Reduction of stent‐associated morbidity by minimizing stent material: a prospective, randomized, single‐blind superiority trial assessing a customized ‘suture stent’

Abstract

To compare a customized 'suture stent' with a standard ureteric stent regarding stent-related symptoms, safety and efficacy. Materials and MethodsPatients with urolithiasis located proximal to the iliac vessel crossing, requiring stenting in preparation for secondary ureterorenoscopy (URS) were randomized to standard ureteric stenting or a suture stent. Secondary ureterorenoscopy was performed 2-6 weeks later. The Ureteral Stent Symptoms Questionnaire (USSQ) was completed after 1 week, on the day before URS and 2-6 weeks after stent removal. Stent efficacy and safety were systematically assessed. ResultsA total of 88 patients were included in the analysis. The median (range) suture stent length was 10 (5-25) cm vs 26 cm for standard stents. Operation time was longer for insertion of the suture stent (24.0 vs 14.5 min; P < 0.001). Patients with a suture stent had a significantly lower USSQ urinary symptoms score 1 week after stent insertion, adjusted for baseline symptoms by subtracting scores from the final visit without indwelling stent (mean 7.1 vs 13.7, difference À6.6, 95% confidence interval [CI] À3.4 to À9.8; P < 0.001). Prior to secondary URS (after 2-6 weeks), baseline-adjusted urinary symptoms (mean 4.7 vs 12.2, difference À7.5, 95% CI À4.5 to À10.4; P < 0.001) and pain subscores (11.5 vs 17.6, difference À6.1, 95% CI À0.7 to À11.6; P = 0.004) were significantly lower in the suture stent group. All other USSQ subscores showed no significant differences. Adverse events occurred in 15 patients and were similarly frequent in the two groups. No significant differences were found between the groups regarding ureteric access during secondary URS. ConclusionReplacement of the distal part of ureteric stents by a suture can reduce stent-associated symptoms without restrictions regarding secondary stone removal or safety.

10-Year Experience with Reinforced Ureteral Stents for Malignant Ureteral Obstruction

“…11,25,26 In recent studies including randomization and patient blinding, the results confirmed that suture stent like JFil ® significantly improved patient comfort. 27,28 About one third of the patients in our study were fitted with these innovative stents. The top priority for future stents suitable for malignant diseases should be to integrate the importance of stent stiffness and shape according to the data of our current knowledge.…”

Characterization of Sonic Hedgehog/Gli1 Signal Expression in Human Ureter Either Un-Stented or Fitted with Double-Pigtail Stent or a Thread

“…2,3 The pigtail-suture stent (JFil ® or MiniJFil ® ) was developed as a means of decreasing urinary symptoms. 4,5 Fortuitously, we discovered that the sutures had surprising properties, and a clear dilation of the ureter without inflammation was observed around the suture. 4 However, the mechanisms involved in the ureteral dilation are still unknown.…”

“…Gli1 is the primary target of Hedgehog pathway activation and serves as a reliable indicator of Hedgehog signaling. 5 The authors were interested in Shh signaling because inactivating Shh in the mouse fetus resulted in hydroureter and overall aperistalsis. 8 Moreover, Shh signaling was important in regulating injury repair and wound healing after tissue damage.…”

Inhibition of Bacterial Biofilm Formation on Ureteral Stent Surface by Jelleine-1 Hydrogel Coating Doped with Copper Nanoparticles

“…The risk factors for colonized bacteriuria are longer indwelling time of the ureteral stent, diabetes, female sex, chronic renal failure, diabetic nephropathy, and cancer, among which the indwelling time of the stent is the only changeable risk factor [17][18][19] . Currently, there are many strategies for ureteral stent, including stent coating [20] , surface modi cation [21] , reduction of stent materials [22] , and biodegradable stent [23] .…”