A randomized trial investigating clinical outcomes and stent‐related symptoms after placement of a complete intra‐ureteric stent on a string versus conventional stent placement

Shah, Milap; Pillai, Suresh S; Chawla, Arun; Rosette, Jean J.M.C.H. de la; Laguna, Pilar; Reddy, Suraj Jayadeva; Taori, Ravi; Hegde, Padmaraj; Mummalaneni, Sitaram

doi:10.1111/bju.15540

Cited by 10 publications

(7 citation statements)

References 25 publications

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“…Removal of the ureteral stent with extraction string was significantly less painful than with cystoscope (mean VAS scores 5.67 vs 2.73; p < 0.001) [ 12 ]. In a recent study, Shah et al compared stent-related complications with the placement of a conventional ureteral stent and a complete intra-ureteric stent with extraction string and showed that no difference in complication rates between the two groups [ 30 ].…”

Section: Discussionmentioning

confidence: 99%

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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

Kong

Xing

et al. 2023

Urolithiasis

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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).

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Section: Discussionmentioning

confidence: 99%

“…The same results were found in our study ( p = 1.00). Shah et al reported a 5% rate of stent migration and accidental dislodgement [ 30 ]. In the present study, we found that 1.5% (one female) of patients with an extraction string prematurely removed the ureteral stent.…”

Section: Discussionmentioning

confidence: 99%

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

Kong

Xing

et al. 2023

Urolithiasis

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“…Although a few studies which compared conventional DJ stents to complete intraureteral stents have demonstrated a reduction in SRS, enhancement of QoL, and less stent-related discomfort [ 20 , 21 , 22 ], a similar study that was conducted at our institute found a reduction in symptom scores across LUTS domains of the USSQ, but the reduction was not statistically significant [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

“…Among women who were stented, individual domains of the FSFI—the Arousal, Orgasm, and Satisfaction subdomains—were statistically lower in the stented group [ 24 , 25 , 26 ]. Meanwhile, studies involving complete intraureteral stents with extraction strings by Kim et al [ 27 ] and Shah M et al [ 23 ] demonstrated a general drop in sexual activity among patients following placement of a stent with extraction strings due to stent-related pain, anxiety of stent dislodgement, or a thread dangling from the urethral meatus.…”

Section: Discussionmentioning

confidence: 99%

Outcomes and Complications from a Randomized Controlled Study Comparing Conventional Stent Placement Versus No Stent Placement after Ureteroscopy for Distal Ureteric Calculus < 1 cm

Reddy

Chawla

et al. 2022

JCM

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Ureteric stent insertion following ureteroscopic lithotripsy (URSL) is a common and widely accepted procedure. However, there is no agreement on whether a ureteric stent should be placed following an uncomplicated URSL. Furthermore, the definition of uncomplicated URSL remains debatable. To compare the efficacy, safety, and morbidity of no stent placement with the conventional stent placement after uncomplicated retrograde semirigid URS for a distal ureteric calculus of size ≤1 cm, we compared the corresponding complication rates, emergency visits, secondary interventions, and pain at follow-up. Following an uncomplicated ureteroscopic lithotripsy, 104 patients were randomized into the conventional stented group (CSG) and nonstented group (NSG). Lower urinary tract symptoms and sexual function were evaluated using validated questionnaires (IPSS + IIEF-5 + MSHQ-EjD/FSFI) preoperatively and at 4 weeks during follow-up. Pain scores at follow-up were recorded using a visual analogue scale (VAS). Patients who visited the emergency room or needed secondary interventions before the recommended follow-up time were noted. The Generalized Estimating Equations method was used to explore the difference in change in the domains of IPSS, IIEF-5, MSHQ-EjD, and FSFI between the two groups over time. A significant difference was noted in the following IPSS domains: Frequency, Urgency, Nocturia, Storage Symptoms, Total IPSS Score (p ≤ 0.001), and QoL (p = 0.002); IIEF-5 domains: Overall Score (p = 0.004); MSHQ-EjD domains: Ejaculation Bother/Satisfaction (p ≤ 0.001); and FSFI domains: Lubrication (p ≤ 0.001), Satisfaction (p = 0.006), and Overall Score (p = 0.004). There was no significant difference between the various groups in terms of distribution of emergency visits, readmission and secondary interventions, pain at follow-up (VAS), and need for long-term analgesia. Nonplacement of stents after uncomplicated URS decreases stent-related symptoms and preserves QoL without placing the patient under increased postoperative risk.

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“…Vogt and colleagues introduced pigtail suture stents (PSS) in 2015, replacing the DJ distal pigtail with a suture thread reaching the bladder [ 6 ]. This device was later investigated by randomized controlled studies (RCT) which assessed more tolerability compared to conventional DJ [ 7 – 10 ].…”

Section: Introductionmentioning

confidence: 99%

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

Bosio,

Ferretti,

Alessandria

et al. 2024

World J Urol

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Purpose To 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 methods Patients 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. Results 93 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. Conclusions Patients 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.

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A randomized trial investigating clinical outcomes and stent‐related symptoms after placement of a complete intra‐ureteric stent on a string versus conventional stent placement

Cited by 10 publications

References 25 publications

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

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

Outcomes and Complications from a Randomized Controlled Study Comparing Conventional Stent Placement Versus No Stent Placement after Ureteroscopy for Distal Ureteric Calculus < 1 cm

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

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