Evaluation of Symptoms and Patients' Comfort for JJ-ureteral Stents With and Without Antireflux-membrane Valve

Ecke, Thorsten; Bartel, Peter; Hallmann, S.; Ruttloff, Jürgen

doi:10.1016/j.urology.2009.07.1258

Cited by 27 publications

(29 citation statements)

References 15 publications

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“…However, the efficacy of these stents in the prevention of urosepsis is not widely accepted. 17,18 In our study, 29.9% of cases had peri-operative complications, which is much higher than reported rates of 1-3% in non-SCI patients. 2,4 Urosepsis, which occurred in 17.9% of the cases or 60% of those with complications, was most common.…”

Section: Discussioncontrasting

confidence: 61%

Ureteroscopy with laser lithotripsy for urolithiasis in the spinal cord injury population

et al. 2012

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Study design: Retrospective study. Objectives: The purpose of this investigation was to review the outcomes and safety of retrograde ureteroscopic laser lithotripsy (URS) for the treatment of urolithiasis in the spinal cord injury (SCI) population. Setting: Virginia, USA. Methods: All patients with SCI who underwent URS with holmium:YAG laser lithotripsy for urolithiasis over a 15-year period were identified. Stone size, location and number at presentation were recorded. Information regarding patient characteristics, intra-operative complications, surgical efficacy, stone clearance, peri-operative complications, and follow-up stone events was collected and analyzed. Results: A total of 67 URS procedures were performed on 29 SCI patients during the study period with an average follow-up of 3.4 years. Patients had an average of 2.3 ipsilateral ureteroscopies. The majority (85.1%) used indwelling catheters for long-term bladder management, and complete stone clearance after the first procedure was 34.3%. Of the 44 cases with residual stones 44 mm, 20 (45.5%) were secondary to technical or procedural limitations. The intra-operative complication rate was comparable to non-SCI studies at 1.5%, but peri-operative complications were significantly higher at 29.9% with the majority due to urosepsis. Factors associated with peri-operative complications include chronic obstructive pulmonary disease, motor incomplete injuries and lack of a pre-operative ureteral stent. Conclusion: URS in the SCI population is an effective treatment for ureteral or renal stones but may be associated with greater risks and reduced efficacy. With advances in endourology, ureteroscopic surgery has become a popular choice for the minimally invasive treatment of urolithiasis. In the general population, studies reveal stone-free rates between 77 and 93% after one procedure. Success varies depending on size, number and location of stones. 2-5 Intra-operative complications range between 0 and 6%, and major peri-operative complications between 1 and 3%. 2,4,6 Unfortunately, it is not known whether these studies are directly applicable to patients with SCI. SCI results in neurogenic bladder, which significantly alters bladder function including ability to empty, bladder pressure, continence and bladder compliance. 7 Detrusor-sphincter-dyssynergia, a common problem in SCI patients with neurogenic bladder dysfunction, can cause elevated detrusor

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Section: Discussioncontrasting

confidence: 61%

Ureteroscopy with laser lithotripsy for urolithiasis in the spinal cord injury population

et al. 2012

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“…Ecke et al reported on less flank pain and bladder pain during voiding in 72 patients undergoing insertion of antireflux stents compared with 61 patients with conventional stents. 32 Their study was randomized and single-blind, but assessment was carried out with three self-developed questions instead of a validated questionnaire, and a sample size calculation was not reported. In 2012, Ritter et al reported on their first experiences with a newly developed antirefluxive stent in a small randomized trial (n = 29).…”

Section: Stent Materials and Designmentioning

confidence: 99%

Prevention and treatment of symptoms associated with indwelling ureteral stents: A systematic review

et al. 2017

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Temporary drainage of the upper urinary tract by internal ureteral stents is a routine procedure in endourology. However, it is associated with a clear side-effect profile. Our aim was to evaluate prevention and treatment options of stent-related symptoms. We carried out a systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines using MEDLINE and SCOPUS, and identified 107 appropriate records. A high number of these studies showed clear methodological limitations. Available data clearly support the use of a 1 -blockers in patients suffering from stent-related symptoms. It seems that antimuscarinic monotherapy or combination with a 1 -blockers might also play an important role, whereas the use of classical analgesics in the treatment of stent-related symptoms has not been assessed systematically within clinical trials so far. Improvements in stent design and material seem to have the potential to reduce stent-related symptoms. However, so far there is no type of stent with outstanding characteristics and clear evidence suggesting fundamental advantages compared with a standard double pigtail stent. Although stent diameter does not seem to influence patients' comfort, it seems to be beneficial to choose a proper stent-length. Coated and drug-eluting stents, as well as intravesical drug application, seem to be promising concepts to prevent stent-related symptoms, but still have to be considered as experimental approaches. Furthermore, thorough patient education has the potential to reduce the morbidity associated with ureteral stenting. Further research in the field seems to be mandatory.

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“…Some etiologies have been hypothesized for their complications including mechanical irritation of the bladder trigone, urine renal reflux resulting obstruction, bacterial colonization, stent positioning as well as stent size and design (1,3,(6)(7)(8)(9)(10). Strategies for managing stent complications include accurate stent indications, stenting maneuvers, stent design and use of medications (1,3).…”

Section: Introductionmentioning

confidence: 99%

Effects of Terazosin and Tolterodine on Ureteral Stent Related Symptoms: A Double-Blind Placebo-Controlled Randomized Clinical Trial

et al. 2013

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Objective: To evaluate the effects of terazosin and tolterodine on ureteral stent discomfort. Materials and Methods: Of 163 patients assessed for eligibility, 104 patients were randomly assigned to receive placebo, 2 mg of terazosin twice daily, 2 mg of tolterodine daily, or both terazosin plus tolterodine during the stenting period. Prior to stenting and at stent removal, the International Prostate Symptom Score (IPSS), the IPSS quality of life (QoL) subscore and the Visual Analog Scale for Pain were determined. The patients also reported their analgesic use during the stenting period. Results: Ninety-four patients completed the study. We noted significant decreases in the total IPSS scores (p = 0.002), irritative subscore (p = 0.039), QoL (p = 0.001), flank pain (p = 0.013), voiding pain (p = 0.01) and amount of analgesics used (p = 0.02) in the groups. However, neither the obstructive subscore nor the suprapubic pain improved significantly (p = 0.251 and p = 0.522, respectively). The patients receiving terazosin plus tolterodine experienced significant reductions in the total IPSS, irritative symptoms, QoL, flank pain, voiding pain and decreased analgesics use compared with those patients receiving placebo. However, compared with placebo, terazosin monotherapy did not affect pain levels, and tolterodine monotherapy did not improve QoL, flank pain or analgesics use. Conclusions: Terazosin plus tolterodine improves ureteral stent-related complications, including irritative symptoms, the amount of analgesics used, QoL, flank pain and voiding pain but does not decrease obstructive symptoms or suprapubic pain. This trial was registered at www.clinicaltrials.gov as NCT01530243.

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Evaluation of Symptoms and Patients' Comfort for JJ-ureteral Stents With and Without Antireflux-membrane Valve

Cited by 27 publications

References 15 publications

Ureteroscopy with laser lithotripsy for urolithiasis in the spinal cord injury population

Ureteroscopy with laser lithotripsy for urolithiasis in the spinal cord injury population

Prevention and treatment of symptoms associated with indwelling ureteral stents: A systematic review

Effects of Terazosin and Tolterodine on Ureteral Stent Related Symptoms: A Double-Blind Placebo-Controlled Randomized Clinical Trial

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