Does every Ureteroscopic Lithotripsy (URSL) patient need to suffer stent symptoms?

Background: Double J stent is a tube placed in the lumen of the ureter to maintain its patency. Double J coils at proximal and distal ends makes it self-retaining by securely anchoring it at renal pelvis and at bladder levels. Materials and methods: A total of 661 patients operated for ureteric calculus from June 2014 to September 2017 at Jeevan Hospital, Omni Hospital, Healthcare Hospital and Evya Hospital Hyderabad, Telangana were studied. Jeevan Hospital was selected to follow strict indications for DJ stenting after ureteroscopic stone removal. Other hospitals were selected for routine DJ stenting after ureteroscopic stone removal. 378 cases were operated in Jeevan hospital and only 54 cases required DJ stenting. Results: Over all the rate of ureteral stenosis was seen in 4 patients (0.60%) of which 2 were from stented group and 2 (0.30%) were from non-stented group and 2 (0.30%) patients required ureteroneocystostomy, 1 patient required ureteroneocystostomy with psoas hitch and one patient was on DJ stent and was on follow up. Conclusion: Stent could be safely avoided in 85.7% of cases following strict indications for stenting. Complications like ureteral stricture are not limited to non-stented group. Judicious use of stent makes many patients symptom free, and makes them to resume duties early and sexual activity early.

Role of MRI in post traumatic posterior urethral distraction defects in comparison to RGU/ MCUG

Pelvic fracture urethral injuries are typically partial and more often complete disruptions of the most proximal bulbar and distal membranous urethra. Emergency management includes suprapubic tube placement. Subsequent primary realignment to place a urethral catheter remains a controversial topic, but what is not controversial is that when there is the development of a stricture (which is usually obliterative with a distraction defect) after suprapubic tube placement or urethral catheter removal, the standard of care is delayed urethral reconstruction with excision and primary anastomosis. This paper reviews the management of patients who suffer pelvic fracture urethral injuries and the techniques of preoperative urethral imaging and subsequent posterior urethroplasty.