Fluoroscopy-free double-J stent placement through ureteroscope working channel postuncomplicated ureteroscopic laser lithotripsy: A novel technique

Abstract

Objectives:To report a technique for ureteroscopic laser lithotripsy (URSL) and retrograde placement of a double-J (DJ) stenting through the ureteroscope working channel without the use of a fluoroscope compared to the conventional technique.Patients and Methods:Between June 2015 and December 2017, 170 patients selected for URSL for treatment of ureteral stones and DJ insertion was evaluated. Patients are divided into two groups according to the use of fluoroscopy. In Group A (100 patients), fluoroscope is used and group B (70 patients) without fluoroscopy guidance. In group B, URSL is performed first and followed by DJ insertion by the semi-rigid ureteroscope 8.5-11 Fr under vision without fluoroscopy.Results:Stone free rate in 96% versus 94.3% for groups A and B respectively. This technique was successful in all the included patients: 166 retrograde DJ stenting post URSL for ureteric calculi and 4 cases for anuria. Group A are exposed to radiation with mean 26.6 seconds in URSL procedure and 4.8 seconds for DJ stenting. Group B was exposed to zero dose. For group A, the stents size was 6 Fr for 70% of patients and 15 % for 4.7 Fr and 15% for 7 Fr stenting. In Group B, stents of 4.7 Fr and length 24-26 cm were used in all patients. Failure of DJ insertion is reported in 9% for group A and 13 (18.5%) patients for group B.Conclusions:This study report the feasibility and efficacy of the completely fluoroscopy free URSL and DJ stenting to treat ureteric stones.

Forgotten Double J Ureteral Stent for 10 years: A Case Report with Review of Literature

“…Stent composition and design have undergone many improvements but are still associated with morbidity in approximately 80% of cases [3]. Aboutaleb et al, reported DJS complications in 170 patients, with postoperative lower urinary tract irritative symptoms in the form of frequency and urgency in 63.5% patients, gross hematuria in 15.9% patients, and colic in 13.5% patients [1]. Upward migration of the stents was observed in 1.2% patients, while downward migration was observed in 5.9% patients.…”

“…Over the last decade, stent design and material have been upgraded to reduce complications. However, serious complications such as migration, fragmentation, encrustation, and stone formation may occur, especially when stents are left in respective locations for long periods [1]. In addition, a forgotten stent may be complex and challenging at the time of removal [2].…”

Forgotten double J stent with maximum stone burden

“…The Double J Stent, a self-retaining ureteral stent used for renal drainage, is widely used in urologic practice. It is used as a part of routine uretroscopy for stone disease, after a multitude of reconstructive surgeries to allow for uretral healing, for obstructive uropathy, before Extracorporeal Shock Wave Lithotripsy (ESWL), for obstructive anuria, etc [1]. However, serious complications such as encrustation, migration, stone formation, fragmentation, and infection can be seen if the stents have been placed for a long time [2].…”

A neglected double J ureteral stent for 10 years: A rare case report

“…Double J stents (DJS) are normally used in the treatment of obstructive anuria, ureteral reconstructive surgery, before extracorporeal shock-wave lithotripsy (SWL), and obstructive uropathy. 1 However, In addition, a forgotten stent may be complex and challenging at the time of removal . 2 Herein, we report a case of a forgotten DJS for 10 years that was complicated due to massive stone burden.…”