Ureteral Stent Symptom Questionnaire Research Articles

Patients undergoing double J substitution with a pigtail suture stent report a significant decrease of stent-related symptoms. Results from a prospective multicenter longitudinal trial

PurposeTo compare stent-related symptoms (SRS) in patients with double J (DJ) undergoing substitution with a pigtail suture stent (PSS) after ureteroscopy (URS), through the Ureteral Stent Symptom Questionnaire (USSQ).Materials and methodsPatients with DJ undergoing URS for stone treatment were enrolled in this prospective multicenter longitudinal study. The USSQ was submitted thrice: 2 weeks after DJ, 2 weeks after PSS and 4 weeks after PSS removal (baseline). Primary endpoint: to compare Urinary Symptom Index Score and the rate of patients with pain 2 weeks after DJ and PSS. Secondary endpoints: to compare other USSQ scores and single answers 2 weeks after DJ and PSS, and DJ and PSS USSQ scores with baseline.Results93 patients were enrolled. 2 weeks Urinary Symptom Index Score (p < 0.001) and the percentage of patients complaining of pain (60.2% vs 88.2%, p < 0.001) were significantly in favour of PSS compared to DJ. 2 weeks scores were significantly improved with PSS compared to DJ: Pain Index (p < 0.001), VAS (p < 0.001), General Health Index (p < 0.001) and Work Performance Index (p < 0.001). All urinary symptoms were significantly decreased with PSS, including renal pain during micturition and pain interfering with life. Pain Index Score (p = 0.622) and VAS (p = 0.169) were comparable to baseline with PSS, while differed with DJ.ConclusionsPatients undergoing DJ substitution with PSS after URS report a significant decrease of SRS. Urologists may consider positioning PSS after URS in pre-stented patients to reduce the impact of SRS.

Ureteral stent related symptoms: A comparative study.

In urology, ureteral stents are used to treat obstructive diseases. Hematuria (54%), fever, discomfort, and lower urinary system symptoms are the predominant symptoms related to ureteral stent. This article links stent symptoms to double-j width and length, as well as patient's height, weight, and body mass index (BMI). Ureteric Stent Symptoms Questionnaire (USSQ) was used to measure ureteral stent symptoms at 1st and 4th week of stent in situ as well as the 4th week after pigtail removal. A 200-patient prospective study, where patients were allocated into four groups following ureteral stent insertion depending on the stent characteristics. Those groups were: 4.8 Fr./26 cm (Group A), 4.8 Fr./28 cm (Group B), 6 Fr/26 cm (Group C), and 6 Fr/28 cm (Group D). Men comprised 53.5% of 200 patients. Participants had an average age of 49 ± 15.5 years, height of 175 ± 8.94 cm, and BMI of 23.8 ± 7.6 cm. The laboratory results were identical between groups. At the first and fourth week, groups had similar urine symptoms, pain severity, health status and occupational activities. The difference in pain location was statistically significant. Group A had 82.4% renal back pain in the first week, whereas Group B had 68.8%, Group C 31.3% and Group D 62.5 (p = 0.04). At the fourth week, 64.7% of Group A patients reported kidney front pain, compared to 100% of Group B, 93.3% of Group C, and 100% of Group D (p = 0.04). There was statistical significance in the sexual activity of the patients. 24.4% of Group C patients stopped sexual activity before stent installation, compared to 10.6%, 8.3%, and 6.4% of the other groups (p = 0.03). A moderate percentage of patients had active sexual activity at week 4 (Group A: 7.8%, Group B: 5.8%, Group C: 8.2%, Group D: 4.1%), p = 0.83. In multivariate analysis, urinary catheter group, age, weight, height, and BMI did not significantly affect urine index score (UIS), pain index score (PIS), general health (GH), quality of work (QW), and quality of sex (QS). Despite various attempts to establish the best ureteral stent, the effect of double-j stent physical features on stent-related symptoms remained unknown. No verdict is conceivable without adequate empirical data.

Complete Intraureteral Stents Decrease Urinary Symptoms Compared with Conventional Ureteral Stents: A Systematic Review and Meta-Analysis.

Introduction: Up to 80% of stent patients report urinary discomfort, negatively impacting their daily activities and quality of life. Conventional Double-J ureteral stents (DJSs) can cause adverse kidney and bladder-related symptoms. Complete intraureteral stents (CISs) may reduce bothersome bladder symptoms by reducing foreign material in the bladder. We sought to aggregate and analyze ureteral stent symptom questionnaire (USSQ) data from the available randomized controlled trials comparing CISs with conventional ureteral stents. Methods: In February 2023, a Preferred Reporting Items for Systematic Reviews and Meta-Analyses-compliant systematic review was performed to identify studies that evaluated the use of CISs and reported outcomes using the USSQ score. Two authors (D.E.H.-G. and G.S.) independently extracted and analyzed data using Review Manager 5.41. Heterogeneity was assessed using Higgins I2%, with values >50% considered heterogeneous and analyzed with a random effects model; otherwise, a fixed effects model was used. The results are presented as the mean difference (MD) with 95% confidence intervals (CIs). We set our significance level at p = 0.05. Results: Six randomized controlled clinical trials compared CISs with DJSs, but only five trials reported the USSQ score. Among these patients, 235 had CISs, whereas the remaining 259 had DJSs or loop-tail stents and served as controls for 494 patients. Urinary symptoms scores were lower in the CIS group (MD -5.19, 95% CI: [-5.89 to -4.50], p < 0.0001). Pain scores were also lower in the CIS group (MD -1.90 [-2.63 to -1.16] p < 0.00001). General health and work performance domains were similar between the groups. A 2.5% stent failure or migration rate requiring endoscopic intervention was reported in the CIS group compared with 0.3% in the DJS group (odds ratio 4.01 [0.96-16.76] p = 0.06). Conclusions: CISs significantly decrease urinary symptoms and pain associated with conventional indwelling ureteral stents. However, further trials are needed to determine the optimal patient selection for this type of stent.

Randomized controlled trial comparing the effectiveness of tamsulosin, tamsulosin with tolterodine and double J stent position in controlling stent related symptoms after ureteroscopic lithotripsy

Background: Objective of the study was to determine the effect of stent position and medications in preventing stent-related symptoms. Methods: This was a prospective study conducted at Meenakshi Mission Hospital and Research Centre Madurai, Tamil Nadu, India. 150 patients who underwent ureteroscopic lithotripsy with indwelling stent were distributed into three groups. On demand analgesics were given to group 1 (n=50), Tamsulosin 0.4 mg daily for group 2 (n=50) and tamsulosin 0.4 mg and tolterodine 4 mg daily for group 3 (n=50). The patients were also subclassified into appropriate or inappropriate group according to stent position. All patients completed various domains of Ureteral stent symptom questionnaire (USSQ) on 1st and 7th postoperative days. Appropriate tests statistics were performed using EPI-Info statistical software package. Results: In control group, patients with appropriate stent position had significantly lower symptom scores than those with inappropriate stent position (p value~0.0001) in all domains of USSQ except global quality of life score (p value=0.08). Addition of tamsulosin 0.4 mg (group 2) had superadded beneficial effect in appropriate position group, but not in patients with inappropriately positioned stents. Patients taking both tamsulosin 0.4 mg and tolterodine 4 mg (group 3) had no significant improvement in symptom scores in appropriate position group (all domains of USSQ) and inappropriate position group (most domains). Conclusions: Appropriate stent position is the most important independent factor than medications in preventing stent related symptoms; tamsulosin has superadded benefit in patients with correctly positioned stents.  

Tamsulosin Versus Mirabegron in Relieving Ureteric Stent-Related Symptoms: A Prospective, Double-Blinded, Randomized Controlled Trial.

Introduction Alpha-adrenergic blockers like tamsulosin are widely used in the treatment of stent-related symptoms due to ureteric stents. Recently, mirabegron has emerged as a potential alternative. So, our study aimed to compare the effect of mirabegron and tamsulosin on ureteric stent-related morbidity. Methods In this randomized controlled study, 80 patients undergoing uncomplicated ureteroscopic lithotripsy with double J stenting for ureteric stones were enrolled. They were divided into two groups: Group A (n=40) received mirabegron (25mg) and Group B (n=40) received tamsulosin (0.4mg). Outcomes were assessed using the Ureteral Stent Symptom Questionnaire (USSQ), International Prostate Symptoms Score (IPSS), and the visual analog pain scale. The t-test and the Chi-square test were utilized to study theefficacy of the interventions across both groups. Results The USSQ urinary symptom score (25.5 vs 33.45; p < 0.001) and body pain score (16.15 vs 26.02; P < 0.001) were significantly lower in the mirabegron group. However, the general health score (17.0 vs 17.28; p = 0.62) and work performance score (7.6 vs 8.0; p = 0.28) did not show a significant difference. The storage symptom score was significantly lower in the mirabegron group (3.98 vs 5.1; p = 0.001). Furthermore, the mirabegron group reported a better quality of life score (2.18 vs 3; p < 0.001). Conclusion Mirabegron has been shown to reduce urinary symptoms associated with ureteric stents and also results in a better quality of life when compared with tamsulosin. However, large-scale, prospective, multicentric studies are further required to holistically evaluate and comprehend the beneficial effects of mirabegron on stent-related morbidity.

Alfuzosin vs. Silodosin in the Improvement of Ureteral Stent-Related Symptoms after Endoscopic Surgical Treatment of Urolithiasis: A Retrospective Comparison

Purpose In this study, we aimed to compare the efficacy of two α-blockers, alfuzosin and silodosin, which have different pharmacological properties despite being uroselective, in the treatment of double-J stent (DJS)-related symptoms. Methodology Fifty-six male patients who underwent DJS implantation and for whom all data were available were included in the study. All patients were asked to complete the validated Turkish version of the Ureteral Stent Symptom Questionnaire (USSQ), international prostate symptom score (IPSS), and international index of erectile function-5 (IIEF-5) the day before stent removal and again one month after stent removal. Statistical analysis of these variables was performed in the groups, and a value of p&lt;0.05 was considered statistically significant. Results Significant decreases in IPSS, IPSS-quality of life, and USSQ scores were observed in both Group A and Group S one month after stent removal compared with before stent removal (p&lt;0.05). Whereas no side effects were observed in the alfuzosin group (Group A), retrograde ejaculation was observed in 8 (25.2%) patients in the silodosin group (Group S) (p=0.006). Furthermore, a statistically significant increase in IIEF-5 score was observed in both groups after stent removal compared with IIEF-5 score with stenting (p&lt;0.05). Conclusion The DJS has a significant impact on patients’ quality of life and should only be used when indicated, not routinely after every endoscopic stone procedure. Considering that silodosin may cause more ejaculation problems than alfuzosin, we believe that both drugs can be used in male patients to resolve DJS-related symptoms.

A Prospective, Randomized Controlled Multicenter Trial Comparing the Bard Inlay Optima and the Cook Universa Soft Stent

To determine if the Bard Inlay Optima with its anti-inflammatory pHreecoat stent coating had reduced stent-related symptoms at Week 1 (W1) and Week 3 (W3) post insertion compared to the Cook Universa Soft (CUS) using the validated Ureteral Stent Symptoms Questionnaire (USSQ). A prospective, double-blinded, randomized controlled trial was performed on patients receiving unilateral retrograde double-J stents for urolithiasis or pelviureteric junction obstruction at three public Urology services. One hundred forty patients that met inclusion criteria were randomized in a 1:1 ratio to each stent. Primary endpoints were the mean USSQ index scores for the urinary, pain, general, and sexual health domains at W1 and W3. Secondary endpoints were responses to individual USSQ questions, early stent removal, and postoperative opioid use. No significant difference was found between the two stents in terms of index scores for all USSQ domains, early stent removal or postoperative opioid use. The CUS had worse symptom scores at W1 relating to self-reported urinary tract infection symptoms (3.1±1.3 vs 2.6±1.3, P=.05). The CUS was also associated with higher rate of representation to hospital at W1 (n=10, 16% vs n=1, 2%, P<.001) and W3 (n=15, 25% vs n=3, 5%, P<.001). This did not remain significant when adjusted to site of recruitment (W1 P=.27; W3 P=.22). The Bard Inlay Optima's anti-inflammatory pHreecoat stent coating did not translate to any significant difference in overall postoperative symptoms across urinary, pain, general, and sexual health domains.

Ureteral Stent-Related Symptoms and Pharmacotherapy: A Brief Narrative Review.

The purpose of this article is to review the effects of different types of pharmacotherapy on symptoms that affect the quality of a patient's life after stent insertion. A thorough Medline/PubMed nonsystematic review was conducted from 1987 to January 2023, using the terms: "pigtail" OR "ureteral stents" AND "lower urinary tracts symptoms" OR "LUTS" AND "pharmacotherapy" OR "drugs". Relevant studies conducted in humans and reported in English language were included. The available reviews and articles associating the use of drugs with stent-related symptoms (SRS) provide conflicting results. Most of them show a clear benefit of alpha blockers, particularly alfuzosin, on treating urinary SRS, and hence there is a strong recommendation for the use of alpha blockers for the treatment of SRS in the guidelines of the European Association of Urology. Anticholinergics and mirabegron have shown a significant benefit in dealing with irritative bladder symptoms. In contrast, the findings for combination therapies are contradictory, with some studies showing that combination therapy is no superior to monotherapy with regards to most of the subsets of the Ureteral Stent Symptom Questionnaire (USSQ), whereas others present a clear benefit of combination therapies, specifically silodosin and solifenacin, in treating stent-associated lower urinary tract symptoms (LUTS), in comparison with any other type of monotherapy or combination therapy. Many studies suggest that some categories of pharmacotherapy, such as alpha blockers, can alleviate SRS. However, there is conflicting evidence concerning most other types of medical treatment. Randomized trials with the largest number of patients are needed to investigate the effectiveness of novel approaches on SRS.

A randomized controlled study of ureteral stent extraction string on patient’s quality of life and stent-related complications after percutaneous nephrolithotomy in the prone position

To demonstrate the Tianjin Institute of Urology (TJIU) technique to place and remove the ureteral stent with extraction string after percutaneous nephrolithotomy (PCNL). Additionally, we aim to compare the pain experienced during stent removal, quality of life during stent retention, and stent-related complications between patients with and without extraction string. 65 patients were included in the final analysis in the string group constructed by the TJIU technique and 66 patients in the conventional double-J ureteral stent (non-string) group. All patients underwent the surgery in a prone position under general anesthesia. They completed the Ureteral Stent Symptom Questionnaire (USSQ) on postoperative days (POD) 7, as well as before their ureteral stent was removed. The visual analogue scale (VAS) pain score (0–10) was completed immediately after the removal of the ureteral stent. Moreover, a specialized person was responsible for recording stent-related complications. All patients completed the USSQ on POD 7, and we did not find a difference in scores in each field. However, there was a significant difference in the “sex” domain before removing the ureteral stent (4.34 vs 3.23; p = 0.01). Notably, the use of extraction string after PCNL could decrease the pain associated with stent removal significantly (mean VAS scores 1.45 vs 2.76; p < 0.01). Extraction string did not increase the incidence of stent-related complications. We concluded that placing a ureteral stent with an extraction string after PCNL reduces the pain of ureteral stent removal without increasing complications such as accidental removal of the stent, febrile urinary tract infection (UTI).

MP35-15 PAIN CATASTROPHIZING IS ASSOCIATED WITH STENT-RELATED PAIN AFTER URETEROSCOPIC LASER LITHOTRIPSY

You have accessJournal of UrologyCME1 Apr 2023MP35-15 PAIN CATASTROPHIZING IS ASSOCIATED WITH STENT-RELATED PAIN AFTER URETEROSCOPIC LASER LITHOTRIPSY Alan J. Yaghoubian, Sarah Mozafarpour, Roman Shimonov, Raymond Khargi, Blair Gallante, Dara Lundon, Johnathan A. Khusid, William M. Atallah, and Mantu Gupta Alan J. YaghoubianAlan J. Yaghoubian More articles by this author , Sarah MozafarpourSarah Mozafarpour More articles by this author , Roman ShimonovRoman Shimonov More articles by this author , Raymond KhargiRaymond Khargi More articles by this author , Blair GallanteBlair Gallante More articles by this author , Dara LundonDara Lundon More articles by this author , Johnathan A. KhusidJohnathan A. Khusid More articles by this author , William M. AtallahWilliam M. Atallah More articles by this author , and Mantu GuptaMantu Gupta More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003269.15AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Ureteral stent-related pain varies in intensity for different patients. While stent-specific factors (e.g. stent position) may influence symptoms, patient-specific factors remain elusive. The pain catastrophizing scale (PCS) is a validated questionnaire quantifying the degree to which an individual may catastrophize painful stimuli. We aim to determine whether PCS score is associated with stent symptoms after ureteroscopic laser lithotripsy (URSLL). METHODS: This is an ongoing prospective study of patients undergoing URSLL. All patients completed the PCS prior to undergoing URSLL with stent placement and were labeled as catastrophizers (top third), non-catastrophizers (bottom third), or semi-catastrophizers (middle third). The ureteral stent symptom questionnaire (USSQ) was completed at 2 time points: post-op day (POD)#1 and POD#10. Prescriptions for phenazopyridine, ibuprofen, and oxybutynin were given. Outcomes included USSQ scores, total analgesic pills taken, pain-related office phone calls, and need for narcotic prescriptions. RESULTS: In sum 41 patients have been enrolled. Median USSQ pain scores on POD#10 were significantly higher among catastrophizers as compared to non-catastrophizers (24.5 vs. 14.0, p=0.036). There were no differences between all 3 groups in other USSQ domains. Catastrophizers took more tablets of phenazopyridine (11.0 vs. 5.5, p=0.027) and total prescribed tablets (26.5 vs. 15.5, p=0.023) compared to non-catastrophizers. Differences between number of pain-related calls between catastrophizers and non-catastrophizers approached significance (46.2% vs. 0%, p=0.057). Semi-catastrophizers had no significantly different outcomes from the other two groups. CONCLUSIONS: Pain catastrophizers have higher post-URSLL pain index scores, use more pain medications, and likely call the office more frequently. The PCS may ultimately become a practical tool to personalize patient care by identifying those at highest risk for severe stent pain. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e475 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alan J. Yaghoubian More articles by this author Sarah Mozafarpour More articles by this author Roman Shimonov More articles by this author Raymond Khargi More articles by this author Blair Gallante More articles by this author Dara Lundon More articles by this author Johnathan A. Khusid More articles by this author William M. Atallah More articles by this author Mantu Gupta More articles by this author Expand All Advertisement PDF downloadLoading ...

The effect of intravesical stent length and Propiverine on ureteral stent related symptoms - Prospective controlled trial

Objective: Ureteral double J stents are widely utilized in urolithiasis. Disturbing stent-related symptoms may occur while the stent is in location. Various medical agents and stent-related solutions were examined for this problem. However, a definite drug has still not been found. We aimed to research the effect of propiverine on stent-related symptoms.Material and Methods: Patients who underwent ureteroscopic stone surgery between June 2020 and May 2022 were included in the study. While the control group was untreated, the treatment group received 45 mg of propiverine daily after 1 week of the operation. Stent-related symptoms were assessed by ureteral stent symptom questionnaire (USSQ) at the end of 1st week and 3rd week of surgery. In addition, the intravesical stent parts of all patients were quantitatively measured with a ruler during stent removal at the end of 3 weeks.Results: A total of 177 patients were assessed in the study. Eighty-seven patients were control and 90 patients of them were treatment group. According to USSQ, urinary symptoms scores, body pain scores, general health scores, work performance scores, sexual health scores, additional problem scores, and global quality of life (QoL) scores were found to decrease in the treatment group (p&amp;lt;0.001 All domains). Intravesical stent length was found positive correlation with the urinary symptom score (1st week) of all patients.Conclusion: Stent-related symptoms are more likely in patients with longer intravesical stent length. Propiverine successfully relieves stent-related symptoms.

Does bacterial colonization influence ureteral stent-associated morbidity? A prospective study

ABSTRACT Objective to evaluate the effect of bacterial colonization on ureteral stent-associated morbidity. Methods This was a prospective study that took place between February 2019 and March 2022. We examined one hundred fifteen patients for ureteric stents application. On the same day of stent removal, the Arabic version of Ureteral Stent Symptoms Questionnaire (USSQ) was used to assess stent-associated morbidity. The stent-associated morbidity and the specificity and sensitivity of culture in the stent and midstream urine were recorded. Results In 15.6% of the patients stent colonization was positive; E. coli was the most common isolated organism. There was no statistically significant difference between sex, age, irrigation fluid volume and duration of operation for stent colonization. However, stent indwelling time was significantly higher in patients with stents with positive cultures. In the colonized stents, there was a statistically significant difference with regards to the total score of USSQ, pain, urinary symptoms, work performance and additional problems of USSQ. Meanwhile, there was no statistically significant difference in the general health and sexual matter. Conclusions stent colonization may be a contributing factor in stent-related morbidity. Stent bacterial colonization increases with the time of stent retention. Stent cultures are not needed as the same microorganisms are detected in urine cultures.

Can ureteral stents with a different format reduce patients’ symptomatology? A single-blinded, randomized, controlled study comparing smooth-walled and grooved ureteral stents

IntroductionThe true benefits of perioperative JJ stent placement are being widely studied due to its known side effects. However, no consensus has been reached in the literature regarding the best type of stent. This prospective, randomized, single-blinded study therefore aimed to compare the symptomatology associated with two JJ stent designs: smooth-walled and grooved. Materials and methodsThe study prospectively recruited 42 patients who underwent JJ stent placement between July 2019 and August 2020. The patients were randomly divided into two groups according to the JJ stent design used: the smooth-walled stent (control) and grooved stent (intervention) groups. After surgery, all patients completed the Portuguese-validated Ureteral Stent Symptom Questionnaire at three timepoints (days 7 and 30 post-surgical procedure, and day 30 post-stent removal). ResultsNo significant differences in gender, age, median body mass index, laterality, type of surgical procedure (flexible, semi-rigid or mixed ureteroscopy) were found. Smooth-walled JJ stents were associated with a higher incidence of flank pain (52.38% vs. 10%, P = .006) and suprapubic pain (57.14% vs. 30%, P = .04) on the 7th post-procedure day. Linear mixed regression showed significantly lower flank (P < .001) and suprapubic pain (P < .01), and significantly better sexual performance in the intervention group (P = .03). ConclusionsUreteral stent with a grooved format are associated with a lower incidence of flank and suprapubic pain and had less impact on the sexual performance of patients.

Distal end of Double-J ureteral stent position on ureteral stent-related symptoms: A systematic review and meta-analysis.

BackgroundMost patients suffer from ureteral stent-related symptoms (USRS) caused by indwelling ureteral stents. Nevertheless, various medications to alleviate discomfort as well as novel stents are continually being developed, and in recent years, some researchers have believed that proper intravesical stent placement can relieve USRS.ObjectiveTo determine appropriate intravesical ureteral stent position may alleviate USRS.MethodsUp to May 1, 2022, the PubMed, Embase, Scopus and Web of Science databases were thoroughly searched, and two independent reviewers included relevant studies that met the PICO (Patient, Intervention, Comparison, Outcome) criteria. Studies methodological quality were assessed by ROB2 and ROBINS-I. Ureteral stent symptom questionnaire (USSQ), international prostate symptom score (IPSS) and quality of life (QoL) was used to quantify the USRS. According to intravesical ureteral stent position, Group A was defined as the contralateral group, that is distal end of ureteral stent crossed the bladder midline, whereas Group B was classified as ipsilateral group, meaning stent end did not cross the midline.ResultsSix studies incorporating a total of 590 patients were eligible. In terms of USSQ score, the meta-analysis showed that contralateral group was associated with a significant increase in USSQ total (MD, 17.55; 95% CI, 12.04 to 23.07; P < 0.001), urinary symptoms (MD, 2.74; 95% CI, 0.48 to 5.01; P = 0.02), general health (MD, 4.04; 95% CI, 2.66 to 5.42; P < 0.001), work performance (MD, 1.36; 95% CI, 0.75 to 1.98; P < 0.001) and additional problems (MD, 0.89; 95% CI, 0.47 to 1.32; P < 0.001) scores while not associated with a significant increase in body pain (MD, 3.13; 95% CI, −0.19 to 6.44; P = 0.06) and sexual matters (MD, 1.01; 95% CI, −0.03 to 2.06; P = 0.06). As for IPSS, although no significant differences in IPSS total (MD, 2.65; 95% CI, −0.24 to 5.54; P = 0.07) or voiding symptoms (MD, −0.84; 95% CI, −3.16 to 1.48; P = 0.48) scores were found, ipsilateral group was associated with a significant decrease in storage symptoms (MD, 1.92; 95% CI, 0.91 to 2.93; P = 0.0002). Furthermore, ipsilateral group was linked to a significant decrease in QoL score (MD, 1.00; 95% CI, 0.18 to 1.82; P = 0.02).ConclusionThis meta-analysis proven that correct intravesical stent position was critical, and patients with stents crossing the midline experienced more severe USRS than those who did not. Further high-quality randomized controlled trials are needed to corroborate our findings.

Translation and Validation of the Ureteral Stent Symptoms Questionnaire in Urdu

IntroductionIn endourology, ureteric stenting is a common procedure, and stent placement is not without adverse health consequences. A ureteric stent symptoms questionnaire (USSQ) was devised to objectively evaluate the symptoms related to it. The original questionnaire is in English and translated into various languages worldwide. We translated the questionnaire into Urdu and validated it in an Urdu-speaking population with a stent in situ.Materials and methodsThe English version of USSQ was translated and back-translated by experts in both languages. Content validity was checked by sending Urdu version to five experts, and their scores were used to calculate the content validity index. The final version was filled by patients with stents on three different occasions, two with stents in situ at one and two weeks post stent placement, and a third time two weeks after stent removal. Discriminant validity was checked by filling of USSQ by 64 healthy individuals. Statistical analysis was done with mean and standard deviation, Cronbach’s alpha, Spearman’s coefficient, and paired sample t-test.ResultsA total of 64 patients filled the complete questionnaire at all times with mean age of 35.31 ± 8.853. All subdomains of USSQ have significant drop in scores with stent in situ in comparison to post stent removal. Reliability was checked by Cronbach’s alpha in all subdomains (71.5-91.1) and test-retest reliability by Spearman’s coefficient (80.5-94.7). Symptoms change in stent in situ with post stent removal checked with paired sample t-test with a p-value of <0.005 in all domains, except body pain. Discriminant validity was checked with healthy controls, and a p-value of <0.005 was found in all subdomains of USSQ, except pain. ConclusionThe Urdu version of the USSQ is a reliable and valid instrument that can be used in clinical practice and future research in an Urdu-speaking population.

Complete intraureteral stent placement reduces stent-related symptoms: Systemic review and meta-analysis

The distal coil of a double-J ureteral stent is considered the major cause of stent-related symptoms. We noticed that some recent studies investigated whether complete intraureteral stent placement (CIU-SP) reduced these symptoms. The current systemic review and meta-analysis aimed to evaluate the safety and the effectiveness of CIU-SP, as compared to conventional stent placement (C-SP). We retrieved relevant trials published before December 2021 from three databases, including PubMED, Embase, and Web of Science. The following medical subject heading were used ((complete intraureteral stent) OR (suture stent)) AND (symptom OR pain) AND (randomized OR randomised). The above search was limited to English language publication. We identified six prospective randomized trials, all of which investigated a short-term (1-2 weeks) stent placement following uncomplicated ureteroscopic lithotripsy. The meta-analysis revealed that CIU-SP significantly reduced stent-related symptoms: CIU-SP had lower USSQ (Ureteral Stent Symptom Questionnaire) Urinary Symptom Index score (MD -5.13; 95%CI [-5.82,-4.44]; P<0.00001), lower USSQ Pain Index score (MD -4.21; 95%CI [-5.25,-3.17]; P<0.00001), and lower VAS pain scale (MD -1.93; 95%CI [-2.17,-1.69]; p<0.00001). Besides, patients with CIU-SP were less likely to have pain (RR 0.78; 95%CI [0.67,0.91]; p=0.001). There was no significant difference regarding the USSQ General Health and Work Performance. Both CIU-SP and C-SP had similarly few complications of Clavien-Dindo grade ≥2. This meta-analysis reveals that CIU-SP significantly decreases stent-related urinary symptoms and pain. Based on the current evidence, CIU-SP is ready to be applied in clinical practice, at least in those requiring short-term stent placement following uncomplicated ureteroscopic lithotripsy.

STUDY ON EVALUATION OF MEDICATION USE PATTERNS IN THE MANAGEMENT OF URETERAL STENT DISCOMFORT

Background: The insertion of double -j stents is considered as a routine and common Urological procedure. It can cause stent related discomfort, which affect nearly 80% of patients with indwelling ureteral symptoms, pharmacological management is one of the main trails that were done to reduce ureteral stent discomfort. This study aimed to evaluate the drug utilization patterns in management of ureteral stent discomfort. Methods: This prospective, observational study was conducted in the Department of Urology. 54 patients were enrolled into the study who underwent ureteral stent positioning, and evaluated the prescription patterns and by administration of validated USSQ for assessment of stent related symptoms. Results: 54 prescription patterns were evaluated and among them 39 are receiving Tamsulosin and 15 are receiving Tamsulosin + Tolterodine. During the follow up the USSQ scores were significantly low after the drug administration. The USSQ scores of Tamsulosin when compared with Tamsulosin in combination with tolterodine, there was significantly more improvement in the reduction of stent discomfort during the combination therapy. Conclusion: Alpha blockers (Tamsulosin), in patients with indwelling stents reduces the stent related symptoms. Combination of alpha blockers (Tamsulosin) and anticholinergics (Tolterodine) seems to have a better efficacy in improving the ureteral stent discomfort. KEY-WORDS: Ultrasonography, Ureteroscopy, Ureteroscopic lithotripsy, Ureteral stent symptom questionnaire (USSQ)

The intraureteral placement of the stent's distal end decreases stent-related urinary symptoms: a prospective randomized clinical trial.

We compared intraureteral stent placement (CIU-SP) with conventional stent placement (C-SP) regarding the stent-related symptoms. We randomized patients who underwent ureteroscopic lithotripsy into two groups. In CIU-SP group, a 16-cm or 18-cm stent was placed with its distal end above the ureterovesical junction. In C-SP group, a 22-cm or 24-cm stent was placed in a conventional method. Stent-related symptoms were assessed with the Ureteral Stent Symptom Questionnaire (USSQ) before the stent was removed, around 7days after the operation. The primary outcome was the urinary symptoms; the secondary outcomes included postoperative pain and quality of life. We randomized 103 patients, of which 91 (45 in CIU-SP and 46 in C-SP) entered the final analysis. Regarding the primary endpoint, the CIU group had less urinary symptoms; the mean USSQ urinary symptom score was significantly lower in the CIU-SP versus C-SP group (25.5 ± 6.3 vs 31.7 ± 5.9, P < 0.001). The CIU-SP group also had more favorable profiles in the following outcomes: lower USSQ body pain score (15.5 ± 5.3 vs 20.1 ± 5.2, P < 0.001), lower overall pain score (3.2 ± 2.2 vs 5.7 ± 2.3, P < 0.001), less number of pain site (1.0 ± 0.9 vs 1.7 ± 0.9, P = 0.001, lower USSQ general health score (10.4 ± 3.7 versus 13.9 ± 3.4, P < 0.001), and lower USSQ work performance score (5.2 ± 3.3 versus 6.7 ± 2.8, P = 0.033). In either group, there was no complication of Clavien-Dindo Class 2 or greater. The complete intraureteral placement significantly decreases stent-related urinary symptoms and pain. It is also associated with better postoperative general health condition and is less likely to limit physical activity and work ability.

¿Puede el diseño del catéter ureteral reducir la sintomatología de los pacientes? Estudio controlado, aleatorizado y simple ciego, que compara el catéter ureteral de superficie lisa con el catéter ureteral de diseño acanalado

IntroductionThe true benefits of perioperative JJ stent placement are being widely studied due to its known side effects. However, no consensus has been reached in the literature regarding the best type of stent. This prospective, randomized, single-blinded study therefore aimed to compare the symptomatology associated with two JJ stent designs: smooth-walled and grooved. Materials and methodsThe study prospectively recruited 42 patients who underwent JJ stent placement between July 2019 and August 2020. The patients were randomly divided into two groups according to the JJ stent design used: the smooth-walled stent (control) and grooved stent (intervention) groups. After surgery, all patients completed the Portuguese-validated Ureteral Stent Symptom Questionnaire at three timepoints (days 7 and 30 post-surgical procedure, and day 30 post-stent removal). ResultsNo significant differences in gender, age, median body mass index, laterality, type of surgical procedure (flexible, semi-rigid or mixed ureteroscopy) were found. Smooth-walled JJ stents were associated with a higher incidence of flank pain (52.38% vs. 10%, P=.006) and suprapubic pain (57.14% vs. 30%, P=.04) on the 7th. post-procedure day. Linear mixed regression showed significantly lower flank (P<.001) and suprapubic pain (P<.01), and significantly better sexual performance in the intervention group (P=.03). ConclusionsUreteral stent with a grooved format are associated with a lower incidence of flank and suprapubic pain and had less impact on the sexual performance of patients.

LBA02-08 RISK FACTORS FOR INCREASED STENT-ASSOCIATED SYMPTOMS FOLLOWING URETEROSCOPY FOR URINARY STONES: RESULTS FROM THE URINARY STONE DISEASE RESEARCH NETWORK (USDRN) STENTS STUDY

You have accessJournal of UrologyCME1 May 2022LBA02-08 RISK FACTORS FOR INCREASED STENT-ASSOCIATED SYMPTOMS FOLLOWING URETEROSCOPY FOR URINARY STONES: RESULTS FROM THE URINARY STONE DISEASE RESEARCH NETWORK (USDRN) STENTS STUDY Jonathan Harper, Hongqiu Yang, Naim Maalouf, Jodi Antonelli, Alana Desai, Henry Lai, Peter Reese, Gregory Tasian, Hunter Wessells, Hussein Al-Khalidi, Ziya Kirkali, and Charles Scales Jonathan HarperJonathan Harper More articles by this author , Hongqiu YangHongqiu Yang More articles by this author , Naim MaaloufNaim Maalouf More articles by this author , Jodi AntonelliJodi Antonelli More articles by this author , Alana DesaiAlana Desai More articles by this author , Henry LaiHenry Lai More articles by this author , Peter ReesePeter Reese More articles by this author , Gregory TasianGregory Tasian More articles by this author , Hunter WessellsHunter Wessells More articles by this author , Hussein Al-KhalidiHussein Al-Khalidi More articles by this author , Ziya KirkaliZiya Kirkali More articles by this author , and Charles ScalesCharles Scales More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002670.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The USDRN STudy to Enhance uNderstanding of sTent-associated Symptoms (STENTS) sought to identify risk factors for increased post-ureteroscopic pain, urinary symptoms, and their interference with daily activities in a prospective multicenter observational cohort study. METHODS: Patients aged ≥12 years undergoing unilateral ureteroscopy with ureteral stent placement for stone treatment were enrolled at 4 U.S. clinical centers. Participants reported symptoms at baseline, on post-operative days (POD) 1, 3, 5, at stent removal, and day 30 post-stent removal using the Brief Pain Inventory short form and PROMIS measures for pain severity and pain interference, the Urinary Score of the Ureteral Stent Symptom Questionnaire, and Symptoms of Lower Urinary Tract Dysfunction Research Network Symptom Index (LURN SI-10). Multivariable analyses using mixed-effects linear regression models were implemented. RESULTS: 424 participants (396 adults) were enrolled. Median age (years) was 54 in adults and 15 in adolescents; 46.9% were female. Dominant stone location was ureteral in 56% and renal in 44% of participants. Mean ureteroscopy time was 57(SD ±30) min. There was a marked increase in pain and urinary symptoms from baseline to POD 1, with a gradual fall on days 3 to 5, returning below baseline 30 days after stent removal. As pain intensity decreased over time, interference remained elevated. On multivariable regression (Table), older age was associated with less postoperative pain intensity (p=0.004). Having chronic pain conditions (p<0.001), prior severe ureteral stent pain (p=0.021), and depression at baseline (p<0.001) were each associated with higher pain intensity. Neither stone location, ureteral access sheath use, nor stent size were associated with average pain intensity, pain interference, or urinary symptoms. CONCLUSIONS: In this well-characterized, multicenter prospective cohort, interference persisted even as pain intensity decreased over time. Patient factors such as depression, rather than surgical factors, impacted symptom severity. These findings provide a foundation for patient counseling and highlight potential targets for future efforts to mitigate the burden of stent-associated symptoms. Source of Funding: NIH/NIDDK © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e1044 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jonathan Harper More articles by this author Hongqiu Yang More articles by this author Naim Maalouf More articles by this author Jodi Antonelli More articles by this author Alana Desai More articles by this author Henry Lai More articles by this author Peter Reese More articles by this author Gregory Tasian More articles by this author Hunter Wessells More articles by this author Hussein Al-Khalidi More articles by this author Ziya Kirkali More articles by this author Charles Scales More articles by this author Expand All Advertisement PDF DownloadLoading ...