Comparison of a magnetic retrieval device vs. flexible cystoscopy for removal of ureteral stents in renal transplant patients: A randomized controlled trial

Abstract

Introduction: Placement of a ureteral stent at the time of renal transplantation can reduce complications when compared to non-stented anastomoses. Removal by flexible cystoscopy can be associated with discomfort, risk for infection, and high costs. New magnetic stents offer a means of bypassing cystoscopy by use of a magnetic retrieval device. Our objective was to compare clinical and cost-related outcomes of conventional and magnetic stents in patients undergoing deceased donor renal transplantation.
 Methods: Patients were randomized to receive either a conventional or a Black-Star® magnetic stent. Clinical, procedural, and cost outcomes were assessed, and the Ureteral Stent Symptom Questionnaire (USSQ) was administered with the stent in situ and after stent removal. All variables were compared between groups.
 Results: Forty-one patients were randomized to conventional (n=19) or Black-Star (n=22) stent. The total time for stent removal under cystoscopy was significantly longer compared to Black-Star removal (6.67±2.47 and 4.80±2.21 minutes, respectively; p=0.019). No differences were found in the USSQ domains between groups. Rates of urinary tract infections and surgical complications between groups were similar. Stent removal was well-tolerated in both groups. Black-Star stent use resulted in a cost savings of $304.02 Canadian dollars (CAD) per case.
 Conclusions: USSQ scores suggest that stent removal with the Black-Star magnetic stent is as equally well-tolerated as flexible cystoscopy by renal transplant patients. Black-Star stent removal was significantly faster than conventional stents. No differences in discomfort, infection rate, or complication rate were found. Use of the Black-Star stent resulted in an estimated annual savings of $27 360 CAD at our centre.

The Function Improved of the Newly Designed Magnetic‐End Ureteric Stenting Retrieval Device: A Clinical Prospective Randomized and Control Trial in a Multicenter Study

“…A magnetic ureteral stent (Black-Star ® , made in Germany) was a typical application for clinical treatment [13,14,16]. e removal of magnetic stents using a retrieval catheter proved to be less painful than using cystoscopy [16,21].…”

Feasibility and Safety of a Simple Non-cystoscopic Double-J Tube Removal Technique in Children

“…These developments have greatly expanded the scope of the application of double-J tubes in clinical practise. Despite several advantages of using a double J-tube, certain drawbacks still exist, an example of which is the need for a second operation to pull out the double-J tube ( 4 , 13 ).…”

“…Several new technologies and materials have been reported to facilitate the removal of the double-J tube through a non-cystoscopic approach. Some examples are as follows: the application of double-J tube with magnetic ends (1)(2)(3)(4), surgical techniques for external placement of the double-J tube (5), and the percutaneous antegrade removal technique (6). However, these methods have certain limitations, such as the high cost of materials, requirement of technical expertise and additional surgical interventions, which increase the risk of complications.…”

Advances in ureteral stent technology

“…Magnetic stent retrieval involves blindly inserting a novel catheter with a magnetic end into the bladder that attracts a small metal bearing attached to the distal end of the ureteral stent. Kapoor et al compared 22 patients undergoing magnetic stent removal to 19 with conventional cystoscopic stent removal following renal transplantation in an RCT [20]. They noted overall comparable success rates (magnetic 95%, cystoscopic 100%), with one magnetic stent requiring cystoscopic removal due to encrustation and was not included in the analysis [20].…”