<p>Strategies to Improve Patient Outcomes and QOL: Current Complications of the Design and Placements of Ureteric Stents</p>

Abstract

Ureteric stents have played a vital role in relieving urinary obstruction in many urological conditions. Although they are extremely successful, stents have been associated with complications and reduced patients' health-related quality of life (HRQoL). There are many factors that may affect the quality and longevity of stents. In this review, we have highlighted the journey and innovation of ureteric stents through the modern day. A literature review was conducted to identify relevant articles over the last 20 years. There is a plethora of evidence with various indications for the use of ureteral stents and how they affect QoL. There is still ongoing research to develop the ideal stent with reduced encrustation, one that resists infection and is also comfortable for the patients. Stents made from metal alloys, polymers and biodegradable materials have unique properties in their own right but also have certain deficiencies. These have been discussed along with an overview of newly developed stents. Certain pharmacological adjuncts have also been highlighted that may be useful to improve patient's tolerance to stents. In summary, this paper describes the features of the different types of stents and the problems that are frequently encountered, including effect on patients' HRQoL and financial burden to healthcare providers.

Fluid mechanical modeling of the upper urinary tract

“…These necessitate more frequent stent replacements, sometimes every few weeks, which is inconvenient for the patient and places an increased burden on the healthcare system. The development of biofilm and encrustation on stent surfaces (Figure 1(c), (d)) therefore remains one of the most challenging topics in both research and clinical studies of the UUT (Ramachandra et al, 2020; Ramstedt et al, 2019; Sali & Joshi, 2020), and UUT models are often developed to investigate aspects of ureteral stents and their performance.…”

Design of a fully intraureteral stent and proof-of-concept in vivo evaluation

“…While considerable literature offers evidence that the bladder (distal) anchor is a major factor affecting patient discomfort (5)(6)(7)(8)(9)(11)(12)(13), literature regarding the degree of discomfort caused by the positioning of the proximal pigtail in the kidney is less clear. However, some literature focuses on identifying the degree to which pigtail positioning in the renal pelvis and different renal calyxes correlates to the intensity of patient discomfort (17,18), which also suggests that a proximal anchor placed essentially anywhere within the kidney may also be a source of patient discomfort.…”

“…Since then, studies have noted the significant, negative effects of ureteral stents on patient quality of life, with stent-related symptoms affecting daily activities of more than 80% of patients (5). Indeed, poor toleration of double-J ureteral stents, with Original Article Design of a fully intraureteral stent and proof-of-concept in vivo evaluation symptoms involving urinary frequency, urgency, dysuria, incontinence, hematuria, incomplete emptying, a feeling of pelvic heaviness, and lumbar pain is well-documented (5)(6)(7)(8)(9). These symptoms are generally believed to be related to anchoring stent ends, which are usually curled, located in the bladder and in the kidney.…”

Current Status of Ureteric Stents on Extraction Strings and Other Non-cystoscopic Removal Methods in the Paediatric Setting: A Systematic Review on Behalf of the European Association of Urology (EAU) Young Academic Urology (YAU) Urolithiasis Group

“…In recent years, there have been numerous advances in stent technology including material, design and stent coating [3]. Many of these modifications have been driven by the need to improve the tolerability of stents given the adverse effect on quality of life (QoL), which they can yield [4]. Removal of the stent can also be bothersome and in the paediatric setting, cystoscopic removal almost always mandates a general anesthetic (GA) [5].…”