Ureteric stent placement with extraction string: no strings attached?

Abstract

E 1 0 6 9What ' s known on the subject? and What does the study add? Of patients treated with an indwelling ureteric stent 80 -90% experience lower urinary tract symptoms that are a hindrance to health-related quality of life. The prevalence of the extraction/retrieval string after ureteroscopy for stone disease and stent placement varies signifi cantly between surgeons and published series, but the benefi ts of eliminating the need for a secondary procedure such as cystoscopy and stent removal, as well as the decrease in cost to the patient are well established.Published reports have not addressed the prevalence of post-procedure related events (PREs) in patients who have received an indwelling ureteric stent with the extraction/ retrieval string still intact after ureteroscopy for stone disease. By analysing PREs (Emergency Room visits, unscheduled clinic visits, and telephone calls) related to their stent or procedure for patients with and without an extraction/retrieval string, the feasibility of the extraction string can be validated and the misconceptions about their use can be alleviated. OBJECTIVE• To review a retrospective ureteric stent cohort with and without extraction string to compare post-procedure related events (PRE), as ureteric stent placement after endoscopic management of urolithiasis is common, but data regarding the potential benefi ts or disadvantages of ureteric stent placement with extraction string are sparse. PATIENTS AND METHODS• Between June 2009 and June 2010, 293 patients underwent ureteroscopy with or without lithotripsy for stone disease.• In all, 181 patients had a unilateral procedure and underwent stent placement postoperatively.• Records were retrospectively reviewed for operative data and PRE occurring within the fi rst 6 weeks after surgery, defi ned as unscheduled clinic or Emergency Room visits, or adverse event telephone calls. RESULTS• Of 181 patients who underwent ureteric stent placement, 43 (23.8%) included an extraction string.• In all, 34.3% of all patients had a PRE, including 37.2% and 33.3% of patients with and without extraction string, respectively ( P = 0.64).• PRE occurred in men with or without an extraction string (27.8 vs 32.4%, respectively; P = 0.71) and women with or without an extraction string (44.0 vs 34.3%, respectively, P = 0.39).• PRE occurred with relatively equal frequency between men and women ( P = 0.28).• Only two women (4.7%) reported removing their stent prematurely, on postoperative days 2 and 6. CONCLUSIONS• Ureteric stent placement with extraction string after ureteroscopy for stone disease does not seem to result in more PRE, regardless of gender.• Prospective randomised trials are needed to determine the benefi ts and disadvantages of ureteric stents with extraction string.

Patient Experiences and Preferences with Ureteral Stent Removal

“…Although studies have previously called into question the necessity of ureteral stenting after uncomplicated lithotripsy, 8,12 postoperative stent placement remains common and the question of whether to stent remains unresolved. 13 The results of this survey identify the morbidity that can be associated with stent removal and provides insight into the experiences and preferences of urologic patients who undergo these procedures.…”

“…We recognize that the choice of a specific method can be influenced by multiple factors, including cost, resources, and the risk of accidental dislodgement when a string is left in place. 12 Delayed pain after stent removal appears to be underappreciated by physicians. As a result, patients often report that they were not adequately counseled about this potential morbidity.…”

Forgotten Reminders: an Experience with Managing 28 Forgotten Double-J Stents and Management of Related Complications

“…A computerbased system that tracks ureteral stents and automatically sends a reminder to both the patient and the urologist's phones has been described [24]. BStents on strings^have been proposed where one end of the stent is tied to a string which is externalized for easy removal later [25]. Treatment of all cases with a DJ stent should be considered incomplete unless the stent is removed.…”

Tether your stents!

“… report on the results of a prospective randomised trial analysing stented patients with or without the extraction strings attached, for both quality of life and postoperative complications after ureteroscopy for stone disease. This follows on from a retrospective series previously reported by the same group . It is pleasing to see the authors, who originally concluded that randomised trials are needed in this area, actually get on and do the trial!…”