ABSTRACT
INTRODUCTION: The placement of a ureteral stent is one of the most widely performed procedures in urology. It can have a negative impact on the patients' quality of life, requiring a cystoscopy for its removal. The objective of this study is to evaluate the symptoms and impact on quality of life derived from the use of a magnetic double-J stent (Black Star®) and compare them to those presented in patients with a traditional double-J stent (OptiMed®). MATERIAL AND METHODS: We conducted a comparative, prospective, randomized study in 46 patients who underwent ureterorenoscopy with double-J stent placement between August 2019 and June 2020. Of all patients included, 23 had a traditional double-J stent placed (group A) and 23 had a magnetic double-J stent (group B) placed. We evaluated the results of the Ureteral Stent Symptom Questionnaire (USSQ) in both groups, assessed the technical difficulty related to stent removal and the pain during the procedure using the Visual Analogue Scale (VAS). We also reviewed the need for medical attention due to problems related to the stent or after its removal. RESULTS: There were no statistically significant differences between groups regarding the answers in the USSQ and the complications related to the use of the stent. Group B showed less pain (1.52 vs. 4, VAS, pâ¯=â¯0.001) and less difficulty during removal (1.61 vs. 3, pâ¯<â¯0.001) associated with a shorter procedure duration (11.65 min vs. 22.17 min pâ¯<â¯0.001). CONCLUSIONS: The tolerance shown by the use of magnetic double-J is comparable to the tolerance of traditional stent, since it does not cause an increase in urinary symptoms nor worsens the quality of life of patients during its use.
Subject(s)
Quality of Life , Ureter , Humans , Magnetic Phenomena , Prospective Studies , Stents , Ureter/surgeryABSTRACT
Introducción: La colocación de un catéter doble J (DJ) es uno de los procedimientos más realizados en urología. Puede causar un impacto negativo en la calidad de vida, siendo necesaria una cistoscopia para su extracción. El objetivo de este estudio es evaluar la sintomatología e impacto en la calidad de vida derivados del uso del catéter DJ magnético (Black Star®) y compararla con la del DJ tradicional (OptiMed®).Material y métodosRealizamos un estudio comparativo, prospectivo y aleatorizado en 46 pacientes sometidos a ureterorrenoscopia (URS) en quienes se colocó un DJ entre agosto del 2019 y junio del 2020. De los pacientes incluidos, 23 llevaron un DJ tradicional (grupo A) y 23 un DJ magnético (grupo B). Valoramos en ambos grupos los resultados del cuestionario de síntomas de catéter ureteral (USSQ). Evaluamos el dolor de la extracción mediante la escala visual analógica (EVA) y la dificultad de la retirada. Revisamos la necesidad de atención médica por problemas relacionados con el catéter o surgidos tras la extracción.ResultadosNo observamos diferencias estadísticamente significativas en el cuestionario USSQ, ni en las complicaciones. El grupo B presentó: menor dolor de la extracción (EVA de 1,52 vs. 4, p = 0,001), menor dificultad en la retirada (1,61 vs. 3, p < 0,001) y menor tiempo de extracción (11,65 vs. 22,17 min p < 0,001).ConclusionesEl DJ magnético es un catéter ureteral que presenta una tolerancia equiparable a los tradicionales, ya que no genera un incremento de la sintomatología urinaria ni empeora la calidad de vida de los pacientes durante su uso. (AU)
Introduction: The placement of a ureteral stent is one of the most widely performed procedures in urology. It can have a negative impact on the patients quality of life, requiring a cystoscopy for its removal. The objective of this study is to evaluate the symptoms and impact on quality of life derived from the use of a magnetic double-J stent (Black Star ®) and compare them to those presented in patients with a traditional double-J stent (OptiMed®).Material and methodsWe conducted a comparative, prospective, randomized study in 46 patients who underwent ureterorenoscopy with double-J stent placement between August 2019 and June 2020. Of all patients included, 23 had a traditional double-J stent placed (group A) and 23 had a magnetic double-J stent (group B) placed. We evaluated the results of the Ureteral Stent Symptom Questionnaire (USSQ) in both groups, assessed the technical difficulty related to stent removal and the pain during the procedure using the Visual Analogue Scale (VAS). We also reviewed the need for medical attention due to problems related to the stent or after its removal.ResultsThere were no statistically significant differences between groups regarding the answers in the USSQ and the complications related to the use of the stent. Group B showed less pain (1,52 vs. 4, VAS, p = 0.001) and less difficulty during removal (1,61 vs. 3, p < 0,001) associated with a shorter procedure duration (11,65 min vs. 22,17 min p < 0,001).ConclusionsThe tolerance shown by the use of magnetic double-J is comparable to the tolerance of traditional stent, since it does not cause an increase in urinary symptoms nor worsens the quality of life of patients during its use. (AU)
Subject(s)
Humans , Magnetic Phenomena , Quality of Life , Stents , Ureter/surgery , Prospective StudiesABSTRACT
OBJECTIVE: Aim of our study was to evaluate the effectiveness and safety of the preoperative placement of JJ stent compared to not doing in patients undergoing ureteroscopy for ureteral and kidney stone. MATERIALS AND METHODS: Prospective, observational, multicenter study. Adult patients, who underwent ureteroscopy treatment for ureteral and kidney stone, were recruited from August 2017 to March 2019, in 23 Argentine institutions. The variables analyzed included: demographic data, stone size and location, stone-free rate (SFR) and complications. RESULTS: 580 patients were included. 473 with ureteral stone (309 with and 164 without prior JJ stent) and 107 with kidney stone (77 with and 30 without prior JJ stent). The SFR was higher in the group with previous JJ stent, both in the treatment of ureteral stone (82.2% vs. 90.9%, OR 2.15 (1.17 to 3.96)), and in the treatment of kidney stone (73.3% vs. 89.6%, OR 3.14 (1.02 to 9.61)). No differences were established in the complication rate both in the treatment of ureteral stone (6.1 vs. 6.1%, OR 0.98 (0.45 to 2.19)) and in the treatment of kidney stone (6.7 vs. 5.2%, OR 0.76 (0.13 a 4.46)). CONCLUSIONS: The preoperative placement of JJ stent, increases SFR in the treatment of ureteral and kidney stone, but not decrease the complication rate.
OBJETIVO: El objetivo fue evaluar la efectividad y seguridad de la colocación preoperatoria del catéter doble J comparado con no hacerlo, en pacientes sometidos a ureteroscopía por litiasis ureteral y renal.MATERIALES Y MÉTODOS: Estudio prospectivo, observacional, multicéntrico. Se reclutaron pacientes adultos, que se sometieron al tratamiento ureteroscópico para litiasis ureteral y renal, desde agosto de 2017 a marzo de 2019, en 23 instituciones Argentinas. Las variables analizadas incluyeron: datos demográficos, tamaño y ubicación de la litiasis, tasa libre de litiasis (LL) al finalizar el procedimiento y de complicaciones en el posoperatorio inmediato. RESULTADOS: Se incluyeron 580 pacientes. 473 con litiasis ureteral (309 con y 164 sin doble J previo) y 107 con litiasis renal (77 con y 30 sin doble J previo). La tasa LL fue mayor en el grupo con doble J previo, tanto en el tratamiento de la litiasis ureteral (82,2% vs. 90,9%, OR 2,15 (1,17 a 3,96)), como en el tratamiento de la litiasis renal (73,3% vs. 89,6%, OR 3,14 (1,02 a 9,61)). No se establecieron diferencias en la tasa de complicaciones tanto en el tratamiento de la litiasis ureteral (6,1 vs 6,1%, OR 0,98 (0,45 a 2,19)) como en el tratamiento de la litiasis renal (6,7 vs 5,2%, OR 0,76 (0,13 a 4,46)). CONCLUSIONES: La colocación preoperatoria del catéter doble J mejoró la tasa LL en el tratamiento de la litiasis ureteral y renal, pero no disminuyó la tasa de complicaciones.
Subject(s)
Kidney Calculi , Ureter , Adult , Humans , Kidney Calculi/surgery , Prospective Studies , Stents , Treatment Outcome , Ureter/surgeryABSTRACT
Objetivo: El objetivo fue evaluar la efectividad y seguridad de la colocación preoperatoria delcatéter doble J comparado con no hacerlo, en pacientes sometidos a ureteroscopía por litiasis ureteral y renal.Materiales y métodos: Estudio prospectivo, observacional, multicéntrico. Se reclutaron pacientes adultos,que se sometieron al tratamiento ureteroscópico paralitiasis ureteral y renal, desde agosto de 2017 a marzode 2019, en 23 instituciones Argentinas. Las variables analizadas incluyeron: datos demográficos, tamaño yubicación de la litiasis, tasa libre de litiasis (LL) al finalizar el procedimiento y de complicaciones en el posoperatorio inmediato.Resultados: Se incluyeron 580 pacientes. 473 conlitiasis ureteral (309 con y 164 sin doble J previo) y107 con litiasis renal (77 con y 30 sin doble J previo).La tasa LL fue mayor en el grupo con doble J previo,tanto en el tratamiento de la litiasis ureteral (82,2% vs.90,9%, OR 2,15 (1,17 a 3,96)), como en el tratamiento de la litiasis renal (73,3% vs. 89,6%, OR 3,14 (1,02a 9,61)). No se establecieron diferencias en la tasade complicaciones tanto en el tratamiento de la litiasisureteral (6,1 vs 6,1%, OR 0,98 (0,45 a 2,19)) comoen el tratamiento de la litiasis renal (6,7 vs 5,2%, OR0,76 (0,13 a 4,46)).Conclusiones: La colocación preoperatoria delcatéter doble J mejoró la tasa LL en el tratamiento dela litiasis ureteral y renal, pero no disminuyó la tasa decomplicaciones.(AU)
Objetive: Aim of our study was to evaluate the effectiveness and safety of the preoperativeplacement of JJ stent compared to not doing in patientsundergoing ureteroscopy for ureteral and kidney stone.Materials and methods: Prospective, observational, multicenter study. Adult patients, who underwent ureteroscopy treatment for ureteral and kidney stone, wererecruited from August 2017 to March 2019, in 23Argentine institutions. The variables analyzed included:demographic data, stone size and location, stone-freerate (SFR) and complications.Results: 580 patients were included. 473 with ureteral stone (309 with and 164 without prior JJ stent)and 107 with kidney stone (77 with and 30 withoutprior JJ stent). The SFR was higher in the group withprevious JJ stent, both in the treatment of ureteral stone(82.2% vs. 90.9%, OR 2.15 (1.17 to 3.96)), and inthe treatment of kidney stone (73.3% vs. 89.6%, OR3.14 (1.02 to 9.61)). No differences were establishedin the complication rate both in the treatment of ureteralstone (6.1 vs. 6.1%, OR 0.98 (0.45 to 2.19)) and inthe treatment of kidney stone (6.7 vs. 5.2%, OR 0.76(0.13 a 4.46)).Conclusions: The preoperative placement of JJstent, increases SFR in the treatment of ureteral and kidney stone, but not decrease the complication rate.(AU)
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Catheters , Nephrolithiasis , Ureteroscopy , Lithotripsy , Lithotripsy, Laser , Prospective Studies , ArgentinaABSTRACT
The purpose of the present study was to develop a narrative review of the available evidence of mirabegron efficacy in three scenarios: as a medical expulsive therapy; as a medical treatment to increase a successful access to stones before ureteroscopy, and management of double-J stent-related symptoms. Only two original studies have evaluated its use as a medical expulsive therapy, with contradictory results in terms of stone expulsion rate; however, both demonstrated a better pain control in the mirabegron group. One randomized controlled trial (RCT) found a higher successful access to ureteral stones when mirabegron was administered 1 week before the ureteroscopy. And two RCTs demonstrated its efficacy in diminishing discomfort related with double-J stent. There is a promising role for the use of mirabegron in the arsenal of urolithiasis treatment, even as a medical expulsive therapy, before ureteroscopy surgery, to increase the successful access to the stones and after the placement of ureteral catheter to reduce the related symptoms. However, larger-scaled prospective double-blinded RCTs are needed before it can be used with these purposes in the clinical scenario.
El propósito de este trabajo fue desarrollar una revisión narrativa de la literatura describiendo la evidencia disponible sobre la eficacia del mirabegrón en tres escenarios: como terapia médica expulsiva, como tratamiento médico antes de la ureteroscopia para incrementar el acceso exitoso al cálculo, y en el manejo de los síntomas asociados con el uso de catéter doble J. Solo dos estudios originales han evaluado su uso como terapia médica expulsiva, con resultados contradictorios en términos de tasa de expulsión del cálculo; sin embargo, ambos demostraron mejor control del dolor en el grupo de mirabegrón. Un estudio aleatorizado multicéntrico encontró un aumento en el acceso exitoso al cálculo durante la ureteroscopia cuando el mirabegrón era administrado una semana antes del procedimiento. Adicionalmente, dos estudios aleatorizados controlados demostraron eficacia del medicamento para disminuir los síntomas relacionados con el catéter doble J. El uso del mirabegrón como parte del arsenal del tratamiento para urolitiasis tiene un rol prometedor, tanto en la terapia médica expulsiva como antes de la ureteroscopia, para aumentar la posibilidad de acceder exitosamente al cálculo, y en pacientes con catéter doble J, para disminuir los síntomas asociados. Sin embargo, se requiere estudios más grandes, prospectivos, doble ciegos y aleatorizados antes de que podamos utilizarlo con estos fines en un escenario clínico.
Subject(s)
Humans , Pharmaceutical Preparations , Ureteroscopy , Urolithiasis , Catheters , Urinary CathetersABSTRACT
PURPOSE: To evaluate the effect of JJ stents on SWL treatment of moderate (15-25mm) renal pelvic stones. MATERIALS AND METHODS: Between January 2016 and December 2017, a total of 152 adult patients who were planned to undergo SWL for a single radiopaque renal pelvic stone were included in the study. Patients with solitary kidney, congenital abnormality, skeletal tract abnormalities, previous urinary system surgery, hydronephrosis (grade 2 or more), untreated urinary tract infection, bleeding disorder, and suspected pregnancy were excluded. The remaining 114 patients were randomly divided into two groups; non-stented and stented. Twenty-two patients whose stone could not be fragmented despite 3 consecutive sessions were also excluded from the study. A total of 92 patients (54 non-stented and 38 stented) were included in the final analysis. RESULTS: There was no significant difference in terms of age, sex, body mass index, renal parancyhimal thickness, hydronephrosis, skin-to-stone distance, Hounsfield units, and stone size between the groups. Success was significantly higher in the stented group than in the non-stented group (71% vs. 39%, P=.002). In stone-free patients, the number of emergency department visits and analgesic tablet consumption was significantly lower in the stented group than in the non-stented group (P<.001 and P<.001, respectively). In non- stone-free patients, analgesic tablet consumption was significantly lower in the stented group than in the non-stented group (P=.004). CONCLUSIONS: Pre-stenting before SWL treatment of moderate sized renal pelvic stones has some advantages in terms of success, emergency service visits, and analgesic tablet consumption.
Subject(s)
Kidney Calculi/surgery , Kidney Pelvis , Lithotripsy , Stents , Adult , Combined Modality Therapy , Female , Humans , Kidney Calculi/pathology , Male , Middle Aged , Prospective Studies , Treatment Outcome , UreterABSTRACT
OBJECTIVE: To assess the outcomes of ureteral stent placement under local anesthesia for the management of multiple ureteral disorders. METHODS: Retrospective study of 45 consecutive ureteral stents placed under local anesthesia from January 2015 to July 2016. Inclusion criteria were hemodynamically stable patients with urinary obstruction, urinary fistula or for prophylactic ureteral localization during surgery. Five minutes before the procedure, 10ml of lidocaine gel and 50ml of lidocaine solution were instilled in the bladder. A 4.8Fr ureteral stent was placed using a 15.5Fr flexible cystoscope under fluoroscopic control. Characteristics of procedures and outcomes were analysed. RESULTS: A total of 45 procedures (33 placement, 12 replacements) were attempted in 37 patients, of which 40 (89%) were successful. There were 10 male (27%) and 27 female patients (73%) with a mean age of 58.6 years (±17.5). Main indications for stent placement were stones (37.8%), extrinsic ureteral compression (28.9%) and surgery ureteral localization (22.2%). The reasons for failing to complete a procedure were the inability to pass the guidewire/stent in 4 cases (8.8%) or to identify the ureteral orifice in 1 (2.2%). Postoperative complications occurred in 8 patients (17.8%) (7 Clavien I, 1 Clavien IIIa). No procedure was prematurely terminated due to pain. Statistical analysis did not find significant successful predictors. The outpatient setting provided a fourfold cost decrease. CONCLUSIONS: Ureteral stent placement can be safely and effectively performed under local anesthesia in the office cystoscopy room. This procedure could free operating room time, reduce costs and minimize side effects of general anesthesia.
Subject(s)
Ambulatory Care/methods , Anesthesia, Local/methods , Catheters, Indwelling , Stents , Ureteral Diseases/therapy , Urinary Catheterization/methods , Administration, Intravesical , Adult , Aged , Anesthetics, Local/administration & dosage , Catheters, Indwelling/adverse effects , Cystoscopy , Female , Fluoroscopy , Humans , Instillation, Drug , Lidocaine/administration & dosage , Male , Middle Aged , Radiography, Interventional , Retrospective Studies , Stents/adverse effects , Urinary Catheterization/adverse effectsABSTRACT
La instalación de catéteres ureterales tipo Doble J o pigtail es una práctica habitual en urología, el principal problema de su instalación radica en que gran parte de los pacientes presentan diferentes tipos de molestias en relación a su uso. Existen algunas alternativas de tratamiento médico que han probado ser efectivas en disminuir parcialmente estos síntomas; sin embargo, pocos estudios han evaluado la posibilidad de terapias locales, y estos reclutaron pocos pacientes por lo que no pudieron demostrar grandes diferencias.
The use of Double J ureteral stents or also called pigtail is common practice in urology; the main problem with its use is that a large number of patients develop discomfort with indwelling stents. To diminish them there are medical treatments that have been proven useful, however, few studies have assessed local therapies, and this studies include a small number of patients.
Subject(s)
Humans , Anesthetics, Local/administration & dosage , Bupivacaine/administration & dosage , Pain/prevention & control , Stents , Ureteroscopy/adverse effectsABSTRACT
Presentamos el caso de un paciente de 61 años, con historia de urolitiasis a repetición. Luego de la instalación de catéteres doble J en forma bilateral, se pierde de controles reapareciendo luego de 14 años. El estudio imagenológico demuestra una nefrolitiasis coraliforme completa izquierda y parcial a derecha, asociada a incrustación de ambos catéteres. Describimos el manejo exitoso de los catéteres incrustados asociados a litiasis, que requirieron una aproximación endourológica a través de cirugía percutánea. La nefrolitotomía percutánea permite el manejo exitoso de un catéter severamente incrustado asociado a una masa de cálculos, incluso en aquellos casos bilaterales.
We review our recent experience with encrusted retained ureteral stents associated with a large stone burden in a patient of 61 years old as well as current endoscopic options available for management. We described the successful management of a retained encrusted stent with endourological procedures. Percutaneous nephrolithotomy is a good option for treating a severely encrusted stent and the associated stone burden.
