Editorial Comment from Dr Kawahara to Prevention and treatment of symptoms associated with indwelling ureteral stents: A systematic review

Abstract

At nearly five decades since the first reported use of a ureteral stent by Zimskind et al., various materials and coatings have been developed to prevent ureteral stent complications, such as encrustation, incrustation, migration and infection.1 Although there are still ureteral stent-related symptoms, including urgency, dysuria, pain and hematuria, there is no widespread consensus on how to reduce ureteral stent complications. 2,3Betschart et al. carried out a systematic review of 107 articles on ureteral stent-related symptoms. 4 The study suggested the effectiveness of alpha-1 blockers in reducing ureteral stent symptoms, and suggested that choosing an appropriate length of ureteral stent seemed beneficial for reducing symptoms. A network meta-analysis by Kwon et al. showed that alpha-1 blockers -especially tamsulosin and alfuzosin -reduced stent-related symptoms in seven randomized control studies. 5Due to the various methods of evaluating stent-related symptoms, including the International Prostate Symptom Score, overactive bladder symptoms score, visual analog pain scare and Ureteral Stent Symptoms Questionnaire, and the variety of stent forms (including the coating, caliber and length), it remains difficult to evaluate the stent-related complications in different published studies.6 Despite these limitations, the administration of alpha-1 blockers and the use of stents of an appropriate length might be good approaches for reducing ureteral stent-related pain based on this article. Further studies are required to confirm the evidence. Even now, ureteral stenting is a fundamental part of many urological procedures that are associated with stent-related symptoms. Ultimately, the way to reduce stent-related symptoms would be to make ureteral stenting unnecessary. Editorial CommentEditorial Comment from Dr Wada and Dr Sadahira to Prevention and treatment of symptoms associated with indwelling ureteral stents: A systematic reviewThe article by Betschart et al. reviews the prevention and treatment of stent-related symptoms (SRS) by the multi-angle approach using a scientific search strategy. 1 We read the article with a great interest because in Japan, the Japanese Society of Endourology will soon be publishing the new guideline for the use of ureteral stents, and group work to acquire the validation of the Japanese version of the Ureteric Stent Symptoms Questionnaire (USSQ) is ongoing. The management for SRS discussed until now is mainly indication of stent-placement, drug therapy, and the properties and positions of stents. Although the present review is well written, several articles remain to be shown here. As a new report published in 2016, Sivalingam et al. reported combination therapy with an alpha 1-blocker and anticholinergic compared with monotherapy with an alpha 1-blocker in a prospective, randomized, double-blind study including 80 patients.2 Data were analyzed by using USSQ, and there were no significant differences between the two groups at any point. Regarding stent position, while the number ...

Bilateral Encrusted Metallic Stent Successfully Removed by Ureteroscopic Lithotripsy Using a Ho:YAG Laser in a Patient with Malignant Myeloma

“…In cases of MUO, ureteral stenting allows percutaneous nephrostomy, an invasive procedure, to be avoided. Metallic ureteral stent insertion was associated with a superior and more durable response in comparison to polyurethane ureteral stent insertion [ 6 , 7 ]. Thus, metallic ureteral stent insertion can increase the time without nephrostomy in patients with MUO.…”

The Use of a Metal Stent in the Treatment of Ureteral Stricture in a Patient Who Had Undergone Radical Cystectomy with the Creation of an Ileal Conduit

“…We previously demonstrated that a polyurethane ureteral stent should be exchanged due to coloring and stone formation [ 8 , 9 ]. Thus, the use of a metallic stent can expected to reduce the need for unnecessary ureteral exchanges [ 10 ].…”

Use of metallic and polymeric ureteral stents in malignant ureteral obstruction

“…Malignant ureteral obstruction (MUO) is often caused by advanced intra‐abdominal cancers. Effective management must be attempted, but the treatment policy is unclear 1–7 . The current management options are retrograde ureteral stent (RUS) placement or percutaneous nephrostomy under local anesthesia.…”

“…Effective management must be attempted, but the treatment policy is unclear. 1 , 2 , 3 , 4 , 5 , 6 , 7 The current management options are retrograde ureteral stent (RUS) placement or percutaneous nephrostomy under local anesthesia. RUS is usually considered as the first treatment choice because of its low invasiveness.…”