Vesicoureteral Reflux in Patients with Double Pigtail Stents

Abstract

A prospective study of 30 renal units in 27 patients with double pigtail ureteral stents seen at our hospital was done. The aim of the study was to confirm or rule out the occurrence of vesicoureteral reflux radiologically, and to define its degree in stented patients. During the filling phase of the cystourethrogram, reflux occurred in 19 of the 30 renal units (63%). Of those 19 renal units the reflux was grade 1/4 in 15 (79%), while in 4 (21%) it was of higher grades (2 to 3/4). During the voiding phase of the cystourethrogram reflux was observed in 24 of 30 renal units (80%). Of those 24 renal units reflux was of high grade (2 to 4/4) in 20 (83%), while it was low grade (1/4) in 4 (17%). In the presence of a double pigtail stent the ureteral peristaltic waves were sluggish and averaged 1 to 2 waves per minute in the 15 patients observed fluoroscopically for 1 minute after voiding. We conclude that in the majority of patients with double pigtail ureteral stents vesicoureteral reflux occurs at a low grade during vesical filling and at a high grade during voiding. Also, the stents adversely affect the ureteral peristaltic activities.

In Vivo Evaluation of the Third Generation Biodegradable Stent: A Novel Approach to Avoiding the Forgotten Stent Syndrome

“…Similarly, pain associated with hydronephrosis and upper urinary tract infection due to vesicoureteral reflux triggered by indwelling ureteral stents would presumably be decreased if the portion that traverses the ureterovesical junction were missing. 17 Stents lacking a distal tail decrease vesicoureteral reflux. 18,19 After the Uriprene stent shortened from the distal end by day 7, the degree of pressure transmission and reflux decreased, possibly resulting in the decreased hydronephrosis ob- served as early as 7 days after insertion in the biodegradable stented animals.…”

Effect of Terazosin on Lower Urinary Tract Symptoms and Pain due to Double-J Stent: A Double-Blind Placebo-Controlled Randomized Clinical Trial

“…It is thought to be a result of urine reflux from the bladder to the kidney especially with the increased pressure created during voiding [9]. Some studies have shown that a-blockers enhance lower ureteral stone clearance in both genders, possibly as a result of ureteral dilation or relaxation [10,11].…”

Late Complications of Ureteral Stents

“…However, after reviewing the literature, we found some case reports and small series reporting morbidity and complications related to indwelling stents. Side effects and complications of stents include early complications such as patient’s discomfort, irritative bladder symptoms, bacteriuria with or without clinical urinary tract infections, urosepsis, hematuria [5, 14], or flank pain [5, 7, 15]and late complications such as upward or downward stent migration [7, 14], calcification, and fragmentation [15]. …”

“…The etiology of flank pain during voiding has been suggested to be secondary to vesicorenal reflux through the stent during periods of increased intravesical pressure [5]. Mosli et al [15]demonstrated an incidence of 79% for reflux grade 1 and one of 21% for reflux grades 2 and 3.…”