Effects of delayed ureteral stents removal during the COVID-19 pandemic on the quality of life and psychological status of postoperative patients with urinary calculi / 北京大学学报(医学版)

OBJECTIVE@#To explore the impacts of delayed ureteral stent removal on the quality of life (QoL) and mental health of urinary calculi postoperative patients due to the corona virus disease 2019(COVID-19) pandemic.@*METHODS@#The demographic and clinical data of patients with ureteral stent placement after urinary endoscopic lithotripsy and returned to Peking University People's Hospital for stent removal from December 2019 to June 2020 were collected. Ureteral stent symptoms questionnaire (USSQ) score and the outcome 20-item self-rating anxiety scale (SAS) and self-rating depression scale (SDS) were collected to estimate the QoL and mental status. The USSQ consisted of 44 questions in 6 domains (including urinary symptom, physical pain, general health, work performance, sexual function, and ureteral stent related infection). For most questions in each domain, its score was a five-point Likert-type scale from 1 to 5, and a small proportion of questions was quantified by 1 to 4 or 1 to 7 scale. SAS and SDS both contained 20 questions used to assess a patient's level of anxiety and depression. Its scoring for each item was on a four-point Likert-type scale from 1 to 4. A total score (ranging from 20 to 80) was the main statistical indicator. The level of clinical anxiety and depression was quantified by using standard scores (total score multiplied by 1.25 to produce integers). And the multi-group structural equation model was constructed by analysis of moment structure (AMOS) analysis.@*RESULTS@#Overall, 71 patients were enrolled for analysis. It was found that the median duration of ureteral stent time differed significantly between the control and delayed groups for 32 (30, 33) d and 94.5 (88, 103) d, respectively. The delayed group resulted in higher scores in the USSQ multidimensional, which included urinary symptoms, general health, work performance and ureteral stent related infections. Anxiety and depression were also significantly serious in the delayed group than in the control group. A longer indwelling time of a ureteral stent could exacerbate the effects of urinary symptoms and physical pain on work performance (P=0.029 < 0.05). Among them, the patients with severe urinary symptoms leading to poor work performance were most significantly affected by prolonged ureteral stent duration time (CR=2.619>1.96).@*CONCLUSION@#Patients with delayed ureteral stent removal due to the COVID-19 had resulted in worse QoL and mental status. Stents related symptoms are more severe in patients with higher anxiety and depression degree during COVID-19. To improve the QoL and mental health of patients after urinary calculi surgery during COVID-19, it is still not recommended to prolong the stent duration time or corresponding intervention measures should be taken.

The feasibility of indwelling ureteral stent for a short time after uncomplicated retrograde intrarenal stone surgery / 中华泌尿外科杂志

Objective:To study the feasibility of indwelling ureteral stent for a short time (72 hours) in patients after uncomplicated retrograde intrarenal stone surgery(RIRS).Methods:The clinical data of 58 patients who underwent uncomplicated flexible ureteroscopic lithotripsy in Xuancheng People's Hospital from October 2020 to December 2021 were retrospectively analyzed. According to indwelling time of ureteral stent after surgery, the patients were divided into two groups. There were 26 cases indwelling within 72 hours after operation, named as the observation group, and 32 cases indwelling for about 3 weeks after operation, named as the control group. There was no significant difference in gender [male/female: 14/12 vs. 21/11], age [(43.4 ± 10.2) vs. (43.9 ± 11.9) years old], affected side [left/right: 17/9 vs. 20/12], and maximum diameter of stones [(9.3 ± 1.8) mm vs. (9.7 ± 1.9) mm] between the observation group and the control group. All patients in the two groups underwent unilateral ureteroscopic lithotripsy under general anesthesia. The stone removal rate, recovery of water accumulation and incidence of postoperative complications in the first and third months after the surgery were compared.Results:There was no statistical difference between the observation group and the control group in the stone removal rate [100.0% (26/26) vs. 96.9% (31/32)] and recovery of hydronephrosis [100.0% (26/26) vs. 96.9% (31/32)] at the first month after surgery. All the stones were removed and all the hydronephrosis recovery in the two groups at the 3rd month after surgery. The rates of postoperative lumbar and abdominal pain [3.9% (1/26) vs. 28.1% (9/32)], carnal hematuria [3.9% (1/26) vs. 59.4% (19/32)], urinary tract infection [0 vs. 15.6% (5/32)], and bladder irritation [0 vs. 68.8% (22/32)] in the observation group were significantly lower than those in the control group ( P<0.05). Conclusions:Indwelling a ureteral stent for a short time (72 hours) after uncomplicated RIRS does not affect the surgical effect and does reduce the risk of complications as well as promote rapid postoperative recovery.

Effect of Quercus Salicina Extract Capsules on preventing adherent stones on ureteral stent tube after percutaneous nephrolithotomy / 国际外科学杂志

Objective:To explore the effect of Quercus Salicina Extract Capsulese on preventing the formation of adherent stones on ureteral stent tube after percutaneous nephrolithotomy (PCNL).Methods:The clinical data of 186 patients who underwent PCNL due to unilateral renal stone in the Affiliated Hospital of Xuzhou Medical University from October 2018 to April 2020 were retrospectively analyzed. All of the patients were indwelling 6 F ureteral stent tube during operation. After postoperative reexamination of kidneys, ureters and bladder, it was confirmed that the postoperative residual stones were clinically meaningless stones (maximum diameter ≤ 4 mm). According to postoperative medication, they were divided into drug group ( n=62) and control group ( n=124). Patients in the drug group were given oral Quercus Salicina Extract Capsules, while patients in the control group did not take the drug. Both groups received the same health education and dietary guidance after operation. The formation of adherent stones on ureteral stent tube was observed when the ureteral stent tube was removed 6 weeks after PCNL. Meanwhile, the adverse reaction, complication and treatment satisfaction of the patients were recorded during the period of taking the drug. Measurement data were expressed as mean ± standard deviation ( ± s), and t-test was used for comparison between groups; the Chi-square test was used to compare the count data between groups. Results:When the ureteral stent tube was removed 6 weeks after PCNL, the weight of adherent stones on ureteral stent tube in the drug group was (334.20±26.65) mg for male, and (336.00±25.64) mg for female. In the control group, the weight of adherent stones on ureteral stent tube was (374.11±42.28) mg for male, (374.42±42.44) mg for female. The weight of adherent stones on ureteral stent tube in the drug group was significantly lighter than that in the control group, and the difference was statistically significant ( P<0.01). The drug group had no obvious serious adverse reaction during the period of taking the drug. At the same time, the complications of the drug group during the intubation period were significantly less than the control group, and the difference was statistically significant ( P=0.040). The satisfaction of patients in the drug group was 93.5%, and that in the control group was 82.3%. The difference was statistically significant between the two groups ( P=0.036). Conclusion:Quercus Salicina Extract Capsules can effectively prevent the occurrence of adherent stones on ureteral stent tube after PCNL, and there are no serious adverse reaction, which is worthy of clinical promotion.

Application of ureteral stent in kidney transplantation / 器官移植

Ureteral stricture, urine leakage and other urinary complications are likely to occur after kidney transplantation, which severely affect the function of renal allograft and even lead to renal allograft loss. Ureteral stent plays a critical role in kidney transplantation, which could promote the urine flow from kidney to bladder after kidney transplantation, lower the pressure within the ureter and reduce the risk of early urinary complications. However, it may also cause urinary tract infection, stent-related complications and BK virus infection, etc. Therefore, clinicians should flexibly grasp the indications for ureteral stent removal. In this article, the application, potential adverse reactions and the timing of removal of ureteral stent in the field of kidney transplantation were reviewed, aiming to provide reference for clinical decision-making related to ureteral stent after kidney transplantation.

Effect of moxibustion on ureteral stent-related symptoms after ureteroscopic lithotripsy / 中国针灸

OBJECTIVES@#To observe the clinical efficacy of moxibustion combined with western medication on ureteral stent-related symptoms after ureteroscopic lithotripsy (URL).@*METHODS@#One hundred and fifty patients with upper urinary tract calculus implanted with ureteral stents after URL were randomly divided into a moxibustion group (50 cases, 1 case dropped out), a placebo moxibustion group (50 cases, 3 cases dropped out) and a blank control group (50 cases). No intervention was performed in the blank control group. On the basis of oral administration with tamsulosin hydrochloride sustained release capsule (starting from the first day after surgery, once a day, 0.2 mg each time, continuously for 4 weeks), in the moxibustion group, moxibustion was operated at Guanyuan (CV 4) and bilateral Shenshu (BL 23); the sham-moxibustion was delivered at the same acupoints in the placebo moxibustion group, once daily, 6 times a week, for 15 min in each treatment. The duration of treatment was 4 weeks. Before treatment, and after 1, 2 and 4 weeks of treatment, the scores of lower urinary tract symptoms, body pain, general health, work performance and satisfaction of sexual matters were compared among the 3 groups. The tract calculus clearance rate, urinary infection and the oral administration of painkillers were compared after 4 weeks of treatment in the 3 groups.@*RESULTS@#The scores of lower urinary tract symptoms, body pain and general health after 1 week of treatment, and the scores of lower urinary tract symptoms, body pain, general health and work performance after 2 and 4 weeks of treatment were lower than those before treatment in the 3 groups (P<0.01). The scores of lower urinary tract symptoms and body pain in the moxibustion group after 1, 2 and 4 weeks of treatment were lower than those in the blank control group and the placebo moxibustion group (P<0.01, P<0.05) respectively. The score of general health in the moxibustion group was lower than that in the blank control group after 1 week of treatment (P<0.01), and lower than those of the blank control group and the placebo moxibustion group after 2 and 4 weeks of treatment (P<0.01, P<0.05). Regarding the score of work performance, it was lower in the moxibustion group after 1 and 2 weeks of treatment compared with those in the blank control group (P<0.05, P<0.01), and lower than those of the blank control group and the placebo moxibustion group after 4 weeks of treatment (P<0.01, P<0.05). The tract calculus clearance rate in the moxibustion group was 95.9% (47/49), higher than that in the blank control group (80.0%, 40/50, P<0.05). The proportion of oral administration of painkillers in the moxibustion group (28.6%, 14/49) and the placebo moxibustion group (40.4%, 19/47) was lower than that in the blank control group (76.0%, 38/50, P<0.01) respectively.@*CONCLUSIONS@#Moxibustion combined with western medication relieves lower urinary tract symptoms and body pain, and accelerate the recovery of general health and work performance in the patients after URL.

Intravenous malposition of double J stent: a case report and literature review / 现代泌尿外科杂志

【Objective】 To investigate the causes of intravenous malposition of double J stent and treatment strategies, in order to improve clinicians’ awareness of this complication. 【Methods】 Clinical data of a patient with intravenous malposition of double J stent were analyzed and relevant literature was reviewed. 【Results】 A 51-year-old female was admitted with post-hysterectomy urinary fistula and diagnosed with right intravenous malposition of double J stent and ureterovaginal fistula. Da Vinci robot-assisted laparoscopic right double J stent removal and ureteral reimplantation were performed. 【Conclusion】 Intravenous malposition is a rare and life threatening complication of double J stent placement, which can migrate further. The surgical method should be selected according to the location of the stent and general condition of the patients. Minimally invasive surgery is the first choice of treatment.

Comparison of different ureteral length measurement methods in the indwelling of double-J stent after ureteroscopy / 现代泌尿外科杂志

【Objective】 To investigate the application of different ureteral length measurement methods in the indwelling of double-J stent. 【Methods】 Clinical data of 260 patients with double-J stent indwelling after ureteroscopic surgery during Jul.2018 and Dec.2020 were prospectively analyzed. The patients were randomly divided into height calculation group, CT measurement group, KUB group and ureteroscopic measurement group. The length of ureter was calculated accordingly and the appropriate length of double-J stent was selected. KUB was performed on the first day after operation and before extubation to determine the position of double-J stent. The patients completed the ureteral stent-related symptom questionnaire (USSQ), urinary symptom score, lower urinary tract symptom (LUTS) score, pain score, hematuria score, and quality of life score before and after double-J catheter placement. 【Results】 There were no significant differences in age, gender, height, side of stent and urinary symptom score among the four groups (P>0.05). The average lengths of the ureters measured by the four methods were (21.5±1.0) cm, (21.5±1.8) cm, (23.8±1.3) cm and (21.7±1.8) cm, respectively. There were no significant differences among the height calculation group, CT measurement group and ureteroscope group, but there was significant difference between the three groups and the KUB group. The ideal ureteral stent length indwelling ratio in the ureteroscopic group was 76.9%, which was better than that in the other three groups. Postoperative indwelling time was 7-42 d (mean 29.8 d). The USSQ score of the ureteroscopic group before extubation was (14.1±1.5), which was lower than that of the other three groups (P<0.05). The ureteroscopic group was better than the other three groups in the comparison of frequency and urgency of urination, nocturia, hematuria, quality of life score, and pain score (P<0.05). 【Conclusion】 Intraoperative ureteroscopic measurement of the ureteral length is a simple and feasible method in guiding the indwelling of double-J stent to reduce ureteral stent related symptoms.

Double versus triple D-J ureteral stents in management of benign secondary ureteral stricture / 现代泌尿外科杂志

【Objective】 To compare the clinical efficacy of double and triple D-J ureteral stents in the treatment of benign secondary ureteral stricture. 【Methods】 Clinical data of 58 patients with benign secondary ureteral stricture treated at our hospital during Dec.2018 and Aug.2021 were retrospectively analyzed. According to the number of D-J ureteral stents, the patients were divided into the double group (n=29) and triple group (n=29). The clinical efficacy, complications during catheterization, and fluctuations of serum creatinine and hydronephrosis volume were compared and analyzed between the two groups. 【Results】 There were no significant differences in the general data, catheter duration and follow-up between the two groups (P>0.05). The triple group had more reduction of hydronephrosis than the double group [-22.8(32) cm3vs. -7.4(12) cm3, P=0.001] . There were no significant differences in the change of serum creatinine [-8.0(15)μmol·L-1 vs. -4.0(15) μmol·L-1, P =0.657] and incidence of complications (34.4% vs. 41.4%, P=0.588) between the two groups. The triple group had higher total effective rate than the double group (93.1% vs. 86.2%), but the difference was not statistically significant (P=0.666). There was no significant difference in the efficacy of balloon dilatation between the two groups (100.0% vs. 90.9%, P=0.407). 【Conclusion】 Both double and triple D-J ureteral stents are safe and effective in the treatment of benign secondary ureteral stenosis, but three D-J ureteral stents can better reduce hydronephrosis. Clinicians can choose appropriate indwelling scheme according to patients’ condition.

Clinical evaluation of long-term indwelling of Allium ureteral stent in the treatment of ureteral stricture / 现代泌尿外科杂志

【Objective】 To evaluate the safety and efficacy of long-term indwelling of Allium ureteral stent in the treatment of ureteral stricture. 【Methods】 The clinical data of patients who underwent endoscopic Allium ureteral stent implantation for ureteral stricture in our hospital during Aug.2020 and Dec.2022 were retrospectively analyzed, and the surgical conditions and adverse events were recorded. The data of serum creatinine, blood urea nitrogen, glomerular filtration rate (GFR) and renal pelvis width under ultrasound were compared before surgery and 1, 3, 6 and 12 months after surgery. 【Results】 A total of 52 patients with ureteral stricture of 1.1 (0.7, 2.0)cm were included. All operations were successful. The operation time was 82.5 (70, 114)min, intraoperative blood loss 20 (10, 20)mL, and postoperative hospitalization stay 1 (1, 2) day. During the follow-up of (13.2±7.8) months, 14 patients had stent displacement, 5 had stone obstruction of stent tubes, 7 had occasional hematuria after movement, 9 had intermittent lumbar and abdominal pain, and 1 had recurrent urinary tract infection. The serum creatinine, blood urea nitrogen and renal pelvis width of 1 month, 3, 6 and 12 months after surgery were significantly decreased, while GFR was significantly increased. 【Conclusion】 Long-term indwelling of Allium ureteral stent is effective in the treatment of ureteral stricture, but the high incidence of stent displacement should arouse attention.

Supine Endoscopically-Combined Intrarenal Surgery (ECIRS) for encrusted ureteral stent with staghorn calculi, ureterolithiasis and cystolithiasis

@#A forgotten and encrusted ureteral stent poses as a management dilemma especially when the encrustations are so severe that they involve the entire length of the ureteral stent. These can lead to staghorn formation, high volume ureterolithiasis and giant cystolithiasis which are all encasing the ureteral stent, This may lead to significant morbidity and mortality as a result of chronic urinary obstruction, recurrent urinary tract infection, and renal dysfunction and renal failure. During the acute phase of the pandemic, a 31-year-old pregnant female, with 9 weeks age of gestation, underwent insertion of an indwelling ureteral stent for an obstructing renal pelvic calculus. She was lost to follow-up only to return two years later, with right flank and lower abdominal pains. Non-contrast CT showed encasement of the ureteral stent with a staghorn calculus on the proximal coil, extensive encrustations on the upper and middle segments, and a giant cystolithiasis at the distal coil of the ureteral stent. She underwent a supine endoscopically-combined intrarenal surgery (ECIRS), allowing retrograde retrieval of the ureteral stent after all the encrustations had been removed. There was minimal blood loss and no intraoperative and postoperative complications.Encrusted ureteral stents with large stone burden may be treated effectively and safely with an endoscopically-combined intrarenal surgery. This combined antegrade and retrograde approaches to the urinary tract allows synchronous treatment of all calcifications around the forgotten ureteral stent, without resorting to open surgery.

Progress in self-expanding metallic ureteral stent in the treatment of ureteral stricture in renal allografts / 器官移植

Ureteral stricture in renal allografts is one of the common postoperative complications in kidney transplant recipients. Due to short ureter in renal allografts, endovascular treatment should be adopted before reconstruction surgery to avoid irreversible injury. Alleviating renal allograft injury, easing obstruction or establishing drainage channel are the key measures to treat ureteral stricture. In endovascular treatment, balloon dilatation and internal incision yield high recurrence rate, and long-term indwelling of self-expanding metallic ureteral stents may be a better option. Compared with traditional stents, metallic stents may maintain urinary tract patency for a long time and mitigate the irritation of lower urinary tract symptoms,with different indications and efficacy. Although all metallic stents may be displaced and occluded, it still plays a positive role in the treatment of ureteral stricture in renal allografts. In this article, the application of self-expanding metallic ureteral stent in ureteral stricture of renal allografts was mainly illustrated, aiming to provide reference for optimizing the treatment of ureteral stricture in renal allografts.

Bacteria resistance and cytotoxicity of copper loaded coatings on ureteral stent / 国际生物医学工程杂志

Objective:To investigate the antimicrobial properties of copper-loaded coatings on the surface of ureteral stents and their biocompatibility in order to determine the most suitable level of copper loading.Methods:Copper-loaded PDA coatings with different copper contents were constructed on the surface of polyurethane (PU) stents using polydopamine (PDA) and dimethylaminomethylborane (DMAB). The antibacterial property of the coating against Escherichia coli and Staphylococcus aureus was investigated by the plate counting method. The bacterial adhesion on the coating surface was studied by scanning electron microscopy. Using the live/dead evaluation, microbes were stained and observed by a fluorescence microscope. The biocompatibility of the copper-loaded coatings was detected by a cell proliferation assay incubated with L929 cells.Results:The antibacterial rates of the copper-loaded samples exceeded 90% after incubation with E. coli and S. aureus for 24 h, respectively, and the antibacterial performance increased with the increase of copper content in the coating. The amount of bacteria adhered to the surface of the copper-loaded samples was significantly lower, and most of them were dead bacteria. When the copper content in the coating preparation solution used was 0.25~1 g/L, the cell proliferation rate on the surface of the copper-loaded coating was higher than 80% and the material was not cytotoxic.Conclusions:A copper-loaded PDA coating with excellent antibacterial properties and good biocompatibility can be prepared with a copper content of 1 g/L in the coating preparation solution, forming a potential solution for the preparation of ureteral stent coatings.

Post operative complications of double-J ureteral stenting: a prospective study

Background: Placement of indwelling ureteral stents has become routine in the management of variety of urinary tract infections. Despite the advances and technology, the ideal stent is not available yet. A double-J stent is never without potential complications which may be minor in form of hematuria, dysuria, frequency, flank and suprapubic pain to major complications such as vesicoureteric reflux, migration, malposition, encrustation, stent fracture etc.Methods: One hundred urological patients who had undergone double-J ureteral stenting attending surgery department were taken. Patients were subjected to detailed history and clinical examination and other routine investigations and symptoms of any complications were recorded starting at the time of placement of double-J ureteral stent till its removal.Results: Majority of the patients in our study had only minor complications related to double-J ureteral stenting like flank or suprapubic pain, dysuria, hematuria and urgency which were managed conservatively. Major complication like stent migration was seen only in 1 patient which was managed with removal of stent.Conclusions: At the end of study, we concluded that double-J stents have become an essential part of many endourological and open urological procedures and their use cannot be completely avoided.

Efficacy of Tamsulosin Alone or Combined with Antimuscarinic Drugs in the Treatment of Ureteral Stent- related Symptoms ：A Meta-analysis / 中国药房

OBJECTIVE：To systematically review the efficacy of tamsul osin a lone or combined with antimuscarinic drugs in the treatment of ureteral stent-related symptom （SRSs），and to provide evidence-based reference for the clinical treatment. METHODS：Retrieved from PubMed ，Embase，Cochrane Library ，CJFD，CBM，VIP and Wanfang database ，from the inception to Oct. 2019，RCTs about tamsulosin alone （monotherapy group ）or combined with antimuscarinic drugs （combination group ） versus placebo or blank control （control group ）in the treatment of SRSs were collected. After data extraction of included clinical studies met inclusion criteria ，their quality was evaluated with Cochrane collaborative network system evaluation manual 5.1.0，and Meta-analysis was conducted by using Rev Man 5.3 statistical software. RESULTS ：A total of 9 RCTs were included ，involving 932 patients. Meta-analysis results showed that after stent placement ，the urinary symptoms score [MD ＝－4.23，95％CI（－5.96， －2.51），P＜0.000 01]，body pain score [MD ＝－4.20，95％CI（－5.30，－3.10），P＜0.000 01]，general health score [MD ＝ － 1.36， 95％ CI（ － 1.75， － 0.98）， P＜0.000 01] in monotherapy group were significantly lower than control group with statistical significance ； there was no significantly 2805097532@qq.com difference in the work performance score [MD ＝0.19，95％CI（－0.99，1.37），P＝0.76]，sexual matters score [MD ＝－0.31 95％CI（－0.68，0.05），P＝0.09] in 2 groups. 4 weeks after the stent was removed ，the body pain score [MD ＝－0.64，95％CI（－0.84，－0.43），P＜0.000 01]，general health score [MD ＝ －0.28，95％CI（－0.41，－0.15），P＜0.000 01] ，urinary symptoms score [MD ＝－0.64，95％CI（－0.84，－0.43），P＜0.000 01] in monotherapy group were significantly lower than control group after stent placement ，with statistical significance ；there was no significantly difference in the work performance score [MD ＝0.31，95％CI（－0.22，0.84），P＝0.25] or sexual matters score [MD ＝ －0.31，95％CI＝（－0.68，0.05），P＝0.09] in 2 groups. The urinary symptoms score [MD ＝5.93，95％CI（2.83，9.02），P＝0.000 2]， body pain score [MD ＝3.49，95％CI（1.39，5.60），P＝0.001] and general health score [MD ＝2.96，95％CI（1.44，4.49），P＝0.000 1] in the monotherapy group were higher than the combination group ；there was no significantly difference in the work performance score [MD ＝1.53，95％CI（－0.12，3.18），P＝0.07] or sexual matters score [MD ＝0.46，95％CI（－1.03，1.96），P＝0.54] in 2 groups. CONCLUSIONS：Tamsulosin has a good therapeutic effect on SRSs ；its combination with antimuscarinic drugs can achieve better therapeutic efficacty.

Transurethral ureteral stent placement and percutaneous nephrostomy in drainage treatment of upper urinary calculi with infection: Effectiveness and timing analyses / 第二军医大学学报

Objective To analyze the effectiveness and the best drainage time of transurethral ureteral stent (D-J catheter) placement or percutaneous nephrostomy (PCN) in treating upper urinary tract calculi with infection at different time points after admission. Methods A total of 104 patients with upper urinary tract calculi and infection were enrolled in our hospital from Jan. 2018 to Dec. 2019. They were randomly divided into D-J catheter group and PCN group. According to the time from admission to operation, each group was then further divided into subgroups of ≤2 h, ＞2 h to 12 h and ＞12 h to 24 h (24, 18 and 10 cases, respectively). The body temperature, blood white blood cell (WBC) count and neutrophil proportion, C-reactive protein (CRP), serum procalcitonin, urine WBC count and the time of body temperature returning to normal were analyzed preoperatively and 1-3 d postoperatively. Results The patients in the two groups successfully received the operation with no change in operation mode. On the first day after the operation, the urine WBC counts were increased significantly in the three subgroups of each group (all P＜0.05). The body temperature, blood WBC count and neutrophil proportion, CRP and serum procalcitonin were significantly higher in the three subgroups of the D-J catheter group than those in the three subgroups of the PCN group, while the urine WBC count was significantly lower (all P＜0.05). In the two groups, the body temperature, blood WBC count and neutrophil proportion, CRP, serum procalcitonin and WBC count were significantly higher in the ＞12 h to 24 h subgroup than those in the ≤2 h and ＞2 h to 12 h subgroups (all P＜0.05). On the second day after the operation, the body temperature, blood WBC count and neutrophil proportion, CRP, serum procalcitonin and urine WBC count were significantly lower in each subgroup of the PCN group than those in each subgroup of the D-J catheter group (all P＜0.05). On the third day after the operation, the body temperature, blood WBC count and neutrophil proportion, CRP and serum procalcitonin were basically decreased to normals, but the above indexes were significantly higher in the ＞12 h to 24 h subgroup than those in the ≤2 h and ＞2 h to 12 h subgroups (all P＜0.05). The time of body temperature returning to normal was similar between the ≤2 h and ＞2 h to 12 h subgroups of the two groups (all P＞0.05), while the time in the ＞12 h to 24 h subgroup of the D-J catheter group was significantly longer than that of the PCN group (P＜0.05). Conclusion Transurethral D-J catheter placement and PCN drainage within 12 h after admission can achieve good efficacy in treating patients with upper urinary tract calculi and infection, and the infection control of PCN is better.

Histocompatibility of poly(L-lactide-co-ε-caprolactone)/cross-linked polyvinylpyrrolidone ureteral stent grafted into the rat bladder / 中国组织工程研究

BACKGROUND: With the development of tissue engineering, materials science, and biomechanics, developing new biodegradable ureteral stent has become an issue of concern. The ureteral stent with poly(L-lactide-co-ε-caprolactone)/crosslinked polypyrrolidone was prepared. OBJECTIVE: To explore the histocompatibility of the ureteral stent grafted into the bladder of Sprague-Dawley rats. METHODS: Sixty male Sprague-Dawley rats (provided by Laboratory Animal Center of Sichuan Academy of Traditional Chinese Medicine) were randomly divided into four groups, each group containing 15 rats. The sham operation group was directly sutured after opening a small incision on the outside of the bladder, and no material was implanted. The other three groups were implanted with polyurethane ureteral stent (control group), poly(L-lactide-co-ε-caprolactone)/8% cross-linked polyvinylpyrrolidone ureter stent (experiment group 1), poly(L-lactide ε- caprolactone)/5% cross-linked polyvinylpyrrolidone ureteral stent (experiment group 2) after opening a small incision on the outer side of the bladder, followed by suturing the incision. At 4, 8, and 16 weeks after operation, the local anatomy of the bladder was observed. The histocompatibility of the materials in each group was observed by hematoxylin-eosin staining. The study was approved by the Ethical Committee of Laboratory Animal Analysis and Testing Center of West China School of Public Health, Sichuan University. RESULTS AND CONCLUSION: (1) Gross observation: At 4, 8 and 16 weeks postoperatively, different degrees of chronic inflammation reaction occurred in the control group and experimental group 1. In the experiment group 2, chronic inflammatory reaction appeared at 4 weeks postoperatively. The stone formation rate in the control group and experimental group 1 was significantly higher than that in the sham operation group (P 0. 05). The calculus formation rate in the experimental group 2 was significantly higher than that in the sham operation group only at 4 weeks postoperatively, and had no significant difference at other time points (P > 0. 05). (2) Pathological observation: Different degrees of foreign body in the outer membrane, inflammatory reaction and diffuse hyperplasia of the mucosa were found in the control group, experimental groups 1 and 2 at different time points postoperatively. There was no significant difference in the rate of diffuse hyperplasia of the mucosa at different time points postoperatively among groups (P > 0. 05), but higher than that in the sham operation group (P < 0. 05). (3) These results indicate that the calculus formation rate and bladder histological reaction of poly(L-lactide-co-ε-caprolactone)/cross-linked polyvinylpyrrolidone ureter stent are comparable with those of commercial ureteral stents, especially the addition of 5% cross-linked polyvinylpyrrolidone has better histocompatibility.

Pathogenic distribution and drug resistance of bacterial biofilm on ureteral stent / 中国组织工程研究

BACKGROUND: Ureteral stents have been extensively applied In the stenosis In the conjunction of the renal pelvis and ureter, the reconstruction of in situ urine flow, ureter or nephroscope lithotripsy, renal transplant, and tumors. However, the long-term retention of ureteral stents can induce catheter-associated urinary tract Infection complications. OBJECTIVE: To Investigate the morphological characteristics of bacterial blofilm on ureteral stent, and to analyze the features of pathogenic distribution and antimicrobial drug resistance to bacterial biofilm. METHODS: Specimens of ureteral stent were collected from 127 patients at Yongchuan Hospital, Chongqing Medical University between January and December 2016. The morphological characteristics of bacterial blofilm on the stent were observed under scanning electron microscope. Each specimen was divided Into three parts (renal pelvis, ureter and bladder) for screening biofilm-forming bacteria strains separately by Congo red medium. The urine was bacterially cultured. Drug susceptibility test was done with the collected biofilm-forming bacteria strains. The study was approved by the Ethics Committee of Yongchuan Hospital, Chongqing Medical University (approval No. 201422). RESULTS AND CONCLUSION: (1) Bacterial blofilm was observed on the surface of ureteral stents at 7,15 and 30 days of retention, with various numbers of inflammatory attachments or crystals. Bacteria on the bacterial biofilm were embraced by large amounts of fiber membranes. Patchy bacterial colonies were observed on the surface of the ureteral stent at 7 and 15 days of retention, which mainly focused on bacillus. Heap-shaped bacterial colonies were found on the surface of ureteral stents that were retained for 30 days, which mainly were bacillus and coccus. (2) A total of 106 bacterial blofilms were detected in the ureteral stent samples obtained from 127 patients. The positive rate was 83.5%, in which the bladder section had the highest positive rate, followed by the renal pelvis section and ureter section. There were 25 copies of positive urine culture, and the positive rate was 19.7%. The strains obtained from the bacterial biofilm on each section of the ureteral stents were significantly higher than that from the urine bacteria culture (P < 0.05). (3) A total of 227 strains were detected from 106 positive samples. Among these samples, the number of Gram-negative strains was significantly higher than that of Gram-positive strains (P < 0.05). Among culture bacteria of the bacterial biofilm on the ureteral stent and urine culture bacteria, colibacillus, pseudomonas aeruginosa, enterococcus faecalis and enterococcus faecium were the most common. (4) The biofilm-forming bacteria on the ureteral stent had a high drug resistance. (5) In summary, bacterial blofilm may be the important reason for catheter-associated urinary tract infection.

Role of Anticholinergic, Uroselective α 1D/1A Blocker, Combination of Two Drugs and Placebo in Treatment of Ureteral Stent Related Discomfort and Urinary Symptoms

Introduction: The ureteral stent placement has become a partof urological clinical practice to relieve ureteral obstructioncaused by variety of urological condition since 1967. Studyaimed to access the role of anticholinergic (Tolterodine),uroselective α 1D/1A blocker (Naftopidil) alone and incombination to evaluate DJ stent related discomfort or pain,lower urinary tract symptoms and impact on quality of life.Materials and methods: This was a randomized double blindplacebo controlled comparative prospective clinical studyconducted between May 2013 to February 2015 to access therole of anticholinergic (Tolterodine), uroselective α 1D/1Ablocker (Naftopidil) alone and in combination to evaluate DJstent related discomfort or pain, lower urinary tract symptomsand impact on quality of life.Result: Total of 280 patients were enrolled for the study. 33patients were excluded. We found Naftopidil and combinationto be significanty better for pain score, combination beingmore effective for storage symptoms, voiding symptoms andquality of life scores.Conclusion: Combination of Tolterodine and Naftopidil canbe recommended for relief of stent related discomfort andurinary symptoms.

Efficacy and safety of tadalafil in ureteric stent related symptoms: a double blind, prospective, randomised study

Background: Is tadalafil effective and safe in ureteric stent related symptoms? The objective of this trial is to study the efficacy and safety of tadalafil and compare it with tamsulosin in relieving ureteric stent related symptoms by using ureteral stent symptom questionnaire.Methods: Total 144 patients with dj stent symptoms were randomized into two groups with 72 patients in each. Group A patients were given tadalafil 5mg and Group B, tamsulosin 0.4mg for 2 weeks. Ureteral stent symptom questionnaire was filled on 7th day and on 21st day after stent insertion. Statistically significant difference between groups was determined by the t-test, Mann-Whitney U-test, Pearson Chi-square test or Fisher's exact test. Comparison between quantitative time related variables was done by Wilcoxon Signed Rank test. All the statistical tests were two-sided and were performed at a significance level of α=.05.Results: Tamsulosin was found more effective then tadalafil in decreasing mean urinary index (p=0.004). Tadalafil caused significant decrease in body pain (p=0.006) and improvement in general health index score, work performance and sex score (P value= 0.041, <0.001 and <0.015 respectively) as compared to tamsulosin. Additional problems score improvement and analgesic use were found comparable in 2 groups (p value =0.193, 0.070 respectively). Adverse effect with both the drugs were minimal, mild to moderate and self-limiting.Conclusions: Tadalafil found more effective then Tamsulosin in relieving body pain, sexual symptoms and improving general health and work performance but less effective in improvement of urinary symptoms.

An Update in the Use of JJ Stents / Actualización en el uso de catéteres JJ

Zoom Image Abstract Introduction Ureteral stents are widely used tools in the daily practice of the urologist due to the fact that they solve the endo- and extraluminal ureteral obstructions, enabling an adequate urine flow. They are the preferred tool because they are easy to insert and versatile, and are used to treat various urologic pathologies; nonetheless, they are not exempt from complications. Objectives To present an update in the use of JJ stents, describing their main associated symptoms and complications, indications and newest developments. Materials and Methods We performed a literature review in the Embase, Pubmed and Google Scholar databases, with the following terms and cross-references: ureteral stent; diagnosis; treatment; and urology, restricting the search to the past 7 years. A total of 428 articles were found, and 49 were used in the revision. Results We described the symptoms and complications associated with the use of JJ stents and their prevention, their use in the treatment of lithiasis and oncologic diseases, the utility of metallic stents, and new designs and improvements in their development. Conclusions JJ stents remain a very useful tool in the daily practice of the urologist, but are not exempt from having adverse effects and complications. There have been advances that decrease the adverse effects associated with their use, mainly infection, symptoms associated to the insertion, and risk of incrustation.

Introducción Los catéteres ureterales son una herramienta ampliamente usada en la práctica diaria del urólogo, dado a que alivian la obstrucción endo y extraluminal ureteral, permitiendo así el adecuado flujo de orina. Se prefieren por encima de otros métodos por su facilidad de inserción y su versatilidad de uso dentro de las distintas patologías urológicas; sin embargo, no están exentos de complicaciones. Objetivos Presentar una actualización en el uso de catéteres JJ que incluya información acerca de los síntomas y complicaciones, sus indicaciones de uso y novedades. Materiales y Métodos Realizamos una revisión narrativa de la literatura en las bases de datos Embase, Pubmed y Google Scholar, con los siguientes términos y sus respectivas referencias cruzadas: ureteral stent; diagnosis; treatment; y urology, restringiendo la búsqueda a los últimos siete años. Se encontraron un total de 428 artículos, de los cuales se tomaron 49 para esta revisión. Resultados Describimos los síntomas y complicaciones asociadas con el uso de catéteres JJ, su prevención, uso en urolitiasis y enfermedades oncológicas, el uso de catéteres metálicos, y nuevos diseños y mejoras en su desarrollo. Conclusiones Los catéteres JJ siguen siendo una herramienta muy útil en la práctica urológica diaria; sin embargo, no están exentos de tener efectos adversos y complicaciones. En la actualidad existen múltiples estrategias que pretenden mejorar su uso y seguimiento. En los últimos años ha habido avances en el desarrollo de los catéteres que se han visto reflejados en una disminución importante en los efectos adversos secundarios a su uso, principalmente infección, los síntomas asociados a la inserción, y riesgo de incrustación.