A Stent for Every Stone? Prestenting Habits and Outcomes from a German Multicenter Prospective Study on the Benchmarks of Ureteroroscopic Stone Treatment (BUSTER)

Werthemann, Peter; Weikert, Steffen; Enzmann, Thomas; Schostak, Martin; Lebentrau, Steffen

doi:10.1159/000504682

Cited by 12 publications

(16 citation statements)

References 18 publications

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“…Surprisingly, pretreatment with a JJ-stent was more frequent in patients who developed strictures. Pre-stenting has been demonstrated to reduce the risk of ureteral lesions during URS [15][16][17] . Nevertheless, the protective properties of the stent might not fully have abolished the deleterious effects of an impacted stone in the present study, and may explain why more strictures occurred in the pre-stented patients.…”

Section: Discussionmentioning

confidence: 99%

Ureteral Strictures Following Ureteroscopic Stone Treatment

Ulvik

Harneshaug

Gjengstø

2021

Journal of Endourology

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Background and purpose: Ureteral stricture is a rare, but serious complication following ureteroscopy (URS) for stones. The aim of this study was to investigate how many patients ended up with a ureteral stricture after URS at our hospital and how these were treated. We also wanted to identify potential risk factors for post endoscopic stricture formation. Materials and methods:A retrospective evaluation of 1001 URS for stone treatment at the day-case surgery unit between 2013 -2018 was performed. Data on pretreatment status, the surgical procedure and follow-up were recorded. Exact χ 2 and independent-samples ttests were used comparing data among those who developed strictures and those who did not. Multiple logistic regression was performed analyzing risk factors for stricture formation. Results:In total, 1001 URS were performed in 725 patients, 289 women and 436 men. Of these, 995 cases were eligible for analysis. At follow-up with computed tomography after 3 months, 28 (3.0%) strictures were identified. Of these, 20 received endourological treatment with balloon dilatation of which 15 (75%) were successful. Definitive treatment in the 13 patients with failed or unattempted endourological treatment included nephrectomy, reconstructive surgery, permanent nephrostomy or observation with no further treatment.In multiple regression analysis, use of access sheath (UAS) (OR 4.6, p = 0.011), ureteral perforation (OR 11.8, p < 0.0001) and surgical time > 60 minutes (OR 5.7, p < 0.005) were found to be risk factors for stricture formation. Conclusion:Ureteral stricture is a rare complication of URS. Balloon dilatation should be the first line of treatment. Use of UAS, perforation and excessive operating time were found to be risk factors for post endoscopic ureteral stricture formation. Special attention to these risk factors should be given to reduce the incidence of ureteral strictures.

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Section: Discussionmentioning

confidence: 99%

Ureteral Strictures Following Ureteroscopic Stone Treatment

Ulvik

Harneshaug

Gjengstø

2021

Journal of Endourology

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“…This can lead to renal parenchyma damage and worsening of the renal function, which may already be compromised prior to stent placement [10,21]. The study of the effects of stents on urinary tract dynamics will contribute to provide more evidence in order to meet the current clinical needs to accurately define the indications of double J ureteral stents in endourological procedures [22].…”

Section: Discussion/conclusionmentioning

confidence: 99%

Assessment of the Grades of Vesicoureteral Reflux in Stented Ureters: An Experimental Study

et al. 2021

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Introduction: The aim of this experimental study is to assess, in a porcine model, the onset and grades of vesicoureteral reflux associated with ureteral stents. Methods: Twenty-four female porcine models were used. A 4.7-Fr ureteral stent was placed in all right ureters and kept in place for 6 weeks. Follow-ups were performed on weeks 1, 3, 6, and 12. Ultrasonography, cystoscopy, and fluoroscopy were used to analyze grade of hydronephrosis, presence and grade of vesicoureteral reflux, bacteriuria, and macroscopic changes of the ureteral orifices. Vesicoureteral reflux was classified using a modification of the International Reflux Study Committee grades. Results: 91.7% animals present vesicoureteral reflux, 89.5% grade IA, 3.5% grade IB, and 7% grade II. There is a significant increase in reflux during follow-ups at 3 and 6 weeks, whereas 6 weeks after removal, 26.3% of the ureters still present vesicoureteral reflux. Hydronephrosis and macroscopic changes of the ureteral orifice increase significantly with stenting, but there is no significant association between them and vesicoureteral reflux; the relationship between bacteriuria and the presence of vesicoureteral reflux is not significant either. Conclusion: Vesicoureteral reflux caused by ureteral stents in an animal model is mostly low grade and mainly affects the distal ureter.

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“…Current studies show that German practices often deviate from recommendations in the guidelines. For example, data from the German BUSTER study show that "pre-stenting" (ureteral stent placement before URS) is performed in 70% of patients before stone extraction in Germany [3,[5][6][7]. Pre-stenting immediately solves urinary transport disorder in the event of an emergency.…”

Section: Introductionmentioning

confidence: 99%

An Empirical Study on the Operative Treatment of Symptomatic Urolithiasis in Germany

et al. 2021

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Purpose: The guidelines of the German, European, and American Urological Associations on urolithiasis advise against general ureteral stenting before and after an uncomplicated ureterorenoscopy (URS). However, German and European guidelines state that stenting prior to URS facilitates stone extraction and reduces intraoperative complications. According to the published literature, German practice seems to deviate from recommendations. This nationwide survey aimed to evaluate the treatment modalities of urolithiasis. Methods: In November 2018 and March 2019, a total of 199 urological hospital departments in Germany were anonymously surveyed about operative care of symptomatic urolithiasis. The response rate was 72.9%. The survey consisted of 25 questions about diagnostics, surgical technique, and aftercare of the URS. This questionnaire is available in the appendix. Results: A primary URS is performed in ≤10% in 49.6% of the hospitals. In every second urological department (49.7%), the German Diagnosis Related Group (G-DRG) system influences the period of pre-stenting before a secondary URS. After a secondary URS, which is performed in 53.8% of the departments in over 80% of the patients, 14% of the departments omit stenting. The standard for stenting seems to be a 28-cm-long 7 Charrière double-J stent in Germany. Conclusion: In Germany, the percentage of primary URS is low, and a ureter stenting is performed in most of the urological departments after URS. Delaying therapy due to economic aspects is the standard in almost half of all urological departments.

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A Stent for Every Stone? Prestenting Habits and Outcomes from a German Multicenter Prospective Study on the Benchmarks of Ureteroroscopic Stone Treatment (BUSTER)

Cited by 12 publications

References 18 publications

Ureteral Strictures Following Ureteroscopic Stone Treatment

Ureteral Strictures Following Ureteroscopic Stone Treatment

Assessment of the Grades of Vesicoureteral Reflux in Stented Ureters: An Experimental Study

An Empirical Study on the Operative Treatment of Symptomatic Urolithiasis in Germany

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