Ureteral Stent Designs to Reduce Stent-Related Symptoms and Improve Patient Quality of Life

Abstract

Considering the impact on the quality of life of patients caused by double-J stents, different strategies have been developed to improve their performance. The exploration of new ureteral stent designs is one of the main pathways, along with the development of materials and coatings. Innovations on stent design have focused on the improvement of patient comfort by mainly decreasing or suppressing vesicoureteral reflux and reducing bladder trigone irritation. Many of these designs are based on changes at the distal end, such as antireflux stents, tail stents, suture stents and intraureteral stents. The trend is therefore towards the reduction of the presence of stent material at the level of the ureterovesical junction. However, the indications of these new designs do not correspond to those of a standard ureteral stent and may be more limited. This will most likely lead to the development of more specific devices adapted to each of the different indications for stenting, with the aim of avoiding stent-related adverse effects that result from the generalized use of standard designs.

Antireflux Ureteral Stents Prevent Stent-Related Symptoms: A Meta-Analysis of Randomized Controlled Trials

“…These stents aim to reduce SRS by minimizing vesicoureteral reflux, which is commonly observed with conventional stents [ 1 ]. The antireflux membrane valve, highlighted by Ecke et al [ 5 , 6 ], is clinically accessible and employs a silicone membrane situated at the vesical end of the double J stent (JJ stent/DJS), forming a one-way valve, thereby obstructing intraluminal vesicoureteral reflux (VUR) upon escalation of bladder pressure. Introduced by Park et al [ 5 , 7 ], the polymeric flap valve is affixed to the vesical edge of the DJS, leveraging the differential pressures between the bladder and ureter to prevent retrograde urine flow; its efficacy was substantiated in vivo by Kim et al [ 5 , 8 ].…”

“…The antireflux membrane valve, highlighted by Ecke et al [ 5 , 6 ], is clinically accessible and employs a silicone membrane situated at the vesical end of the double J stent (JJ stent/DJS), forming a one-way valve, thereby obstructing intraluminal vesicoureteral reflux (VUR) upon escalation of bladder pressure. Introduced by Park et al [ 5 , 7 ], the polymeric flap valve is affixed to the vesical edge of the DJS, leveraging the differential pressures between the bladder and ureter to prevent retrograde urine flow; its efficacy was substantiated in vivo by Kim et al [ 5 , 8 ]. An innovative design demonstrated by Vogt et al avoids the traditional bladder pigtail of the DJS in favor of a silicone piece with antireflux functionality positioned at the ureteral orifice [ 9 , 10 ].…”