Editorial Comment to Dual ureteral stent placement after redo laser endoureterotomy to manage persistent ureteral stricture

Background When antegrade ureteral intervention fails due to severe ureteral stricture or tortuosity, a longer sheath can be used to facilitate ureteral catheterization. Purpose To evaluate the feasibility and effectiveness of the use of a long sheath in antegrade ureteral stent placement after failure of antegrade ureteral stent placement using a short sheath. Material and Methods Among 1284 procedures in 934 patients who received ureteral stent placement, a long sheath was used after stricture negotiation failure using a short sheath in 57 (4.4%) procedures in 53 patients. The data of these 53 patients were retrospectively reviewed. Results The most common reasons for long sheath use were failure of balloon catheter (59.6%) or guidewire (29.8%) advancement across the stricture. Technical success, successful stricture negotiation after using a long sheath, was achieved in 50/57 (87.7%) procedures. In two of seven failed procedures, an additional TIPS sheath was used and the technical success rate improved to 91.2% (52/57). The technical success rate was significantly higher in the patients who have failed balloon catheter advancement (97.1%, 33/34) than the patients who have failed guidewire advancement (64.7%, 11/17) (Fisher’s exact test, P = 0.004). Self-limiting hematoma occurred in one patient after use of the long sheath and was considered a minor complication. Conclusion Ureteral catheterization using a long sheath is feasible and effective when antegrade ureteral intervention using a short sheath fails. When using a long sheath, the technical success rate was higher when advancing the balloon catheter over the guidewire than when advancing the guidewire through tight stricture.

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Ureteral stent versus no ureteral stent for ureteroscopy in the management of renal and ureteral calculi: A Cochrane review

Canadian Urological Association Journal ◽

10.5489/cuaj.5957 ◽

2019 ◽

Vol 14 (2) ◽

Author(s):

Maria Ordonez ◽

Eu Chang Hwang ◽

Michael Borofsky ◽

Caitlin J. Bakker ◽

Shreyas Gandhi ◽

...

Keyword(s):

Stent Placement ◽

Cochrane Review ◽

Stone Disease ◽

Ureteral Stent ◽

Ureteral Stricture ◽

Time Intervals ◽

Comprehensive Search ◽

Publication Language ◽

Post Hoc ◽

Patients Experience

Introduction: We aimed to assess the effects of postoperative ureteral stent placement after uncomplicated ureteroscopy. Methods: We performed a comprehensive search with no restrictions on publication language or status up to February 1, 2019. We only included randomized trials. Two review authors independently examined full-text reports, identified relevant studies, assessed the eligibility of studies for inclusion, extracted data, and assessed risk of bias. We performed statistical analyses using a random-effects model and assessed the certainty of the evidence according to GRADE. Results: We included 23 studies with 2656 randomized patients. Primary outcomes: It is uncertain whether stenting reduces the number of unplanned return visits (very low CoE). Pain on the day of surgery is probably similar (mean difference [MD] 0.32; 95% confidence interval (CI) -0.13‒0.78; moderate CoE). Pain on postoperative days 1‒3 may show little to no difference (SMD 0.25; 95% CI -0.32‒0.82; low CoE). It is uncertain whether stented patients experience more pain on postoperative days 4‒30 (very low CoE). Stenting may result in little to no difference in the need for secondary interventions (relative risk [RR] 1.15; 95% CI 0.39‒3.33; low CoE). Secondary outcomes: We are uncertain whether stenting reduces the need for narcotics and reduces ureteral stricture rates up to 90 days (very low CoE). Rates of hospital admission may be slightly reduced (RR 0.70; 95% CI 0.32‒1.55; low CoE). This review was limited to patients in whom ureteroscopy was deemed ‘uncomplicated.’ In addition, time intervals for the grouping for the reported degree of pain were established post hoc. The CoE for most outcomes was rated as low or very low for methodological reasons. Conclusions: Findings of this review illustrate the tradeoffs of risks and benefits faced by urologists and their patients when it comes to decision-making about stent placement after uncomplicated ureteroscopy for stone disease.

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