Double J stent is an essential tool in urology, being a basic part of many urological procedures. However, some issues related to their use still occur. Our study aimed to evaluate an important number of procedures, the complications of ureteral stents, and their prevention and treatment retrospectively. We evaluate 50,000 procedures performed between 1996 and 2021 on 36,688 patients. According to the stenting duration, the cases were divided into short-term (less than 6 weeks – 34,213 procedures), respectively long-term stenting (more than 6 weeks – 15,757 procedures). The indications of stenting for both groups were noted. The total number of complications was 41,369. We encountered 153 cases (0.3%) of JJ stent malposition, of which 3 cases were into the retroperitoneum, one case with parenchymal perforation and hematoma. Considering the double J migrations, we found proximal migration in 427 cases (0.9%) and distal double J migrations in 352 (0.7%) cases. The obstruction of the ureteral stent, causing inefficient drainage, was encountered in 925 cases, while irritative bladder symptoms occurred in 16,326 cases (32.7%). Hematuria was observed in 5,213 cases, in 7 cases blood transfusion being nec-essary. Urinary tract infection was diagnosed in 7,436 cases (14.8%). Stent encrustation and calcification occurred in 832 cases, while stent fragmentation was noted in 52 cases. Double J stent complications should be promptly evaluated and treated. Encrustation and stone formation in forgotten stents often lead to serious complications and should be managed with stent removal and combined endourological techniques.
Large meta-analyses demonstrated that ureteral access sheaths (UAS) have specific complications during and after flexible ureteroscopy (fURS). The present study focused on the technical aspects, advantages, drawbacks, and limitations of the latest “no-touch” technique (NTT) in the flexible ureteroscopic therapeutic approach of renal stones. A total of 288 patients with a single pyelocaliceal stone (largest diameter between 11 and 29 mm) underwent fURS: 144 using the 12/14 Fr UAS (group 1) and 144 without UAS (group 2). For NTT, we used four types of ureteroscopes: Olympus URF-V2 (8.5 Fr) – 33 cases, Storz Flex X2 (8.4 Fr) – 60 cases, single-use PUSEN PU 3022 (9.5 Fr) – 37 cases, and single-use PUSEN – PU 3033A (7.5 Fr) – 14 cases. For group 1, we used the Olympus URF–V2 ureteroscope in 44 cases, the Storz Flex X2 in 58 cases, and the single-use PUSEN PU 3022 in 42 cases. We compared the operative time, hospitalization periods, and complications. Successful access sheath insertion was noted in 83.3% of cases from group 1, and successful ureteroscope insertion was noted in 90.9% of cases from group 2. The average operative time was slightly higher in group 1 vs. group 2 (47 vs. 39 min). Stone-free rates (SFRs) were overall lower in group 2 (76.3% vs. 86.8%) at 1 month. At 3 months, we did not find a significant difference between these two groups. Superficial mucosal ureteral wall lesions were found in 38.8% of patients from group 1 and 4.1% from group 2. Hospitalization periods were longer in group 1 vs. group 2 (21 vs. 29 hours, respectively). The single-use 7.5 Fr ureteroscope should receive a special mention: the insertion was simple, we did not encounter any mucosal ureteral wall lesions, and all patients were discharged on the same day. Despite the clear advantages of routine UAS usage, there are many adverse events for the patient. Larger diameter sheaths involve a greater risk of ureteral wall injury. NTT seems to improve peri- and postoperative safety while preserving therapeutic efficiency. The new 7.5 Fr ureteroscopes appear to optimize surgical efficiency and diminish complications in the flexible ureteroscopic treatment of renal stones.
Background and objectives: Renal stones are widespread, with a lifetime prevalence of 10% in adults. Flexible ureteroscopy enables urologists to treat lower calyx stones or even complex renal stones through the natural orifice and achieve an acceptable stone-free rate. Hence, we analyzed the effectiveness and safety of FURS versus PCNL in treating renal stones between 20 and 40 mm in diameter. Materials and methods: We retrospectively analyzed 250 consecutive patients with large renal solitary stones (stone burden between 2 and 4 cm) from 1 January 2019 to 31 December 2020. The patients were divided into two groups: group 1 (125 patients), in which the patients were treated by a retrograde flexible ureteroscopic approach, and group 2 (125 patients), in which we used percutaneous nephrolithotomy. Stone characteristics and anatomical data were observed based on the computed tomography (CT) and/or KUB (Kidney-ureter-Bladder) radiography imaging archive. Results: The mean stone burden was 26.38 ± 4.453 mm in group 1 and 29.44 ± 4.817 mm in group 2. The stone-free rate after the first ureteroscopy was higher for the PNL(percutaneous nephrolithotomy) group (90.4%) than the F-URS group (68%). After two sessions of ureteroscopy, the SFR was 88.8% in the first group, and after three procedures, the SFR rose to 95.2%. The overall complication rate was higher in group 1 than in group 2 (18.4% vs. 16.8%), but without statistical relevance (p > 0.5). Furthermore, we encountered more grade III and IV complications in the PNL group (8.8% vs. 4.8%, p < 0.05). Conclusion: Flexible ureteroscopy proves to be efficient in treating renal stones over 2 cm. However, the patients must be informed that more than one procedure might be necessary to overcome the entire stone burden.
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