Office-based ureteric stent removal is achievable, improves clinical flexibility and quality of care, whilst also keeping surgeons close to their patients

Abstract

IntroductionDiagnostic pressure on endoscopy suites can result in stent removal not receiving the required priority and unnecessary morbidity for patients. As well as using stents with extraction strings, the introduction of a portable single-use flexible cystoscope for ureteric stent removal (Isiris™), offered an opportunity to negotiate these issues by relocating stent removal to the office/clinic. This study aimed to determine whether such flexibility reduced stent dwell time with the assumption this would improve patient experience and decrease associated complications.Materials and methodsA retrospective review of ureteric stents placed during stone procedures was undertaken. Data collection included; patient demographics; stent dwell times; the number of emergency department (ED) attendances and hospital readmissions; procedure cancellation rates and the number of urinary tract infections.ResultsIn total, 162 stents were removed (113 Standard, 34 Isiris™, 15 via strings). Excess dwell time was reduced in both Isiris™ (median 1 day, mean 1.37 days, p = 0.0009) and Strings Groups (median 0.96 days, mean 0.96 days, p = 0.022) compared with the Standard Group (median 8 days, mean 15.34 days).ED attendances and readmissions were reduced by 33.5% and 22% respectively in the Isiris™ Group compared with the Standard Group. There were no ED attendances in the Strings Group. Reductions in length of stay, urine infections and cancellation on the day of procedures were also observed.ConclusionsThe clinical flexibility provided by Isiris™ and 'stents on strings' has objectively improved patient experience and is associated with a reduction in complications as well as increasing diagnostic capacity and cost efficacy.

Efficacy of the novel, innovative, single‐use grasper integrated flexible cystoscope for ureteral stent removal: a systematic review

“…17 Since the sterility is manufacture guaranteed and not a reusable item, both the rates of bacteriuria and urinary tract infections have shown to be reduced. 12 The cost-benefit in comparison to "in-theatre" ureteral stent removals has also been demonstrated. 8,10 Due to the accessibility of the device, stent indwelling times are also shorter, with a lesser burden on the hospital staff.…”

“…14,15 The aims and objectives within the published papers were consistent in outlining the precise role and impact that this novel SUGIFC device has had on the clinical and economic components of ureteral stent removal. These aims included: cost analysis and comparison to other removal techniques, [7][8][9][10]13 potential role in the detection of bladder malignancy, 11 emergency department (ED) presentations and readmissions, 12 technical aspects and intrinsic properties of functionality 14,15 and its role in the removal of foreign bodies within the ED. 16 Patient cohorts (cumulative patient numbers, cumulative procedure numbers, complications and failures)…”

“…The studies appraised in this systematic review were published in the years 2016 to 2020 (Table S2) [7][8][9][10][11][12][13][14][15][16] (Baston et al 12 ; Beebe et al 7 ; Doizi et al 14 ; Donato et al 8 ; Oderda et al 9 ; Phan et al 13 ; Pietropaolo et al 10 ; Seyam et al 11 ; Smith et al 16 ) with various countries across the globe being represented, including the United States, 7 Australia, 8 Italy, 9 the United Kingdom, 10,12,13,16 Saudi Arabia 11 and two European multi-centre studies involving various countries within the European Union. 14,15 The aims and objectives within the published papers were consistent in outlining the precise role and impact that this novel SUGIFC device has had on the clinical and economic components of ureteral stent removal.…”

“…14 The study by Baston et al also compared a subset with tethered (stents on strings) in their comparative assessment. 12…”

“…10 The emergency room attendance and readmission rates were also reduced with a favourable patientrelated experience. 12 Phan et al have shown the SUGIFC group to be more costly, but have applauded the flexibility and ease that this method of stent removal affords clinicians in today's modern era. 13…”