Clinical efficacy of modified ureteral stent for the related lower urinary tract symptoms caused by ureteral double J stent indwelling
Guo Kai1,2, Wang Yongchuan2, Du Jing2, Zhou Haijun2, Ren Anji2, Wang Kai2, Lun Xiaolu2, Wang Xiaolong2, Shao Yi3
1Department of Surgery, Weifang Medical University, Shandong 261053, China;
2Weifang Traditional Chinese Medicine Hospital;
3Shanghai Jiaotong University Affiliated First People's Hospital
Abstract：Objective: To observe the preventive effect of the modified ureteral stent indwelling for the double-J stent related lower urinary tract symptoms (LUTS) and other discomforts. Methods: Fifty-eight cases of upper urinary tract calculi treated by flexible ureteroscopic lithotripsy (fURL) were randomly divided into two groups: the observation group treated with the modified ureteral stent (the distal circle end was cut in different length according to the length of patients' ureter, the lower part of ureteral stent was completely pushed into the ureteral lumen above the intramural part (usually 1-3 cm), and the end of ureteral stent was fixed with 3-0 absorbable suture for those patients whose ureteral stent was planned to be removed in two weeks after fURL; the control group was treated with the routine ureteral stent indwelling method. The ureteral stents usually were removed in 2-4 weeks after fURL, while the ureteral stent indwelling time was prolonged to 3 or 6 months for those patients with proximal or middle ureteral stenosis. All the patients were asked to complete the ureteral stent symptoms questionnaire (USSQ) and international prostate symptom score (IPSS) before fURL and 2-4 weeks after the operation. The LUTS, physical pain and the general condition scores were evaluated. Results: There was no significant difference between the two groups before fURL (P>0.05). Before the removal of the ureteral double J stent indwelling, the USSQ scores in the control group and observation group were (25.4±5.5) vs. (29.2±5.7); the physical pain symptom scores were (7.8±1.8) vs. (15.7±2.8); the hematuria scores were (1.5±0.5) vs. (2.6±0.9); the general condition scores were (11.3±4.1) vs. (13.4±3.4); the IPSS scores were (9.7±2.2) vs. (13.7±1.6), respectively. All the differences above between the two groups were statistically significant (P<0.05). Conclusions: The modified ureteral stent indwelling method can significantly improve the related LUTS and other discomforts caused by routine ureteral double-J stent indwelling.
[1] Ucuzal M, Serce P.Ureteral stents: impact on quality of life. Holist Nurs Pract, 2017,31(2):126-132.
[2] Dellis AE, Papatsoris AG, Keeley J, et al.Tamsulosin, solifenacin, and their combination for the treatment of stent-related symptoms: a randomized controlled study. J Endourol, 2017,31(1):100-109.
[3] Lingeman JE, Preminger GM, Goldfischer ER, et al.Assessing the impact of ureteral stent design on patient comfort. J Urol, 2009,181(6):2581-2587.
[4] Chew BH, Lange D.Advances in ureteral stent development. Curr Opin Urol, 2016,26(3):277-282.
[5] Hao P, Li W, Song C, et al.Clinical evaluation of double-pigtail stent in patients with upper urinary tract diseases: report of 2685 cases. J Endourol, 2008,22(1):65-70.
[6] Joshi HB, Newns N, Stainthorpe A, et al.Ureteral stent symptom questionnaire: development and validation of a multidimensional quality of life measure. J Urol, 2003,169(3):1060-1064.
[7] Dauw CA, Simeon L, Alruwaily AF, et al.Contemporary practice patterns of flexible ureteroscopy for treating renal stones: results of a worldwide survey. J Endourol, 2015,29(11):1221-1230.
[8] Wang JE, Zhang XB, Zhang TD, et al.The role of solifenacin, as monotherapy or combination with tamsulosin in ureteral stent-related symptoms: a systematic review and meta-analysis. World J Urol, 2017,35(11):1669-1680.
[9] Lee JN, Kim BS.Comparison of efficacy and bladder irritation symptoms among three different ureteral stents: A double-blind, prospective, randomized controlled trial. Scand J Urol, 2015,49(3):237-241.
[10] Betschart P, Zumstein V, Piller A, et al.Prevention and treatment of symptoms associated with indwelling ureteral stents: A systematic review. Int J Urol, 2017,24(4):250-259.
[11] 徐庆康,于田强,段跃,等.输尿管镜检查术后留置双J管长度对生命质量和并发症的影响.中华泌尿外科杂志,2014,35(12):952-953.
[12] Al-Kandari AM, Al-Shaiji TF, Shaaban H, et al.Effects of proximal and distal ends of double-J ureteral stent position on postprocedural symptoms and quality of life: a randomized clinical trial. J Endourol, 2007,21(7):698-702.
[13] Lee SJ, Yoo C, Oh CY, et al.Stent position is more important than α-blockers or anticholinergics for stent-related lower urinary tract symptoms after ureteroscopic ureterolithotomy: a prospective randomized study. Korean J Urol, 2010,51(9):636-641.
[14] Shabeena KS, Bhargava R, Map M, et al.Characteristics of bacterial colonization after indwelling double-J ureteral stents for different time duration. Urol Ann, 2018,10(1):71-75.
[15] Chew BH, Seitz C.Impact of ureteral stenting in ureteroscopy. Curr Opin Urol, 2016,26(1):76-80.
[16] Vogt B, Desgrippes A, Desfemmes FN.Changing the double-pigtail stent by a new suture stent to improve patient's quality of life: a prospective study. World J Urol, 2015,33(8):1061-1068.
[17] Vogt B, Desgrippes A, Desfemmes FN.[Pigtail suture stent: decisive progress towards double-pigtail stent tolerance and unexpected properties of the suture in the ureter]. Prog Urol, 2014,24(7):441-450.
[18] Lange D, Bidnur S, Hoag N, et al.Ureteral stent-associated complications-where we are and where we are going. Nat Rev Urol, 2015,12(1):17-25.
[19] 崔雪冬,刘亚东,安瑞华,等.输尿管镜取石术后双J管移位的影响因素.现代泌尿外科杂志,2017,22(11):848-851.
