Double-Pigtail Stents for Distal Ureteral Calculi: An Alternative Form of Definitive Treatment

Abstract

In this study, we treated patients with a solitary distal ureteral stone of less than 10 mm in maximum diameter by placing a double-pigtail stent and subsequently removing it allowing the calculus to pass spontaneously. A total of 40 patients were enrolled in the study with a mean stone size of 5.1 × 3.5 mm (range 2–8 mm in length and 2–7 mm in width). The indication for intervention was intractable pain in 5 patients, infection due to obstruction in 2, highly obstructed urinary tract in 10, absence of progression for 30 days in 21 and desire of the patient to be free of stone in 2. A double-pigtail stent was inserted in the involved ureter under local anesthesia and left in place for 2 weeks. After stent removal, 34 patients succeeded in passing the stone within an average time of 5.8 days. The overall success rate was 85%. We suggest this method as an alternative form of treatment for distal ureteral calculi to extracorporeal Shockwave lithotripsy or ureterolithotripsy under selected clinical circumstances.

Ureteral stents and their use in endourology

“…Several studies have been published assessing the ability of ureteral stents to facilitate stone passage. These investigators concluded that calculi of up to 10 mm in size located in the distal ureter will pass 83±85% of the time after insertion of an internal ureteral stent [19,20]. Conversely, investigators from Ireland determined that in a canine model, stone passage from the proximal ureter may be limited due to reduced motility effects of the stent on the ureter.…”

Is Stent Placement Necessary After Uncomplicated Ureteroscopy for Removal of Impacted Ureteral Stones?

“…The most important advantage of stent placement is prevention of ureteral obstruction; hence, occurrence of renal colic that may arise from ureteral edema or passage of stone fragments. [1][2][3] Also, ureteral dilation caused by stents may ease the passage of small stone particles. It is proposed that other advantages of the application of stents are quicker healing of the ureter and prevention of ureteral strictures.…”

“…It is proposed that other advantages of the application of stents are quicker healing of the ureter and prevention of ureteral strictures. 2,3 An impacted ureteral stone is variably considered either as a condition in which a stone remains at the same site for more than 2 months 4 or the inability to pass a guidewire or catheter on initial attempts. 5 Many ureteroscopic procedures can be classified as uncomplicated.…”

The Applicability of Using Straight Ureteral Stents for the Treatment of Ureteral Stones in Presumably Non-Compliant Patients

“…Deliveliotis et al [3] investigated 40 patients with a mean stone size of 5.1 ! 3.5 mm fluoroscopically who were stented under local anesthesia for 2 weeks.…”

“…Although distal stones can be managed with extracorporeal shock wave lithotripsy (ESWL) or ureteroscopy, studies exist in which indwelling ureteral stents, placed under local anesthesia, have been utilized as a definitive therapy for small distal ureteral calculi [3]. Historically, such stents have been used as a temporary modality of treatment to relieve obstruction.…”