Comparison of efficacy and tolerance of short-duration open-ended ureteral catheter drainage and tamsulosin administration to indwelling double J stents following ureteroscopic removal of stones

Abstract

Objectives:To evaluate the efficacy of shortduration, open-ended ureteral catheter drainage as a replacement to indwelling stent, and to study the effect of tamsulosin on stent-induced pain and storage symptoms following uncomplicated ureteroscopic removal of stones.Design: Prospective randomised study.Setting: School of Medical Sciences and Research, Sharda University, Greater Noida, India. Patients:Patients who underwent ureteroscopic removal of stones for lower ureteral stones between November 2011 and January 2014 were randomly assigned into three groups. Patients in group 1 (n=33) were stented with 5-French double J stent for 2 weeks. Patients in group 2 (n=35) were administered tablet tamsulosin 0.4 mg once daily for 2 weeks in addition to stenting, and those in group 3 (n=31) underwent 5-French open-ended ureteral catheter drainage for 48 hours. Main outcome measures:All patients were evaluated for flank pain using visual analogue scale scores at days 1, 2, 7, and 14, and for storage (irritative) bladder symptoms using International Prostate Symptom Score on days 7 and 14, and for quality-of-life score (using International Prostate Symptom Score) on day 14.Comparison of efficacy and tolerance of shortduration open-ended ureteral catheter drainage and tamsulosin administration to indwelling double J stents following ureteroscopic removal of stones New knowledge added by this study • This study shows that short-duration (up to 48 hours) ureteral drainage following ureteroscopic removal of stones (URS) has better efficacy and tolerance than indwelling stent placement with respect to the need for postoperative drainage. Hence, this can be a replacement for double J stenting.• Routine tamsulosin administration in patients with indwelling stents following URS has beneficial effects not only on irritative bladder symptoms but also on flank pain (both persistent and voiding). Implications for clinical practice or policy • Replacement of stents with short-duration open-ended ureteral catheter drainage provides early and more rehabilitation to the patients following URS. This is a viable option because there is no need for follow-up for stent-related symptoms, or maintaining records for planning its removal (no lost or retained stents).• It avoids a second invasive endoscopic procedure of stent removal, thereby reducing the medical and financial burden on the patient (especially important in developing countries). Patients are more likely to undergo URS again if required in the future (with stone recurrence) than opt for less effective or expensive choices like medical management, shock wave lithotripsy, or alternative forms of medicine.• In stented patients, tamsulosin administration improves the overall quality of life, and makes the period with stent in situ more bearable and asymptomatic.

The Efficacy of JJ Stent on Stone Free Rate After Extracorporeal Shock Wave Lithotripsy: A Retrospective Study

“…In other studies, it is defined that use of a stent is not beneficial with stones even larger than 1.0 cm. Moreover, our study confirmed these reports and concluded that stents do not interfere with stone-free rates after ESWL but enhance the stent-related complications such as steinstrasse and discomfort [18][19][20][21][22][23] . We recommend that routine usage of DJ stent after every ESWL should be minimized and only selected patients get DJ stenting after ESWL.…”

“…However, in the literature, there are no differences found in hospitalized and recovered patients after the stenting procedure 16,17 . Ureteral stents are associated with major symptoms including pain, LUTs, and reduced working capacity, which results in reduced quality of daily life, whereas ureteral stents, may cause pain and LUTs specifically dysuria, urgency and mild to moderate hematuria [18][19][20][21][22] .…”

The Application of External Ureteral Catheters in Children With Acute Kidney Injury Caused by Ceftriaxone-Induced Urolithiasis

“…Gonen et al showed that external ureteral catheters were more comfortable with the adult patients in a short time while being as reliable and safe as an indwelling stent (11). Vikram et al also reported that external open-ended ureteral catheter drainage was equally effective and better tolerated than routine stenting following the uncomplicated ureteroscopic removal of stones (12). In this study, we demonstrate that the placement of external ureteral catheters instead of double-J stents, is a viable option to relieve bilateral ureteral obstruction and provide short-term urine drainage.…”

Ureteral stent versus no ureteral stent for ureteroscopy in the management of renal and ureteral calculi: A Cochrane review

“…In all, 14 studies did not meet the inclusion criteria or were not relevant to the question under question. 1,11,[16][17][18][19][20][21][22][23][24][25][26][27] We identified one ongoing trial. 28 In all, 23 studies with 24 relevant articles (abstracts or secondary publications: not listed in the references) ultimately met the inclusion criteria and were included in the qualitative synthesis of this review.…”