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

Abstract

Temporary drainage of the upper urinary tract by internal ureteral stents is a routine procedure in endourology. However, it is associated with a clear side-effect profile. Our aim was to evaluate prevention and treatment options of stent-related symptoms. We carried out a systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines using MEDLINE and SCOPUS, and identified 107 appropriate records. A high number of these studies showed clear methodological limitations. Available data clearly support the use of a 1 -blockers in patients suffering from stent-related symptoms. It seems that antimuscarinic monotherapy or combination with a 1 -blockers might also play an important role, whereas the use of classical analgesics in the treatment of stent-related symptoms has not been assessed systematically within clinical trials so far. Improvements in stent design and material seem to have the potential to reduce stent-related symptoms. However, so far there is no type of stent with outstanding characteristics and clear evidence suggesting fundamental advantages compared with a standard double pigtail stent. Although stent diameter does not seem to influence patients' comfort, it seems to be beneficial to choose a proper stent-length. Coated and drug-eluting stents, as well as intravesical drug application, seem to be promising concepts to prevent stent-related symptoms, but still have to be considered as experimental approaches. Furthermore, thorough patient education has the potential to reduce the morbidity associated with ureteral stenting. Further research in the field seems to be mandatory.

Comparison of 4.8 Fr and 6 Fr ureteral stents on stent related symptoms following ureterorenoscopy: A prospective randomized controlled trial

“…A recent review published by Bestchart et al. has showed that LUTS were increased up to 60% after stent insertion [10]. In accordance with the literature, our study showed that ureteral stent insertion caused increasing scores on sections about LUTS of USSQ in groups 1 and 2 compared to the control group.…”

“…The previous studies hypothesize that ureteric contractions and trigonal irritations due to ureteral stents and vesicorenal reflux through the ureteral stents lead to lower urinary tract symptoms (LUTS) [14]. A recent review published by Bestchart et al has showed that LUTS were increased up to 60% after stent insertion [10]. In accordance with the literature, our study showed that ureteral stent insertion caused increasing scores on sections about LUTS of USSQ in groups 1 and 2 compared to the control group.…”

“…In the literature, the stent sizes, lengths, materials and some medications (anticholinergic and alpha blocker) were studied to decrease stent‐related symptoms. However, to date, an optimal strategy to decrease stent‐related symptoms is unclear [10].…”

Feline ureteral obstructions Part 2: surgical management

“…Since that time, multiple design iterations, including introduction of the "Double J" configuration, which was designed to prevent migration into the kidney and bladder in 1978 (Finny 1978). Indwelling ureteral stents cause passive dilation of the ureter within the days to weeks after placement, facilitating stone passage and urine drainage (Berent 2011, Adin & Scansen 2011, Lennon 1997, Betschart 2017. In human urology, ureteral stents are most commonly used after ureterolith intervention, such as ureteroscopy and extracorporeal shockwave lithotripsy (SWL; Haleblian et al 2008).…”

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

“…2,3 Betschart 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 blockersespecially tamsulosin and alfuzosinreduced stent-related symptoms in seven randomized control studies.…”