Do ureteric stent extraction strings affect stent‐related quality of life or complications after ureteroscopy for urolithiasis: a prospective randomised control trial

Abstract

Objective To determine whether ureteric stent extraction strings affect stent‐related quality of life (QoL) or increase complications after ureteroscopy (URS) for stone disease. Patients and Methods In all, 68 patients undergoing URS (October 2011 to May 2013) for stone disease were randomised to receive a ureteric stent with or without an extraction string. Patients completed the Ureteric Stent Symptom Questionnaire (USSQ) on postoperative days 1 and 6, and 6 weeks after stent removal. Pain was assessed at stent removal. Adverse events, including early stent removal, stent migration, retained stent, urinary tract infection (UTI), emergency room (ER) visits and postoperative phone calls were monitored. Results There was no difference in stent‐related QoL as measured by the USSQ between those with and without a stent extraction string, pain at stent removal between those who pulled their stent independently vs those who underwent cystoscopy for stent removal, or in the rate of UTIs, ER visits or phone calls between groups. Five patients (four female, one male) removed their stent early by inadvertently pulling the string; none required replacement. Patients without a string had a significantly longer period with the postoperative ureteric stent (10.6 vs 6.3 days, P < 0.001). One patient without a stent string retained her ureteric stent for 6 months, which was removed by cystoscopy without incident. Conclusion Ureteric stent extraction strings may offer several advantages without increasing stent‐related urinary symptoms, complications, or postoperative morbidity.

Patient Experiences and Preferences with Ureteral Stent Removal

“…Barnes and colleagues reported similar findings in their study. 15 In their prospective, randomized study, they found no difference in visual analog pain scores between patients who had stents removed by cystoscopy and those who had theirs removed by stent string.…”

Part of the Solution and Part of the Problem-Report on the Ureteric Stent Use in a Tertiary Referral Center in Australia

“…A questionnaire for stent symptoms was developed [6] (addressing pain, voiding symptoms, work performance, sexual health, overall general health and additional problems) [7] and it can form the base for future analysis of our cohort. Alpha blockade is associated with decreased stent related morbidity and smaller studies have shown benefit of anticholinergic medication.…”

Comparison of cost of care for tethered versus non‐tethered ureteric stents in the management of uncomplicated upper urinary tract stones

“…Tethered stents eliminate the need for a second procedure for removal. Studies have demonstrated that this can be done safely by the patient at home, eliminating the need for a return visit to an out‐patient clinic for removal . Despite this, many surgeons are still reserved about their utility given their associated complications.…”

“…Despite this, many surgeons are still reserved about their utility given their associated complications. Of particular concern is stent migration, which frequently results from the tether getting caught on clothing, or from accidental removal during hygiene practices, particularly in female patients . Tethered stents are more frequently used in cases where short stent‐dwell times are anticipated; although even in these instances, some surgeons will still choose to use a non‐tethered stent for fear of complications.…”

“…Non‐tethered stents require a second procedure for removal and are frequently used where a longer stent dwell time is desired. In instances where an in situ stent is absolutely required, or where a stent‐dwell time of more than a week is planned, surgeons tend to use non‐tethered stents as their risk of migration and other stent‐related complications is known to be lower . The general consensus is that the requirement for a second procedure for their removal, renders the use of the non‐tethered stent more costly.…”