent-related symptoms (all from group 1) and 5 (3%) patients with failed stent insertion. There was no ureteral stent migration noted in this study. CONCLUSIONS Based on this study, there is no difference in the impact on quality of life in patients who had either a multi-length or 24cm ContourTM ureteral stent. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e256 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Robert Calvert Liverpool, United Kingdom More articles by this author Kee Wong Liverpool, United Kingdom More articles by this author Sudhanshu Chitale Norwich, United Kingdom More articles by this author Stuart Irving Norwich, United Kingdom More articles by this author Muthuswamy Nagarajan Wakefield, United Kingdom More articles by this author Chandra Biyani Wakefield, United Kingdom More articles by this author Anthony Browning Wakefield, United Kingdom More articles by this author James Young Bristol, United Kingdom More articles by this author Anthony Timoney Bristol, United Kingdom More articles by this author Francis Keeley Bristol, United Kingdom More articles by this author Neil Burgess Norwich, United Kingdom More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Extracorporeal Membrane Oxygenation as a Bridge to Definitive Airway Security in 3 Severe Acute Extrinsic Airway Compression Patients - A Case Report -

Extracorporeal membrane oxygenation (ECMO) has been used for cardiac and respiratory failure for over 30 years. Recently, however, ECMO has emerged as a useful means of short-term support in the management of hypoxic patients for nontraditional indications. Here, we report the use of veno-venous ECMO as a bridge to support a patient with severe airway obstruction because of tumor compression. Case 1: A patient with extrinsic airway compression secondary to a large metastatic cancer on neck was successfully managed using ECMO. Case 2: The successful use of ECMO to support a patient with extrinsic airway compression secondary to a recurred thyroid cancer. Case 3: A pregnant woman with airway obstruction secondary to metastatic lymphadenopathy of lung cancer who underwent successful tracheal stent insertion. The 3 patients were successfully weaned off ECMO without any complication. Although these conditions are uncommon indications, ECMO is a potential option for such life-threatening conditions.