Isiris™ for Ureteric Stent Removal in Renal Transplantation: An Initial Single-Centre Experience of 150 Cases

2021 ◽  
pp. 155335062110072
Author(s):  
Daniel T. Doherty ◽  
Zia Moinuddin ◽  
Ben R. Grey ◽  
David van Dellen
Keyword(s):  
Outpatient Clinic ◽  
Healthcare Providers ◽  
Operating Theatre ◽  
Stent Insertion ◽  
Environmental Implications ◽  
Ureteric Stent ◽  
Stent Removal ◽  
Ureteric Stents ◽  
Urological Complications ◽  
Single Use

Background. Ureteric stent insertion is performed at the time of renal transplant to minimise the risk of post-operative urological complications, including anastomotic leak and ureteric stenosis or obstruction. Transplant ureteric stent removal (TUSR) has historically been performed via flexible cystoscopy, predominantly in a theatre setting. Isiris™ is a single-use cystoscope with integrated grasper designed for removal of ureteric stents. We report our initial experience. Methods. A retrospective analysis of a contemporaneously maintained database was performed with review of case notes from October 2017 to September 2018. TUSR was performed by surgical middle grades with a single nurse assistant. Results. One hundred and fifty ureteric stents were removed in transplant recipients (mean age 50.2 years, SD ± 15.2; 61.3% male). 91.3% ( n = 137) of cases were performed in the outpatient clinic. Median time to TUSR was 42 days (IQR 30-42). 147 attempts at removal were successful. One urinary tract infection (UTI) was reported following TUSR. Use of the Isiris™ for TUSR corresponds to a £63,480 saving in this cohort compared to conventional practice. This value is conservative and does not include income that has been gained from the reallocation of operating theatre capacity. Conclusion. Isiris™ can safely be employed for the timely performance of non-complicated TUSR. Isiris™ releases this procedure from the confines of the operating theatre to the outpatient clinic. This reduces the resource burden for healthcare providers and may result in improved patient satisfaction. The environmental implications of disposable healthcare equipment require consideration. Evaluation of Isiris™ TUSR for encrustation is required.

scholarly journals The Utility of Routine Ultrasound Imaging after Elective Transplant Ureteric Stent Removal

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Bibek Das ◽  
Dorian Hobday ◽  
Jonathon Olsburgh ◽  
Chris Callaghan
Keyword(s):  
Kidney Transplantation ◽  
Added Value ◽  
Stent Insertion ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Renal Imaging ◽  
Ureteric Stent ◽  
Stent Removal ◽  
Urological Complications ◽  
Repeat Imaging

Background. Ureteric stent insertion during kidney transplantation reduces the incidence of major urological complications (MUCs). We evaluated whether routine poststent removal graft ultrasonography (PSRGU) was useful in detecting MUCs before they became clinically or biochemically apparent.Methods. A retrospective analysis was undertaken of clinical outcomes following elective stent removals from adult single renal transplant recipients (sRTRs) at our centre between 1 January 2011 and 31 December 2013.Results. Elective stent removal was performed for 338 sRTRs. Of these patients, 222 had routine PSRGU (median (IQR) days after stent removal = 18 (11–31)), 79 had urgent PSRGU due to clinical or biochemical indications, 12 had CT imaging, and 25 had no further renal imaging. Of the 222 sRTRs who underwent routine PSRGU, 210 (94.6%) had no change of management, three (1.4%) required repeat imaging only, and eight patients (3.6%) had incidental (nonureteric) findings. One patient (0.5%) had nephrostomy insertion as a result of routine PSRGU findings, but no ureteric stenosis was identified. Of 79 patients having urgent PSRGU after elective stent removal, three patients required transplant ureteric reimplantation.Conclusions. This analysis found no evidence that routine PSRGU at two to three weeks after elective stent removal provides any added value beyond standard clinical and biochemical monitoring.

scholarly journals Cost Analysis and Service Delivery on Using Isiris α™ To Remove Ureteric Stents

2018 ◽  
Vol 1 (1) ◽  
pp. e3-e16 ◽  
Author(s):  
Yih Chyn Phan ◽  
Jonathan Cobley ◽  
Wasim Mahmalji
Keyword(s):  
Medical Association ◽  
Cost Analysis ◽  
Ureteric Stent ◽  
Flexible Cystoscopy ◽  
Stent Removal ◽  
Ureteric Stents ◽  
Flexible Cystoscope ◽  
Single Use ◽  
College Of Nursing ◽  
The Cost

Introduction Isiris α™ (Coloplast®) is an innovative single-use disposable flexible cystoscope with an integrated ureteric stent grasper designed specifically to remove ureteric stents. It allows clinicians to remove ureteric stents easily on the wards or in clinics without the need of arranging a routine and dedicated flexible cystoscopy appointment for patients. We evaluated Isiris α’s practical use and cost analysis against traditional reusable endoscopes. Method We compared the cost of removing ureteric stents using Isiris α™ in 10 patients prospectively versus traditional flexible cystoscopes in 10 patients retrospectively. The costs of the equipment, medications, reprocess machines, and utility costs were consulted from the relevant departments and companies. As for labour cost, we have sourced British Medical Association (BMA) and Royal College of Nursing (RCN) websites. Results From our study, it costs £260.65 and £123.41 on average to remove a ureteric stent using Isiris α™ and traditional flexible cystoscope respectively (p<0.001). Stent removal in the endoscopy department was delayed in 60% of patients, on average 6.4 days, compared to 0% of patients using Isiris α™ (p = 0.048). Conclusion Although Isiris α™ is shown to be a more expensive option to remove ureteric stents based on our analysis, it still provides clinicians flexibility and ease in removing ureteric stents in the outpatient clinic, reducing the pressure and demand for dedicated flexible cystoscopy slots in the endoscopy department.

scholarly journals The Impact of Timing of Stent Removal on the Incidence of UTI, Recurrence, Symptomatology, Resistance, and Hospitalization in Renal Transplant Recipients

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Ziad Arabi ◽  
Khalefa Al Thiab ◽  
Abdulrahman Altheaby ◽  
Mohammed Tawhari ◽  
Ghaleb Aboalsamh ◽  
...  
Keyword(s):  
Renal Transplantation ◽  
Group Versus ◽  
Renal Transplant Recipients ◽  
Ureteric Stent ◽  
Stent Removal ◽  
Urological Complications ◽  
Tract Infections ◽  
The Impact ◽  
Removal Group

Purpose. To evaluate the impact of early (<3 weeks) versus late (>3 weeks) urinary stent removal on urinary tract infections (UTIs) post renal transplantation. Methods. A retrospective study was performed including all adult renal transplants who were transplanted between January 2017 and May 2020 with a minimum of 6-month follow-up at King Abdulaziz Medical City, Riyadh, Saudi Arabia. Results. A total of 279 kidney recipients included in the study were stratified into 114 in the early stent removal group (ESR) and 165 in the late stent removal group (LSR). Mean age was 43.4 ± 15.8; women: n: 114, 40.90%; and deceased donor transplant: n: 55, 19.70%. Mean stent removal time was 35.3 ± 28.0 days posttransplant (14.1 ± 4.6 days in the ESR versus 49.9 ± 28.1 days in LSR, p < 0.001 ). Seventy-four UTIs were diagnosed while the stents were in vivo or up to two weeks after the stent removal “UTIs related to the stent” (n = 20, 17.5% in ESR versus n = 54, 32.7% in LSR; p = 0.006 ). By six months after transplantation, there were 97 UTIs (n = 36, 31.6% UTIs in ESR versus n = 61, 37% in LSR; p = 0.373 ). Compared with UTIs diagnosed after stent removal, UTIs diagnosed while the stent was still in vivo tended to be complicated (17.9% versus 4.9%, p : 0.019), recurrent (66.1% versus 46.3%; p : 0.063), associated with bacteremia (10.7% versus 0%; p : 0.019), and requiring hospitalization (61% versus 24%, p : 0.024). Early stent removal decreased the need for expedited stent removal due to UTI reasons (rate of UTIs before stent removal) (n = 11, 9% in the early group versus n = 45, 27% in the late group; p = 0.001 ). The effect on the rate of multidrug-resistant organisms (MDRO) was less clear (33% versus 47%, p : 0.205). Early stent removal was associated with a statistically significant reduction in the incidence of UTIs related to the stent (HR = 0.505, 95% CI: 0.302-0.844, p = 0.009 ) without increasing the incidence of urological complications. Removing the stent before 21 days posttransplantation decreased UTIs related to stent (aOR: 0.403, CI: 0.218-0.744). Removing the stent before 14 days may even further decrease the risk of UTIs (aOR: 0.311, CI: 0.035- 2.726). Conclusion. Early ureteric stent removal defined as less than 21 days post renal transplantation reduced the incidence of UTIs related to stent without increasing the incidence of urological complications. UTIs occurring while the ureteric stent still in vivo were notably associated with bacteremia and hospitalization. A randomized trial will be required to further determine the best timing for stent removal.

scholarly journals A survey of Canadian renal transplant surgeons: Use of ureteric stents and technique of the ureteroneocystotomy

2018 ◽  
Vol 12 (12) ◽  
Author(s):  
Luke F. Reynolds ◽  
Tad Kroczak ◽  
R. John Honey ◽  
Kenneth T. Pace ◽  
Jason Y. Lee ◽  
...  
Keyword(s):  
Renal Transplant ◽  
Dwell Time ◽  
Online Survey ◽  
Primary Outcome ◽  
Prophylactic Antibiotics ◽  
Ureteric Stent ◽  
Stent Removal ◽  
Ureteric Stenting ◽  
Ureteric Stents

Introduction: The role of ureteric stenting in renal transplant has been well-demonstrated. The goal of this survey was to determine the use of ureteric stents by Canadian transplant surgeons and how the ureteroneocystotomy and followup is performed. Methods: An online survey was sent to the 40 surgeon members of the Canadian Society of Transplantation. The primary outcome was the rate of ureteric stent use at the time of renal transplantation. The secondary outcomes were the ureteric stent dwell time, use and type of prophylactic antibiotics, and the use of routine post-transplant ultrasonography. Results: All respondents (25) used ureteric stent routinely and 92% remove the stent between four and six weeks postoperatively. Prophylactic antibiotics were used 64% of the time for ureteric stent removal. The majority of surgeons do not routinely perform a post-stent removal ultrasound. Fifty-six percent of respondents perform a refluxing anastomosis. Conclusions: Ureteric stents are routinely used in renal transplant in Canada. Areas for improvement and topics of debate identified from this survey are the need for peri-stent removal antibiotics, the role of post-stent removal ultrasound, the duration of stent dwell time, and the need for a non-refluxing ureteroneocystotomy.

Outcomes and Cost Evaluation Related to a Single-Use, Disposable Ureteric Stent Removal System: a Systematic Review of the Literature

2021 ◽  
Vol 22 (8) ◽  
Author(s):  
Thomas Hughes ◽  
Amelia Pietropaolo ◽  
Patrick Jones ◽  
Marco Oderda ◽  
Paolo Gontero ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cost Evaluation ◽  
Review Of The Literature ◽  
Ureteric Stent ◽  
Stent Removal ◽  
System A ◽  
Single Use ◽  
Removal System

scholarly journals Timing of Ureteric Stent Removal and Occurrence of Urological Complications after Kidney Transplantation: A Systematic Review and Meta-Analysis

2019 ◽  
Vol 8 (5) ◽  
pp. 689 ◽  
Author(s):  
Isis J. Visser ◽  
Jasper P. T. van der Staaij ◽  
Anand Muthusamy ◽  
Michelle Willicombe ◽  
Jeffrey A. Lafranca ◽  
...  
Keyword(s):  
Systematic Review ◽  
Kidney Transplantation ◽  
Cohort Studies ◽  
Meta Analysis ◽  
Ureteral Stenosis ◽  
Ureteric Stent ◽  
Urinary Leakage ◽  
Stent Removal ◽  
Urological Complications ◽  
Tract Infections

Implanting a ureteric stent during ureteroneocystostomy reduces the risk of leakage and ureteral stenosis after kidney transplantation (KTx), but it may also predispose to urinary tract infections (UTIs). The aim of this study is to determine the optimal timing for ureteric stent removal after KTx. Searches were performed in EMBASE, MEDLINE Ovid, Cochrane CENTRAL, Web of Science, and Google Scholar (until November 2017). For this systematic review, all aspects of the Cochrane Handbook for Interventional Systematic Reviews were followed and it was written based on the PRISMA-statement. Articles discussing JJ-stents (double-J stents) and their time of removal in relation to outcomes, UTIs, urinary leakage, ureteral stenosis or reintervention were included. One-thousand-and-forty-three articles were identified, of which fourteen articles (three randomised controlled trials, nine retrospective cohort studies, and two prospective cohort studies) were included (describing in total n = 3612 patients). Meta-analysis using random effect models showed a significant reduction of UTIs when stents were removed earlier than three weeks (OR 0.49, CI 95%, 0.33 to 0.75, p = 0.0009). Regarding incidence of urinary leakage, there was no significant difference between early (<3 weeks) and late stent removal (>3 weeks) (OR 0.60, CI 95%, 0.29 to 1.23, p = 0.16). Based on our results, earlier stent removal (<3 weeks) was associated with a decreased incidence of UTIs and did not show a higher incidence of urinary leakage compared to later removal (>3 weeks). We recommend that the routine removal of ureteric stents implanted during KTx should be performed around three weeks post-operatively.

P1736FIRST PROSPECTIVE CLINICAL STUDY OF A SINGLE-USE STERILE CYSTOSCOPE DESIGNED FOR DOUBLE J (DJ) STENT REMOVAL IN AN ITALIAN TRANSPLANT CENTER

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Antonio AMATO
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Urine Culture ◽  
Operating Theatre ◽  
Obstructive Nephropathy ◽  
Symptomatic Urinary Tract Infection ◽  
Stent Removal ◽  
Dj Stent ◽  
Single Use

Abstract Background and Aims A DJ is routinely placed during kidney transplantation then post-operatively removed, usually within the first month after transplantation. The removal is mainly performed in urology unit, through reusable rigid scope in an operating theatre with anesthesiologist assistance. Such removal procedure requires a complex environment with reprocessing, periodic maintenance and repairs of scopes, leading to delays and postponed stent removals. Hematuria, pain or dysuria due to the local trauma, and urinary infection are the most common complications of the DJ removal procedure. To overcome these issues, we introduced in April 2018 in our unit the single use sterile cystoscope ready to use with integrated grasper designed for DJ removals. Method We hereby report our experience with single-use flexible cystoscope (Isiris® – Coloplast). We prospectively collected data of any DJ stent removal operation from April 2018 to December 2019 (92 procedures). Urine culture at the removal day and usually 1 week after, at the first outpatient control was performed. All complications (related or not to the procedure) were recorded. All removals were performed in our unit by the nephrologist. 87 patients were treated, from which 82 as outpatients, and 5 as in-patients. Results 86 out of 87 patients stent removals were effectively done with Isiris®. In a single case, we could not remove the stent with the single-use instrument and resorted to traditional rigid cystoscopy under general anaesthesia. This happened with the sixth patient of our series and we think that this failure happened in the learning curve phase. In 4 cases stent removal wasn’t possible at first attempt due to likely interference of the internal stitches of the anastomosis: our policy is NOT to force stent removal if any resistance is felt to light pulling. Indeed, in all 4 cases a second procedure performed one month later was completely successful with smooth withdrawal of the device. In one case, a removal procedure was not possible because of urethral stricture and stent removal was postponed after its treatment. Taking into account these five patients the success rate of using Isiris® is 98.9% during this period. No patient was admitted for complications related to the removal procedure, namely for symptomatic urinary tract infection requiring antibiotics. Two patients were admitted for obstructive nephropathy (namely ureteral stenosis) which became evident after stent removal. 16 patients had an asymptomatic positive urine culture for a multi-resistant microbe before the stent removal and maintained positivity after the procedure. 11 patients were negative on the day of the stent removal and resulted positive in the control done at the first control. Again, none developed symptoms, and none required treatment. 9 patients were positive before stent removal and were negative on the first control. The rest of the patients were negative both at baseline and thereafter. Conclusion Due to the simplicity of the procedure by the single use solution (with 98.9% removal success, no operating theatre, no anaesthesiologist) and the fact that it is entirely managed by the transplantation clinic staff, the timing of the stent removal always respected physician’s indication, with no procedure delayed for organizational reasons. Knowing the infection risk associated with longest ureteral stent dwell durations, and the vulnerability of these immunosuppressed patients, it is important to remove the DJ as safely as possible and in defined time. In our study, no patient had to be admitted for urinary tract infection after the procedure nor developed symptomatic urinary tract infection to be treated with antibiotics.

RESEARCH: Dry Heat Processing of Single-Use Respirators and Surgical Masks

2020 ◽  
Vol 54 (6) ◽  
pp. 410-416
Author(s):  
Joyce M. Hansen ◽  
Scott Weiss ◽  
Terra A. Kremer ◽  
Myrelis Aguilar ◽  
Gerald McDonnell
Keyword(s):  
Microbial Contamination ◽  
Healthcare Providers ◽  
High Volume ◽  
Airborne Particles ◽  
Heat Processing ◽  
Protective Equipment ◽  
Healthcare Facilities ◽  
Dry Heat ◽  
Surgical Masks ◽  
Single Use

The COVID-19 pandemic, caused by severe acute respiratory syndrome coronavirus 2, has challenged healthcare providers in maintaining the supply of critical personal protective equipment, including single-use respirators and surgical masks. Single-use respirators and surgical masks can reduce risks from the inhalation of airborne particles and microbial contamination. The recent high-volume demand for single-use respirators and surgical masks has resulted in many healthcare facilities considering processing to address critical shortages. The dry heat process of 80°C (176°F) for two hours (120 min) has been confirmed to be an appropriate method for single-use respirator and surgical mask processing.

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