Ureteric Stent Card Register – A 5-Year Retrospective Analysis

Abstract

INTRODUCTION Ureteric stenting is a common urological procedure. Forgotten stents have a well-documented morbidity and mortality. Therefore, we asked the question, is a stent register an important factor in reducing the number of lost or overdue stents? PATIENTS AND METHODS We conducted a retrospective review of 203 patients who had ureteric stents inserted in the operating theatre, for the 5-year period 1 December 1998 to 1 December 2003. We analysed all stent cards, patient notes and theatre logs; where no record of stent removal was found, we contacted the patient, their GP or their local hospital. RESULTS A total of 191 patients were identified from the stent card register. An additional 12 patients were found from the theatre logs, but with no record in the stent card register. Of the 203 patients, 8 had bilateral stents. The most common indication for stenting was stone disease. Of the 203 patients, 11 had overdue stents and 51 had no record of the stents ever being removed. The 51 presumed ‘forgotten’ stents were traced, and it was found that 42 patients had had their stents removed by other hospitals, and 9 patients died with stents in situ, but before they were due for removal. CONCLUSIONS Our current stent card tracking system is ineffective, because it was infrequently reviewed. However, despite overdue and ‘forgotten’ stents which were removed by other hospitals, no patients came to any real harm and we had no lost stents. Our stent register system did not appear to play any role in terms of preventing stent loss, and it seems likely that there are other more effective safeguards in place to prevent this from happening. However, if a stent register was required at all, a computerised system would be preferable. Alternatively, patients could share some of the responsibility of stent tracking with their clinicians.

Tricks and tacks in the management of the forgotten double J stent

“…17 Tang VC et al studied the stent card system to track the retained DJ stent and have proposed the computerized DJ stent registry and similarly Lynch MF et al in their study showed the importance of electronic stent register and stent extraction reminder facility to avoid the DJ stent follow up loss and avoid the morbidity associated with it. 18,19 McCahy et al recommended that a computer record should be made recording the patients that stent was placed in urology clinics and warning and informing the urology physicians about the time of removal of stents. 20 Stents on strings have been proposed where one end of the stent is tied to a sting, which is externalized for easy removal later.…”

Computerized System for Online Control of Ureteral Catheters Hosted on Google Drive: An Alert Tool

“…Tang et al 12 emphasize that patients should take an active role in the monitoring and management of their catheters, a situation that is not always possible due to the socioeconomic and cultural conditions of patients due to the context in which the catheters are implanted, often after intraoperative complications of surgeries performed by specialties other than urology. Most of the catheters are placed in medical centers that have a considerable flow of patients where monitoring is frequently by other medical teams such as gynecology, proctology and oncology.…”

A solution for medical and legal problems arising from forgotten ureteral stents: initial results from a reminder short message service (SMS)

“…However, recognizing the inadequacy of this system, the authors recommended using a new system that included a patient education leaflet and a stent removal date that was planned prior to his/her discharge from the hospital [6]. Tang et al [7] retrospectively analyzed patients who had received stents within the previous 5 years and emphasized that their specific stent card tracking systems were ineffective during monitoring because of infrequent revisions and difficulties in updating the system. The failure of these systems was attributed to the fundamental problem of human negligence when registering patients, while the importance of successfully applying computerized systems that minimize human error was also emphasized.…”

“…In this system, all of the responsibility is with the attending surgeon. Tang et al [7] emphasized that the patients must assume an active role in the monitoring and management of their stents. In our system, short reminder messages and information are sent to both patients and physicians.…”