Effects of proximal and distal ends of double-J ureteral stent position on postprocedural symptoms and quality of life: a randomized clinical trial.

PURPOSE: To evaluate the effect of the position of the proximal and distal ends of Double-J ureteral stents on postprocedural flank pain, lower urinary-tract symptoms, and quality of life. PATIENTS AND METHODS: The study included 120 patients who required unilateral Double-J ureteral stents for various indications. They were randomized into two equal groups. Group 1 had longer stents, with the proximal end in the upper calix and the distal end crossing the midline of the bladder. Group 2 had proper stent length with the proximal end in the pelvis and the lower end just beyond the vesicoureteral junction. Patients answered a questionnaire regarding flank pain, dysuria, and urgency as well as quality of life after 1 week of stenting. RESULTS: Forty patients (67%) of group 1 and 43 (72%) of group 2 had mild flank pain, especially during urination. There was no significant difference in the degree of flank pain in the two groups. Moderate to severe dysuria was reported by 53 patients (88%) in group 1 and 11 patients (18%) in group 2 (P < 0.001). Moderate to severe urgency was reported by 48 patients (80%) in group 1 and in 14 (23%) in group 2 (P < 0.001). A worse quality of life was reported by patients in group 1, among whom moderate to severe bother was noted by 51 (85%) compared with group 2, in which moderate to severe bother was reported by only 13 patients (22%) (P < 0.001). CONCLUSION: Ureteral stents are associated with flank pain and lower urinary-tract symptoms. The flank pain was not affected by the length of stent. Urgency and dysuria as well as a worse quality of life were significantly more common in the patients who had longer stents.

Comparison of outcomes of different varicocelectomy techniques: open inguinal, laparoscopic, and subinguinal microscopic varicocelectomy: a randomized clinical trial.

OBJECTIVES: To compare the outcomes of the different surgical techniques used in varicocelectomy. METHODS: The study included 120 patients with 147 clinically palpable varicoceles who underwent varicocelectomy. The patients were randomly allocated to one of three equal groups according to the varicocelectomy technique, which included the open inguinal approach, a laparoscopic approach, and subinguinal microscopic varicocelectomy. The assessment included operative and postoperative parameters, together with semen analysis and pregnancy rate. The mean follow-up was 18 months (range 11 to 26). RESULTS: The operative time in the microscopic group was significantly longer than that for the other two groups. At follow-up, none of the patients of the microscopic group had developed postoperative hydrocele; however, it was observed in 7 (13%) of 52 varicoceles in the open group and 10 (20%) of 50 in the laparoscopic group. This difference was statistically significant in favor of the microscopic group only. Only 1 patient in the microscopic group experienced recurrence of one varicocele compared with 7 and 9 patients in the open and laparoscopic groups, respectively. This difference was statistically significant in favor of the microscopic group only. Improvement in sperm motility and/or concentration was comparable and observed in 65%, 67%, and 76% of the open, laparoscopic, and microscopic groups, respectively. Also, the pregnancy rate at 1 year was not significantly different and was 28%, 30%, and 40% in three groups, respectively. CONCLUSIONS: The findings of our study have demonstrated that, compared with open inguinal and laparoscopic varicocelectomy, subinguinal microsurgical varicocelectomy offers the best outcome.