Predictors of morbidity in patients with indwelling ureteric stents: results of a prospective study using the validated Ureteric Stent Symptoms Questionnaire

Abstract

OBJECTIVE:\ud \ud To assess the predictors of morbidity in patients with indwelling ureteric stents using a validated questionnaire.\ud PATIENTS AND METHODS:\ud \ud Eighty-six consecutive patients with indwelling double-J ureteric stent of different length and size enrolled at an Italian tertiary academic centre were prospectively evaluated with the Italian-validated Ureteric Stent Symptoms Questionnaire (USSQ), which explores the stent-related symptoms in six domains. Ureteric stents were placed for benign ureteric obstruction or after uncomplicated ureterorenoscopy, and were all removed after 28 days. The questionnaire was administered on days 7 and 28 after stent placement and on day 28 after removal. A plain abdominal X-ray was performed on days 7 and 28 after placement to determine stent location. Univariable and multivariable analyses tested the association of patient age, sex and body mass index (BMI), and stent side, length, calibre and distal loop location, with the index score of the various domains on days 7 and 28.\ud RESULTS:\ud \ud All patients completed the study. At multivariable analysis, on day 7, sex, BMI and stent calibre were significantly associated with one domain (general health, body pain and work performance, respectively), while location of stent distal loop was significantly associated with five domains (urinary symptoms, body pain, general health, work performanc, and sexual matters). On day 28, body mass index was significantly associated with two domains (body pain and general health), while location of stent distal loop remained significantly associated with the same five domains (urinary symptoms, body pain, general health, work performance and sexual matters).\ud CONCLUSION:\ud \ud Location of stent distal loop with respect to midline had the strongest association with most domains of the USSQ on both days 7 and 28 after stent placement. The visualization of stent distal loop crossing the midline may therefore identify patients at higher risk of post-procedural morbidity requiring early management

Effects of Terazosin and Tolterodine on Ureteral Stent Related Symptoms: A Double-Blind Placebo-Controlled Randomized Clinical Trial

“…Some studies concerning the stent position have argued that crossing the stent distal apart from bladder midline was significantly related to ureteral stent discomforts (7,24). Considering this issue, all of the patients in the present study underwent X-ray imaging after stenting to confirm the proper stent placement.…”

“…Some etiologies have been hypothesized for their complications including mechanical irritation of the bladder trigone, urine renal reflux resulting obstruction, bacterial colonization, stent positioning as well as stent size and design (1,3,(6)(7)(8)(9)(10). Strategies for managing stent complications include accurate stent indications, stenting maneuvers, stent design and use of medications (1,3).…”

Ureteric stent placement with extraction string: no strings attached?

“…It is possible that variability in surgical technique could lead to a discrepancy in PRE, based on factors other than the stent string itself. In a recent prospective study using the Ureteric Stent Symptoms Questionnaire (USSQ), the authors found that the most important factors for stent tolerability were gender, with women reporting more of an effect on general health, and whether or not the distal stent coil crossed midline [ 9 ] . The study did not report on whether an extraction string was left in place and did not seek to determine if any intraoperative variables were associated with stent symptoms postoperatively.…”

Prevention and treatment of symptoms associated with indwelling ureteral stents: A systematic review

“…38 Giannarini et al were the first to investigate this question using the USSQ. 39 They tried to identify predictors of morbidity in a prospective evaluation of 86 patients undergoing temporary ureteral stenting. In a multivariate analysis, the location of the distal stent loop showed the strongest association with most of the USSQ-domains at both 7 and 28 days after insertion.…”

“…These findings were confirmed by a further small non-randomized trial by Damiano et al 43 Furthermore, other studies investigated stent diameter as a secondary outcome measure, and found no influence on the associated SRS. 39,44 Summarized, although there is a lack of well-designed trials of adequate power, it seems that SRS cannot be influenced by stent diameter.…”