A review of current practices and controversies in the use of indwelling ureteric stents

Czech version

Authors: H. B. Joshi
Published in: Urol List 2013; 11(1): 40-46

Overview

Placement of ureteric stent, for short term use, remains one of the commonest urological interventional procedures. Indwelling ureteric stents are associated with significant side effects and problems that influence patient’s health related Quality of Life (HrQOL). Ureteric Stent Symptoms Questionnaire (USSQ)is a validated measure that helps capture impact of stents and serves as a useful outcome measure for clinical studies. In clinical practice, various types of stents are available for use without clear evidence of superiority of one brand over another. Newer stent designs continue to be marketed, and pharmacological treatments proposed, to address stent related morbidity. This overview looks at current practices, problems related to the stents and looks at the basis for different solutions offered.

Key words:
ureteral, stents, practices, problems

Sources

1. Zimskind PD, Fetter TR, Wilkerson JL. Clinical use of long-term indwelling silicone rubber ureteral splints inserted cystoscopically. J Urol 1967; 97(5): 840–844.

2. Nabi G, Cook J, N'Dow J et al. Outcomes of stenting after uncomplicated ureteroscopy: systematic review and meta-analysis. BMJ 2007; 334(7593): 572.

3. www.hesonline.nhs.uk – Hospital Episode Statistics HES online, NHS information centre.

4. Tolley D. Ureteric stents, far from ideal. Lancet 2000; 356(9233): 872–873.

5. Joshi HB, Stainthorpe A, MacDonagh RP et al. Indwelling ureteral stents: evaluation of symptoms, quality of life and utility. J Urol 2003; 169(3): 1065–1069.

6. Denstedt JD, Wollin TA, Sofer M et al. A prospective randomized controlled trial comparing nonstented versus stented ureteroscopic lithotripsy. J Urol 2001; 165(5): 1419–1422.

7. Auge BK, Sarvis JA, L'esperance JO et al. Practice patterns of ureteral stenting after routine ureteroscopic stone surgery: a survey of practicing urologists. J Endourol 2007; 21(11): 1287–1291.

8. Djaladat H, Tajik P, Payandemehr P et al. Ureteral catheterization in uncomplicated ureterolithotripsy: a randomized, controlled trial. Eur Urol 2007; 52(3): 836–841.

9. Tanriverdi O, Yencilek F, Sarica K. Emergent stenting after uncomplicated ureteroscopy: evaluation of 23 patients Urology 2011; 77(2): 305–308.

10. Kawahara T, Ito H, Terao H et al. Ureteral stent encrustation, incrustation and colouring: morbidity related to indwelling times. J Endourol 2012; 26(2): 178–182.

11. Joshi HB. Ureteral stent encrustation, incrustation and colouring: morbidity related to indwelling times J Endourology 2012; 26(7): 924–925.

12. Canales BK, Higgins L, Markowski T et al. Presence of five conditioning film proteins are highly associated with early stent encrustation. J Endourol 2009; 23(9): 1437–1442.

13. Vanderbrink BA, Rastinehad AR, Ost MC et al. Encrusted urinary stents: evaluation and endourologic management. J Endourol 2008; 22(5): 905–912.

14. Sancaktutar AA, Tepeler A, Söylemez H et al. A solution for medical and legal problems arising from forgotten ureteral stents: initial results from a reminder short message service (SMS). Urol Res 2012; 40(3): 253–258.

15. Joshi HB, Newns N, Stainthorpe A et al. Ureteral Stent Symptom Questionnaire: Development and validation of a multidimensional quality of life measure. J Urol 2003; 169(3): 1060–1064.

16. Lingeman JE, Preminger GM, Segura JW et al. Use of a temporary ureteral drainage stent (TUDS) after uncomplicated ureteroscopy. J Urol 2003; 169(5): 1682–1688.

17. Tenke P, Riedl CR, Jones GL et al. Bacterial biofilm formation on urologic devices and heparin coating as preventive strategy. Int J Antimicrob Agents 2004; 23 (Suppl 1): S67–74.

18. Carlos E, Mendez-Probst LW, Goneau KW et al. The use of Triclosan eluting stents effectively reduces ureteral stents symptoms: a prospective randomized trial. BJU Int 2012; 110(5): 749–754.

19. Beiko BT, Knudsen BE, Denstedt JD. Advances in ureteral stent design. J Endourol 2003; 17(4): 195–199.

20. Lennon GM, Thornhill JA, Sweeney PA et al. ‘Firm’ versus ‘soft’ double pigtail ureteric stents: a randomised blind comparative trial. Eur Urol 1995; 28(1): 1–5.

21. Joshi HB, Chitale SV, Nagarajan M et al. A prospective randomized single-blind comparison of ureteral stents composed of firm and soft polymer. J Urol 2005; 174(6): 2303–2306.

22. Davenport K, Kumar V, Collins J et al. Prospective randomized trial the Bard Inlay ureteric stent with the Boston Scientific Polaris stent using the validated ureteric stent symptom questionnaire. BJU Int 2008; 101(5): 52.

23. Lee C, Kuskowski M, Premoli J et al. Randomized evaluation of ureteral stents using validated symptom questionnaire. J Endourol 2005; 19(8): 990–993.

24. El-Nahas AR, El-Assmy AM, Shoma AM et al. Self-retaining ureteral stents: Analysis of factors responsible for patient discomfort. J Endourol 2006; 20(1): 33–37.

25. Erturk E, Sessions A, Joseph JV. The impact of ureteral stent diameter and symptoms on tolerability. J Endourol 2003; 17(2): 59–62.

26. Ho CH, Chen SC, Chung SD et al. Determining the appropriate length of a double-pigtail ureteral stent by both stent configurations and related symptoms. J Endourol 2008; 22(7): 1427–1431.

27. Al-Kandari AM, Al-Shaiji TF, Shaaban H et al. Effects of proximal and distal ends of double-J ureteral stent position on post procedural symptoms and quality of life: a randomized clinical trial. J Endourol 2007; 21(7): 698–702.

28. Dunn MD, Portis AJ, Kahn SA et al. Clinical effectiveness of new stent design: Randomized single-blind comparison of tail and double pigtail stents. J Endourol 2000; 14(2): 195–202.

29. Lingeman JE, Preminger GM, Goldfischer ER et al. Assessing the Impact of Ureteral Stent Design on Patient Comfort. J Urol 2009; 181(6): 2581–2587.

30. Olweny EO, Portis AJ, Sundaram CP et al. Evaluation of a chronic indwelling prototype mesh ureteral stent in a porcine model. Urology 2000; 56(5): 857–862.

31. Krebs A, Deane LA, Borin JF et al. The 'buoy' stent: evaluation of a prototype indwelling ureteric stent in a porcine model. BJU Int 2009; 104(1): 88–89.

32. Lange D, Hoag NA, Poh BK et al. Drainage characteristics of the 3F MicroStent using a novel film occlusion anchoring mechanism. J Endourol 2011; 25(6): 1051–1056.

33. Ecke TH, Bartel P, Hallmann S et al. Evaluation of symptoms and patients' comfort for JJ-ureteral stents with and without antireflux-membrane valve. J Urology 2010; 75(1): 212–216.

34. Gupta M, Patel T, Xavier K et al. Prospective randomized evaluation of periureteral botulinum toxin type A injection for ureteral stent pain reduction. J Urol 2010; 183(2): 598–602.

35. Beiko DT, Watterson JD, Knudsen BE et al. Double-blind randomized controlled trial assessing the safety and efficacy of intravesical agents for ureteral stent symptoms after extracorporeal shock-wave lithotripsy. J Endourol 2004; 18(8): 723–730.

36. Norris RD, Sur RL, Springhart WP et al. A prospective, randomized, double-blinded placebo-controlled comparison of extended release oxybutinin versus phenazopyridine for the management of postoperative ureteral stent discomfort. Urology 2008; 71(5): 792–795.

37. Deliveliotis C, Chrisofos M, Gougousis E et al. Is there a role for alpha1-blockers in treating double-J stent-related symptoms? Urology 2006; 67(1): 35–39.

38. Davenport K, Keeley FX Jr., Timoney AG. A comparative in vitro study to determine the beneficial effect of calcium-channel and alpha (1)-adrenoceptor antagonism on human ureteric activity. BJU Int 2006; 98(3): 651–655.

39. Beddingfield R, Pedro RN, Hinck B et al. Alfuzosin to releave ureteral stent discomfort: A prospective, randomized, placebo controlled study. J Urol 2009; 181(1): 170–176.

40. Damiano R, Autorino R, de Sio M et al. Effect of tamsulosin in preventing ureteral stent-related morbidity: A prospective study. J Endourol 2008; 22(4): 651–656.

41. Wang CJ, Huang SW, Chang CH. Effects of specific alpha-1A/1D blocker on lower urinary tract symptoms due to double-J stent: A prospectively randomized study. Urol Res 2009; 37(3): 147–152.

42. Park SC, Jung SW, Lee JW et al. The effects of tolterodine extended release and alfuzosin for the treatment of double-j stent-related symptoms. J Endourol 2009; 23(11): 1913–1917.

43. Alastair D, Lamb, Sarah L et al. Wiseman: Meta-analysis showing the beneficial effect of blockers on ureteric stent discomfort BJU Int 2011; 10(8): 1894–1902.

44. Yakoubi R, Lemdani M, Monga M et al. Is There a Role for alpha-Blockers in Ureteral Stent Related Symptoms? A Systematic Review and Meta-Analysis: J Urol 2011; 186(3): 928–934.

45. Krambeck AE, Walsh RS, Denstedt JD et al. A novel drug eluting ureteral stent: a prospective, randomized, multicenter clinical trial to evaluate the safety and effectiveness of a ketorolac loaded ureteral stent. J Urol 2010; 183(3): 1037–1042.

46. Joshi HB, Newns N, Stainthorpe A et al. The development and validation of a patient-information booklet on ureteric stents. BJU Int 2001; 88(4): 329–334.