Outcomes of Ureteral Stent Placement for Hydronephrosis in Patients with Gynecological Malignancies

Objective: We examined the outcomes of patients undergoing ureteral stent placement for hydronephrosis that occurred during treatment for gynecological malignancies. Materials and Methods: From January 2004 to December 2009, we enrolled 33 patients with 45 ureters undergoing ureteral stent placement for hydronephrosis which occurred during treatment for gynecological malignancies. We examined the outcomes of the patients after stent placement. Results: The causes of hydronephrosis were obstruction of the urinary tract by a tumor (n = 22), obstruction due to lymph node swelling (n = 6), ureteral stenosis after radiation therapy (n = 4), and others (n = 1). The ureteral stent was inserted into both ureters in 12 cases, and into one ureter in 21 cases. Ureteral stents were replaced 1-26 times during the observation period (median 3 times). Eighteen (40%) ureteral stents were removed. The reasons for ureteral stent removal were hydronephrosis improvement (11 ureters, 24.4%), a change to nephrostomy (cystectomy: 1 ureter, progression of ureteral stenosis: 2 ureters), renal atrophy (3 ureters), and ureteral dilatation (1 ureter). All of the cases in which ureteral stent withdrawal due to hydronephrosis improvement were cases in which the ureter was compressed by a tumor and were lower ureteral obstructions. Twenty-one patients (64%) died due to cancer after stent placement. The periods from the first stent placement to death ranged from 1 to 58 months (median 18 months). Conclusion: Ureteral stent placement was associated with a poor prognosis in patients with gynecological malignancies. There were a few cases in which stent withdrawal became possible due to the improvement of hydronephrosis. In such cases, the withdrawal rate varied according to the cause and obstructive level.

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Novel method to decrease the exposure time of the extraction string of the ureteral stent and its efficiency and safety verification in the clinic

Scientific Reports ◽

10.1038/s41598-021-01821-2 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

WenGang Hu ◽

YaJun Song ◽

Yang Li ◽

YueHua Li ◽

Jiao Mu ◽

...

Keyword(s):

Exposure Time ◽

Medical Costs ◽

Demographic Characteristics ◽

Ureteral Stent ◽

Continuous Exposure ◽

The Novel ◽

Ureteral Stents ◽

Stent Removal ◽

Significant Difference ◽

Novel Method

AbstractUreteral stent removal by an extraction string is advantageous. However, the increased risk of complications attributed to the continuous exposure of the string outside the urethra must be managed. This paper introduces a method to decrease the exposure time, and conducts a retrospective study to verify its efficiency and safety. A total of 231 male patients undergoing routine ureteroscopy (URS) were included, and all of them accepted indwelling ureteral stents with strings. Among them, 123 patients (Normal-S group) underwent the normal method to determine the length of string (Lstring), which was shortened to 4 cm (cm) past the urethral meatus; 108 patients (Novel-S group) underwent the novel method (Lstring = Lurethra + 2 cm), the length of urethra (Lurethra) was measured during ureteroscopy by ureteroscope body. The demographic characteristics, stent indwelling and removal-related variables, complications, and medical costs in each group were recorded. There was no significant difference in demographic characteristics, the rate of UTI, the operative duration of URS, or the VAS pain scores for stent removal between the 2 groups. For the Novel-S group, the stent dwelling time was longer, the self-rated discomfort and symptom, the stent dislodgement rate, the numbers of clinic or emergency visits and the overall medical cost post operation was lower in comparison with the Normal-S group, while the rate of removal of stents by hand was lower, the time for removing ureteral stents was longer. This novel method improved stenting comfort, avoided ureteral stent dislodgement, decreased complications, and lowered medical costs, it was safe and reliable and merits widespread application.

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Innovation and new technology in ureteral stents

Insight Urology ◽

10.52786/isu.a.39 ◽

2021 ◽

Vol 42 (2) ◽

pp. 160-168

Author(s):

Tongtra Watcharawittayakul ◽

◽

Manint Usawachintachit ◽

Keyword(s):

Clinical Trials ◽

New Technology ◽

Material Design ◽

Ureteral Stent ◽

Biodegradable Materials ◽

Stent Insertion ◽

Ureteral Stents ◽

Stent Removal ◽

Silicone Polymers ◽

Removal Technique

Ureteral stent insertion is a procedure performed extensively by all urologists. Nevertheless, stent-related symptoms and stent encrustation are still common complications pushing the innovation and development of novel ureteral stents. Developments are focussing on three significant aspects: material, design, and removal technique. Various materials including silicone, polymers, and metals are frequently utilized, with or without an additional coating. The use of biodegradable materials is looking promising but these is a lack of proven clinical trials in association with this in humans. The new designs focus on the reduction of stent-related symptoms through the modification of the bladder end. The new stent removal techniques with extraction strings or novel magnetic end may exclude subsequent cystoscopic procedures. Finally, utilization of a ureteral stent tracker application helps in reminding both physicians and patients to remove the stent at the appropriate time.

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Iatrogenic Urological Lesions in Vascular Surgery: Uretero-Arterial Fistula after Positioning of “double J” for Ureteral Stenosis after Aorto-Phemoral Bypass

Urologia Journal ◽

10.1177/039156039205900216 ◽

1992 ◽

Vol 59 (2) ◽

pp. 69-72

Author(s):

G. Contemori ◽

S. Omacini ◽

A. Bolgan ◽

U. Santucci Delli Ponti ◽

S. Petracco

Keyword(s):

Urinary Tract ◽

Vascular Surgery ◽

Ureteral Obstruction ◽

Bypass Surgery ◽

Ureteral Stent ◽

Ureteral Stents ◽

Ureteral Stenosis ◽

Vascular Bypass ◽

Iatrogenic Complications ◽

Utmost Care

The Authors report the case of a patient with double iatrogenic complications: 1) ureteral obstruction secondary to vascular bypass surgery; 2) uretero-arterial fistula after positioning of an indwelling double J ureteral stent. The increasing frequency of these complications stresses the need for utmost care regarding urinary tract integrity after vascular surgery and the choice, positioning and functioning of ureteral stents.

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Efficacy of Tamsulosin in relieving double-J stent-related symptoms: a randomized controlled study

Journal of Society of Surgeons of Nepal ◽

10.3126/jssn.v18i3.15301 ◽

2016 ◽

Vol 18 (3) ◽

pp. 38 ◽

Cited By ~ 1

Author(s):

DK Thakur ◽

S Chapagain ◽

BR Luitel ◽

PR Chalise ◽

UK Sharma ◽

...

Keyword(s):

Quality Of Life ◽

Stent Placement ◽

Ureteral Stent ◽

Controlled Study ◽

Control Group ◽

Stent Removal ◽

Double J Stent ◽

Dj Stent ◽

And Control

Introduction: Ureteral stent placement is an increasingly common procedure in urological practice.They are used for both prevention and treatment of ureteral obstruction. Despite improved design and materials, many patients still develop stent-related symptoms which commonly affect quality of life and sometimes necessitate early removal. Tamsulosin improves stent-related symptoms and quality of life, and can be applied in routine clinical practice. In the present study, the effect of Tamsulosin in improving double-J stent-related symptoms and quality of life following ureteral stent placement was studied.Methods: This RCT was carried out in the Department of Surgery, Tribhuvan University Teaching Hospital, Kathmandu, Nepal from February 2015 to January 2016. Forty six patients were included in the study and randomized into Tamsulosin(T) group and Control(C) group each having 23 patients. In addition to standard postoperative care, Tamsulosin group received 0.4mg Tamsulosin daily and Paraceramol on demand and control group received only Paracetamol. Stent related symptoms and quality of life was assessed by IPSS at discharge (day2) and at the time of DJ stent removal (2 weeks). Pain was evaluated by VAS and analgesic requirement was documented. Data were analysed using SPSS 20, chi-square test and Student’s t- test was used. A p-value of <0.05 was considered significant.Results: Mean age in Tamsulosin group was 37.96±12.98 and Control group 36.43± 10.99(p=0.67).There was no significant difference in IPSS(p=0.141), QoL index (p=0.089) and VAS (p=0.59) in the two groups at the time of discharge.At the time of DJ stent removal, IPSS (p<0.001), QoL index (p<0.001), VAS (p=0.004) and analgesic needed (p<0.001) was significantly lower in T group than in C group.Conclusion: Tamsulosin lowers stent related symptoms, pain and improves quality of life in patients with indwelling DJ stent though the effect is not immediate.

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Efficacy of Tamsulosin in Relieving Double-J Stentrelated Symptoms: a Randomized Controlled Study

Journal of Society of Surgeons of Nepal ◽

10.3126/jssn.v19i2.24541 ◽

2016 ◽

Vol 19 (2) ◽

pp. 3-6

Author(s):

Deepak K Thakur ◽

Suman Chapagain ◽

Bhojraj Luitel ◽

Pawan Raj Chalise ◽

Uttam Kumar Sharma ◽

...

Keyword(s):

Quality Of Life ◽

Stent Placement ◽

Ureteral Stent ◽

Controlled Study ◽

Control Group ◽

Stent Removal ◽

Significant Difference ◽

Dj Stent ◽

And Control

Introduction: Ureteral stent placement is an increasingly common procedure in urological practice. They are used for both prevention and treatment of ureteral obstruction. Despite improved design and materials, many patients still develop stent-related symptoms which commonly affect quality of life and sometimes necessitate early removal. Tamsulosin improves stent-related symptoms and quality of life. But such study has not been conducted in Nepalese context. In the present study, the effect of Tamsulosin in improving double-J stent-related symptoms and quality of life following ureteral stent placement was studied. Methods: This study was carried out in the Department of Urology and Kidney Transplant Surgery, Tribhuvan University Teaching Hospital, Kathmandu, Nepal from February 2015 to January 2016. Forty six patients were included in the study and randomized into Tamsulosin (T) group and Control (C) group each having 23 patients. In addition to standard postoperative care, Tamsulosin group received 0.4 mg Tamsulosin daily for 2 weeks and Paracetamol on demand and control group received only Paracetamol (1gram/dose). Stent related symptoms and quality of life was assessed by International prostate symptom score (IPSS) at discharge (day2) and at the time of DJ stent removal (2 weeks). Pain was evaluated by visual analog scale (VAS) and analgesic requirement was documented. Data were analysed using Statistical Package for the Social Sciences (SPSS) 20, chisquare test and Student’s t- test was used. A p-value of <0.05 was considered significant. Results: Mean age in Tamsulosin group was 37.96±12.98 years and Control group 36.43± 10.99 years (p=0.67).There was no significant difference in IPSS (p=0.141), QoL index (p=0.089) and VAS (p=0.59) in the two groups at the time of discharge. At the time of DJ stent removal, IPSS (p<0.001), QoL index(p<0.001), VAS(p=0.004) and analgesic needed(p<0.001) was significantly lower in T group than in C group. Conclusion: Tamsulosin lowers stent related symptoms, pain and improves quality of life in patients with indwelling DJ stent though the effect is not immediate.

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Stent encrustation or fragmentation? A case report of post stent removal encrustation in postpartum woman and literature review

BMC Pregnancy and Childbirth ◽

10.1186/s12884-021-04262-x ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Zhaohua Ye ◽

Qiwu Mi ◽

Renzhao Huang

Keyword(s):

Case Report ◽

Foreign Body ◽

Literature Review ◽

Medical Malpractice ◽

Ureteral Stent ◽

Postpartum Woman ◽

Ureteral Stents ◽

Case Presentation ◽

Stent Removal ◽

Indwelling Time

Abstract Background Ureteral stents are commonly used in the field of urology to relieve ureteral obstruction. However, complications relating to ureteral stent use, such as encrustation continue to occur, especially with prolonged indwell time. Case presentation Here we present a 37-year-old postpartum woman with a foreign body in her bladder after removing a ureteral stent 1 month before. She insisted that the foreign body was the fragment of stent and asked for medical malpractice indemnity payments while the surgeon of her insisted that the stent was intact during the procedure. Finally, the foreign body was confirmed as an encrustation by cystoscopy and the patient received 10,000 yuan ($ 1500) as indemnity payments after encrustation removal. Conclusion In the absence of guidelines, stent indwelling time vary with centers’ habits, stent materials and patient’s education. Early detection of stent encrustation and timely removal of the encrusted stent are still the best way to avoid stent retention. Violent stent removal is of danger and not recommended in any case.

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MP22-13 DOUBLE URETERAL STENT PLACEMENT REDUCES RESTENOSIS AFTER INCISION AND DILATATION FOR URETERAL STENOSIS

The Journal of Urology ◽

10.1097/ju.0000000000000855.013 ◽

2020 ◽

Vol 203 ◽

pp. e332-e333 ◽

Cited By ~ 1

Author(s):

Teruaki Sugino* ◽

Shuzo Hamamoto ◽

Masahiko Isogai ◽

Yutaro Tanaka ◽

Rei Unno ◽

...

Keyword(s):

Stent Placement ◽

Ureteral Stent ◽

Ureteral Stenosis

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Risk of chronic kidney disease in patients with retained ureteral stents

Journal of Clinical Urology ◽

10.1177/20514158211017720 ◽

2021 ◽

pp. 205141582110177

Author(s):

Justine R Yamashiro ◽

Travis J Cole ◽

Cornelia S de Riese ◽

Chip Shaw ◽

Werner T de Riese

Keyword(s):

Chronic Kidney Disease ◽

Glomerular Filtration Rate ◽

Kidney Disease ◽

Glomerular Filtration ◽

Stent Placement ◽

Filtration Rate ◽

Estimated Glomerular Filtration Rate ◽

Ureteral Stent ◽

Ureteral Stents ◽

New Onset

Objective: Numerous publications describe the management of stent encrustations, but few address long-term risks. The purpose of this study is to analyze the incidence of new chronic kidney disease attributed to retained ureteral stents in a large multi-institutional patient population. Materials and methods: A retrospective chart review of stone disease patients with ureteral stent placement was done in the nation-wide Cerner Health Facts database between 10 July 2009 and 7 June 2018. The estimated glomerular filtration rate was calculated using serum creatinine and the Modification of Diet in Renal Disease Study equation. The study focused on patients with stent duration longer than 6 months and an estimated glomerular filtration rate above 60 ml/min/1.73 m2 before stent placement. Results: A total of 1234 stent placements were documented in the Cerner database, 108 patients had a normal estimated glomerular filtration rate prior to the retained stent. The median duration of retained stents was 12.1 months (range 6.1 to 77.7 months), and 33 (30.6%) patients developed new onset chronic kidney disease compared to 8.3% in patients with non-retained stents. Conclusion: A new onset of chronic kidney disease was observed in 30.6% of patients with retained ureteral stent, emphasizing the importance of patient counseling and preventive measures to ensure patient compliance and follow-up. Level of evidence: Not applicable in this multi-institutional cohort study.

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Silicone or polyurethane ureteral stent: assessment of the intensity of stent-related symptoms

Aspirantskiy Vestnik Povolzhiya ◽

10.17816/2072-2354.2020.20.3.125-131 ◽

2020 ◽

Vol 20 (5-6) ◽

pp. 125-131

Author(s):

Nariman K. Gadzhiev ◽

Sergey B. Petrov ◽

Andrey O. Ivanov ◽

Vladimir M. Obidnyak ◽

Vladislav E. Grigoriev ◽

...

Keyword(s):

Ureteral Stent ◽

Control Group ◽

Ureteral Stents ◽

Stent Removal ◽

Pain Visual Analog Scale ◽

Group A ◽

Bladder Symptoms ◽

Cook Medical ◽

Group B ◽

Experimental Group

Introduction. About 80% of patients with ureteral stents experience symptoms associated with them. We believe that the intensity of stent-assosiated symptoms (SAS) can be reduced by the replacement of the stent material with a less solid one. The aim of our research was to compare the intensity of the symptoms and signs as well as the safety of silicone and poly urethane ureteral stent. Materials and methods. The study included 70 patients who were divided into two groups. Group A included patients who were placed with polyurethane stents (Rsch, Teleflex). The experimental group B included patients who were placed with silicone stents (Cook Medical). Specialized questionnaires like pain Visual Analog Scale (VAS) and Overactive Bladder Symptoms (OAB) questionnaires were used to study the patients for SAS severity 1 hour after the stent was placed, in the middle of the observation period and before the stent was removed or ureteroscopy was performed. In addition, each group was assessed for the effectiveness of the stent placement, the presence of hematuria, the number of unscheduled visits to the doctor and the degree of stent incrustation. Results. A total of 70 patients participated in the study, while the control group A included of 30 patients and experimental group B included 40 patients. Group B participants having silicone ureteral stents showed significantly lower average VAS values 2 weeks before stent removal and shortly before stent removal (p = 0.023 and p = 0.014 respectively). No other comparisons between the two groups were statistically significant. Conclusions. The obtained findings demonstrate that silicone ureter stents, unlike polyurethane ureter stents, cause less pain according to VAS two weeks before and during the stent removal procedure.

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A85 THE CLINICAL IMPACT OF COVID-19 DELAYS ON PLASTIC BILIARY STENT REMOVAL IN NOVA SCOTIA

Journal of the Canadian Association of Gastroenterology ◽

10.1093/jcag/gwab002.083 ◽

2021 ◽

Vol 4 (Supplement_1) ◽

pp. 54-56

Author(s):

D R Lim ◽

M Tsai ◽

S E Gruchy ◽

J Jones ◽

G Williams ◽

...

Keyword(s):

Survival Analysis ◽

Nova Scotia ◽

Stent Placement ◽

Biliary Stent ◽

Biliary Stents ◽

Stent Occlusion ◽

Stent Removal ◽

Kaplan Meier ◽

And Migration

Abstract Background The COVID-2019 pandemic continues to restrict access to endoscopy, resulting in delays or cancellation of non-urgent endoscopic procedures. A delay in the removal or exchange of plastic biliary stents may lead to stent occlusion with consensus recommendation of stent removal or exchange at three-month intervals [1–4]. We postulated that delayed plastic biliary stent removal (DPBSR) would increase complication rates. Aims We aim to report our single-centre experience with complications arising from DPBSR. Methods This was a retrospective, single-center, observational cohort study. All subjects who had ERCP-guided plastic biliary stent placement in Halifax, Nova Scotia between Dec 2019 and June 2020 were included in the study. DPBSR was defined as stent removal >=90 days from insertion. Four endpoints were assigned to patients: 1. Stent removed endoscopically, 2. Died with stent in-situ (measured from stent placement to documented date of death/last clinical encounter before death), 3. Pending removal (subjects clinically well, no liver enzyme elevation, not expired, endpoint 1 Nov 2020), and 4. Complication requiring urgent reintervention. Kaplan-Meier survival analysis was used to represent duration of stent patency (Fig.1). Results 102 (47.2%) had plastic biliary stents placed between 2/12/2019 and 29/6/2020. 49 (48%) were female, and the median age was 68 (R 16–91). Median follow-up was 167.5 days, 60 (58.8%) subjects had stent removal, 12 (11.8%) died before replacement, 21 (20.6%) were awaiting stent removal with no complications (median 230d, R 30–332), 9 (8.8%) had complications requiring urgent ERCP. Based on death reports, no deaths were related to stent-related complications. 72(70.6%) of patients had stents in-situ for >= 90 days. In this population, median time to removal was 211.5d (R 91-441d). 3 (4.2%) subjects had stent-related complications requiring urgent ERCP, mean time to complication was 218.3d (R 94–441). Stent removal >=90 days was not associated with complications such as occlusion, cholangitis, and migration (p=1.0). Days of stent in-situ was not associated with occlusion, cholangitis, and migration (p=0.57). Sex (p=0.275), cholecystectomy (p=1.0), cholangiocarcinoma (p=1.0), cholangitis (p=0.68) or pancreatitis (p=1.0) six weeks prior to ERCP, benign vs. malignant etiology (p=1.0) were not significantly associated with stent-related complications. Conclusions Plastic biliary stent longevity may have been previously underestimated. The findings of this study agree with CAG framework recommendations [5] that stent removal be prioritized as elective (P3). Limitations include small sample size that could affect Kaplan-Meier survival analysis. Despite prolonged indwelling stent time as a result of COVID-19, we did not observe an increased incidence of stent occlusion or other complications. Funding Agencies None

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