Complete intraureteral stent placement relieves daytime urinary frequency compared with conventional placement in patients with an indwelling ureteral stent: post-hoc analysis of a randomized, controlled trial

Abstract

A previous randomized, controlled trial had demonstrated that complete intraureteral stent placement (CIU-SP) was superior to conventional stent placement (C-SP) in terms of improvement of stent-related urinary symptoms. However, it is unclear as to which subdomain symptom and cohort could benefit the most from CIU-SP compared to C-SP in urinary symptoms while considering the baseline urinary status. To determine this, a post-hoc analysis was performed using data from a previous study (CIU-SP group, n = 39; C-SP group, n = 41). We assessed the mean changes in the International Prostate Symptom Score (I-PSS) and the Overactive Bladder Symptom Score (OABSS) from baseline to day 14. Statistical comparison between the two groups was performed using analysis of covariance with adjustment of baseline urinary status as a covariate. Among 80 patients, the total I-PSS was significantly lower in the CIU-SP group than in the C-SP group in the cohort with mild urinary symptoms (P = 0.005), but not in those with moderate/severe symptoms (P = 0.521). The CIU-SP group showed significantly improved I-PSS and OABSS daytime frequencies, with the highest t statistic (2.47 and 2.10, respectively) among subdomains of both symptom scores compared with the C-SP group (both P < 0.001). In multivariate regression analysis, the stent placement method (CIU-SP vs. C-SP) was independently associated with the I-PSS daytime frequency on day 14 (P = 0.017). This study suggests that CIU-SP significantly improved stent-related daytime frequency compared with C-SP, and it may benefit especially those patients who have mild urinary symptoms before the placement of ureteral stents.

Advances in ureteral stent technology

“…They found that patients with mild baseline lower urinary tract symptoms (LUTS) benefited more from intraureteral stent placement compared to those with moderate or severe baseline LUTS [16]. Additionally, patients with baseline storage symptoms, particularly daytime frequency, showed greater benefit [16]. These studies add to the literature that limiting material within the bladder reduces stent-associated symptoms and stenting across the ureteral orifice may not be necessary.…”

“…Yoshida performed a RCT that demonstrated superior outcomes in terms of stent-related symptoms of intraureteral stent placement (Polaris Loop, Boston Scientific, Marlborough, Massachusetts, USA) compared to the conventional placement of double pigtail stents [15]. A more recent investigation in 2020, by Matsuki et al , performed a posthoc analysis looking into which subset of patients may benefit from intraureteral stent placement [16]. They found that patients with mild baseline lower urinary tract symptoms (LUTS) benefited more from intraureteral stent placement compared to those with moderate or severe baseline LUTS [16].…”

“…A more recent investigation in 2020, by Matsuki et al , performed a posthoc analysis looking into which subset of patients may benefit from intraureteral stent placement [16]. They found that patients with mild baseline lower urinary tract symptoms (LUTS) benefited more from intraureteral stent placement compared to those with moderate or severe baseline LUTS [16]. Additionally, patients with baseline storage symptoms, particularly daytime frequency, showed greater benefit [16].…”