Effectiveness of medical treatment in overcoming the ureteral double-J stent related symptoms

Abstract

Background: We investigated whether the frequency of lower urinary tract symptoms (LUTS) increased in patients in whom double-J stents were applied. We also evaluated several medical therapy protocols to treat symptoms related with ureteral stents. Materials and Methods: A total of 108 patients, in whom unilateral double-j stent was applied during ureteral stone treatment, were included. Before the double-J stent was applied, all patients completed storage components of the "International Prostate Symptom Score" (IPSSs), quality of life components of the IPSS (IPSS-QOL) and "Overactive Bladder Questionnaire" (OABq) forms and scores were calculated. After the procedure, cases were randomized into 5 groups, an antiinflammatory was given to Group 1, spasmolytic to Group 2, anticholinergic to Group 3 and α-blocker to Group 4. No additional drug was given to Group 5 as this control group. During the fourth week of the procedure, IPSSs, IPSS-QOL and OABq forms were again completed and scores were compared with the previous ones. Results: When all the cases were evaluated, the IPSSs, IPSS-QOL and OABq scores of patients in whom the double-J stent was applied were statistically significantly higher the procedure. Compared to the control group, the cases where the double-J stent was applied showed a higher IPSSs, IPSS-QOL and OABq scores and none of the medical therapies could prevent this increase. Interpretation: The frequency of LUTS increased in cases where the ureteral stent was applied and discomfort continued as long as the stent stayed in the body. IntroductionCystoscopic intraluminal placement of ureteral stents has become a routine practice in urology. Ureteral stents preserve urine flow from the kidney to the bladder in cases of ureteral obstruction (intrinsic or extrincis). In patients with obvious ureteral obstruction, the placement of a ureteral stent will restart urine transport and protect the kidney from possible risks. The stents also prevent urine extravasation after an operation or trauma.One of the most preferred stents is the double-J stent with J-shaped ends on both sides. Ureteral double-j stents are generally placed for a temporary period. The duration of the stent may differ due to the reason of the application and the experience of the doctor. Although double-J stents are generally safe and well-tolerated, they have complications, such as pain, discomfort, urinary infection, recurrent obstruction, stent encrustation, stent fragmantation and stent migration. Their negative effects on quality of life and sexual functions have also been emphasized by some researchers.1,2 Research is ongoing in developing and validating questionnaires on symptoms related to ureteral stents and the effects of these symptoms on daily life.A way to reduce symptoms related with stents might be to alter the design and material of the stents. Researchers continue to study the effect of several medical therapies on reducing the negative symptoms which affect quality of life. 1,3 In this study, we investigated whet...

α1-blockers for the reduction of ureteric stent-related symptoms: A systematic review and meta-analysis

“…IPSS scores for urinary tract symptoms were divided into voiding and storage symptoms sub-scores, which were respectively pooled in the present meta-analysis. Voiding and storage symptoms data were available in five (15,26,27,29,32) and six studies (15,26,27,29,31,32), respectively. In terms of the results of statistical analysis, significant differences in IPSS voiding symptom sub-scores (MD, -2.66; 95% CI, -4.36 to -0.96) were detected; however, no significant differences in IPSS storage symptom sub-scores (MD, -0.93; 95% CI, -2.28 to 0.43) were detected (Table IV).…”

“…Table I outlines the characteristics of each study included in the present meta-analysis. All included studies were RCTs; eight studies were performed in Asia, (24)(25)(26)(27)(28)31,32) three in Europe (13,16,22), two in Africa (15,29), and one in America (23). Participant ages ranged from 17-87 and the follow up periods were 1-6 weeks.…”

“…A Russian article published in Urologiia met the inclusion criteria according to the English abstract in PubMed; however it was subsequently excluded, since the full text could not be located (21). A total of 14 RCTs including 1,075 patients were included in the present meta-analysis (13,15,16,(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32).…”

“…In order to assess the quality of life of patients following the placement of an indwelling ureteral stent, the IPSS scores in seven studies (15,(25)(26)(27)29,31,32) and the USSQ scores in three studies (13,16,30) were pooled. In the α 1 -blockers groups, the IPSS (MD, -1.46; 95% CI, -2.64 to -0.28) and USSQ quality of life scores (MD, -0.69; 95% CI, -1.10 to -0.28) were significantly different, as compared with in the control groups (Table IV).…”

Spontaneous fracture of indwelling polyurethane ureteral stents: A case series and review of literature

“…Pain, bladder irritative symptoms and fever are signs of early complications related to polyurethane ureteral stents; moreover, late complications, such as encrustation, infections and fragmentation, are more troublesome. [3][4][5][6] Cases of fragmented ureteral stents are rare [7][8][9][10][11][12][13][14][15] and are classified as grade 3 on the Clavien Classification of Surgical Complications. 16 We present 4 cases of spontaneous polyurethanene ureteral stent fragmentation and review the literature to generate a summary for its risk factors as well as preventive strategies.…”