Comparison of 4.8 Fr and 6 Fr ureteral stents on stent related symptoms following ureterorenoscopy: A prospective randomized controlled trial

Abstract

The effects of ureteral stent diameters on ureteral stent‐related symptoms were evaluated by using Turkish‐validated Ureteral Stent Related Symptoms Questionnaire (USSQ). Datas on 126 patients underwent uncomplicated flexible ureterorenoscopy and 62 patients underwent uncomplicated semirigid ureteroscopy surgery without stent insertion (group 3) were collected. Patients were randomized preoperatively in a double‐blind fashion to 4.8 French (group 1) and 6 French (group 2) ureteral JJ stents groups. The first follow‐up visit was done at one week after surgery for all groups. Stents were removed on the third postoperative week for stented groups. The second follow‐up visit was done at one week after stent removal for group 1 and group 2, and four week after surgery for group 3. Preoperative characteristics, operation time and hospitalization times were similar in both groups. Total USSQ scores were 91.9, 103.0, 44.2 at first visit and 54.3, 58.7, 28.5 at second visit in group 1, group 2, and group 3, respectively. At both first and second visits, the group 2 had significantly higher USSQ scores than the group 1 (p = 0.01 and p < 0.001, respectively). Group 1 and 2 had higher scores than group 3 at both visits. Ureteral stents are associated with poor effects on patients' comfort and high USSQ scores. Using 4.8 Fr JJ stents improves stent‐related symptoms and decreases the USSQ score more than 6 Fr JJ stents. Therefore, if ureteral stent is to be used after URS, we recommend using 4.8 Fr stent.

The Effect of Ureteral Stents on Postoperative Pain

“…However, these studies did not pay attention to the different features of the DJ stents. According to a study grouped according to stent properties by Alkan Çubuk et al after URS operations, Ureteral Stent Related Symptoms Questionnaire (USSQ) scores were significantly low both in the 1st week po and after stent removal for the group without stent compared to the group with stent inserted (17). In our study, in general all groups had significant falls in NPS on the po 3rd and 7th days compared to preop values, and this fall was more pronounced in the NPS examined after stent removal (Tables 3, 4).…”

Does a small stent size increase the risk of post-operative complications following reconstructive robotic surgery in the pediatric population?

“…We did not take into consideration other stent characteristics including length, coil length or material, previously proven to influence stent symptoms and failure [4,18,19]. In addition, although pain and lower urinary tract symptoms (LUTS) have been included in the definition of ureteral stent failure in some reports of adult ureteral stenting, and though some studies on adult population found that smaller diameter DJS improved the severity of these symptoms, these symptoms are usually quantified by 'quality of life' questioners and personal interviews, making it difficult to assess in pediatric patients [10,11]. Thus, these complications were excluded from our study [5].…”

“…Moreover, Lee et al, in their study of stent failure in the pediatric population, have concluded that 3Fr DJS was the only risk factor for stent failure [5]. On the other hand, some studies have found that the use of smaller diameter DJS lowers the severity of DJS-related symptoms [10,11]. In addition, some pediatric urologists tempt to avoid passing a DJS through pediatric uretero-vesicular junction (UVJ), to avoid UVJ injury and subsequent stenosis.…”

<p>Strategies to Improve Patient Outcomes and QOL: Current Complications of the Design and Placements of Ureteric Stents</p>

“…Common type of stents include metallic stents 5,16,17 and polymeric stents. [27][28][29][30][31][32][33][34][35][36]…”

“…These studies showed no differences between stone-free rates following planned and repeated unilateral ureteroscopy (URS). 35 Based on previously discussed modifications, a dual-lumen stent with two drainage pathways was tested by Hafron et al and reported improved urine drainage when compared to single lumen stents in an ex vivo kidney model. 36…”