Peak stent discomfort occurs early and ureteral stent with distal loop design has less pain-A pilot prospective randomised single-blinded trial over 2 weeks.

OBJECTIVES: The Polaris™ loop ureteric stent reduces the severity of stent discomfort by minimising stent material in the bladder. Early impact of ureteral stenting on quality of life (QoL) within 1 week remains unclear. The usefulness of the patient-administered ureteral stent symptoms questionnaire (USSQ) during this period of stent insertion was assessed. In this pilot single-blinded prospective randomised study, we investigate 1) the presence of early (within the 1st week) stent discomfort via the visual analog scale (VAS); 2) determine the QoL of the loop stent against conventional stent. METHODS: Forty adults requiring retrograde unilateral ureteral stent placements were enrolled. Patients with single ureteric stone or benign stricture were selected. Patients were randomised in 1:1 ratio to the loop and pigtail arm. The USSQ was administered before placement (baseline), USSQ and VAS were administered on Day 3, 7, and 14. RESULTS: There were no significant differences between the USSQ scores. Median pain scores on Day 3 were lower in the loop stent group (2.9 vs. 4.0, p=0.047). There was a significant reduction in pain from Day 3-7 (0 vs. -1, p=0.016) in the pigtail group. CONCLUSIONS: Our results suggest that peak stent discomfort occurs but resolves quickly within 1 week of post-stent insertion. The loop stent offers a better pain profile compared with conventional stents at Day 3 but no difference in QoL. The loop stent reduces early pain experience post-stent insertion and may have a role in the care of patients who experience significant stent discomfort previously.

Rare isolated synchronous splenic metastasis in a patient with type II papillary renal cell carcinoma.

Metastatic disease is common in renal cell carcinoma (RCC), with a third of cases being synchronous. RCC is known to metastasize to any organ in the body; however, isolated splenic metastasis is extremely rare. We report a case of synchronous splenic metastasis from type II papillary RCC with 80% sarcomatoid change. He was successfully treated with a right radical nephrectomy with en-bloc right liver resection and splenectomy with negative margins to achieve removal of the primary tumour and complete metastasectomy. He underwent 6 cycles adjuvant chemotherapy with Gemcitabine. The patient developed disease recurrence in the spine at the 6th post-operative month with a pathological fracture at T3 and cord indentation for which he underwent posterior decompression and instrumentation and palliative radiotherapy. He recovered well and remains ambulant. Surveillance scans 16 months post-surgery revealed no tumour recurrence or new metastasis.