Investig Clin Urol.  2017 Nov;58(6):440-446. 10.4111/icu.2017.58.6.440.

Impact of loop-tail ureteral stents on ureteral stent-related symptoms immediately after ureteroscopic lithotripsy: Comparison with pigtail ureteral stents

• Taguchi M
• Inoue T
• Muguruma K
• Murota T
• Kinoshita
• Matsuda T

• KMID: 2414772
• DOI: http://doi.org/10.4111/icu.2017.58.6.440

Abstract

PURPOSE
To evaluate urination-related quality of life (QoL) in patients with an indwelling ureteral stent immediately after ureteroscopic lithotripsy (URSL) for upper urinary calculi. We compared the effects of loop-tail and pigtail ureteral stents on urination-related QoL.
MATERIALS AND METHODS
Of 135 patients who underwent URSL between May 2014 and March 2015 at our hospital, we retrospectively analyzed the records of 70 patients (42 men, 28 women; median age, 63 years) in whom the stent tail was positioned inside the bladder without crossing the midline and who completed the core lower urinary tract symptoms score (CLSS) questionnaire pre- and postoperatively.
RESULTS
There were significant differences in incomplete emptying (p=0.048) and bladder pain (p=0.041) between patients with loop-tail versus pigtail ureteral stents after URSL. In the multivariate analysis, stent type had a stronger association with incomplete emptying (p=0.022) and bladder pain (p=0.018) than age, sex, body mass index, stent side, operation time, diameter of ureteral access sheath, and stent type.
CONCLUSIONS
Patients with loop-tail ureteral stents had better urination-related QoL in the immediate post-URSL stage than patients with pigtail stents.

Keyword

Lower urinary tract symptoms; Stents; Ureter

MeSH Terms

Body Mass Index
Female
Humans
Lithotripsy*
Lower Urinary Tract Symptoms
Male
Multivariate Analysis
Quality of Life
Retrospective Studies
Stents*
Tail
Ureter*
Urinary Bladder
Urinary Calculi

Reference

1. Zimskind PD, Fetter TR, Wilkerson JL. Clinical use of long-term indwelling silicone rubber ureteral splints inserted cystoscopically. J Urol. 1967; 97:840–844. PMID: 6025928.

2. Başeskioğlu B, Sofikerim M, Demirtaş A, Yenilmez A, Kaya C, Can C. Is ureteral stenting really necessary after ureteroscopic lithotripsy with balloon dilatation of ureteral orifice? A multi-institutional randomized controlled study. World J Urol. 2011; 29:731–736. PMID: 21590466.

3. Joshi HB, Okeke A, Newns N, Keeley FX Jr, Timoney AG. Characterization of urinary symptoms in patients with ureteral stents. Urology. 2002; 59:511–516. PMID: 11927301.

4. Lingeman JE, Preminger GM, Goldfischer ER, Krambeck AE. Comfort Study Team. Assessing the impact of ureteral stent design on patient comfort. J Urol. 2009; 181:2581–2587. PMID: 19375088.

5. Kawahara T, Ito H, Terao H, Ogawa T, Uemura H, Kubota Y, et al. Changing to a loop-type ureteral stent decreases patients' stent-related symptoms. Urol Res. 2012; 40:763–767. PMID: 22899382.

6. Damiano R, Autorino R, De Sio M, Cantiello F, Quarto G, Perdonà S, et al. Does the size of ureteral stent impact urinary symptoms and quality of life? A prospective randomized study. Eur Urol. 2005; 48:673–678. PMID: 16039775.

7. Hendlin K, Vedula K, Horn C, Monga M. In vitro evaluation of ureteral stent compression. Urology. 2006; 67:679–682. PMID: 16600353.

8. Joshi HB, Chitale SV, Nagarajan M, Irving SO, Browning AJ, Biyani CS, et al. A prospective randomized single-blind comparison of ureteral stents composed of firm and soft polymer. J Urol. 2005; 174:2303–2306. PMID: 16280829.

9. Pedro RN, Hendlin K, Kriedberg C, Monga M. Wire-based ureteral stents: impact on tensile strength and compression. Urology. 2007; 70:1057–1059. PMID: 18158013.

10. Joshi HB, Newns N, Stainthorpe A, MacDonagh RP, Keeley FX Jr, Timoney AG. Ureteral stent symptom questionnaire: development and validation of a multidimensional quality of life measure. J Urol. 2003; 169:1060–1064. PMID: 12576846.

11. Joshi HB, Stainthorpe A, Keeley FX Jr, MacDonagh R, Timoney AG. Indwelling ureteral stents: evaluation of quality of life to aid outcome analysis. J Endourol. 2001; 15:151–154. PMID: 11325084.

12. Miyaoka R, Monga M. Ureteral stent discomfort: Etiology and management. Indian J Urol. 2009; 25:455–460. PMID: 19955667.

13. Homma Y, Yoshida M, Yamanishi T, Gotoh M. Core Lower Urinary Tract Symptom score (CLSS) questionnaire: a reliable tool in the overall assessment of lower urinary tract symptoms. Int J Urol. 2008; 15:816–820. PMID: 18657204.

14. Fujimura T, Kume H, Nishimatsu H, Sugihara T, Nomiya A, Tsurumaki Y, et al. Assessment of lower urinary tract symptoms in men by international prostate symptom score and core lower urinary tract symptom score. BJU Int. 2012; 109:1512–1516. PMID: 21883834.

15. Fujimura T, Kume H, Tsurumaki Y, Yoshimura Y, Hosoda C, Suzuki M, et al. Core lower urinary tract symptom score (CLSS) for the assessment of female lower urinary tract symptoms: a comparative study. Int J Urol. 2011; 18:778–784. PMID: 21951201.

16. Kuehhas FE, Miernik A, Sharma V, Sevcenco S, Javadli E, Herwig R, et al. A prospective evaluation of pain associated with stone passage, stents, and stent removal using a visual analog scale. Urology. 2013; 82:521–525. PMID: 23768523.

17. Olvera-Posada D, Suárez-Santos M, Castillejos-Molina R, Gabilondo-Navarro F, Méndez-Probst CE. Validation of the Spanish version of Ureteral Stent Symptom Questionnaire: prevalence of symptoms in a tertiary care center in Mexico. J Endourol. 2014; 28:377–382. PMID: 24112085.

18. Giannarini G, Keeley FX Jr, Valent F, Manassero F, Mogorovich A, Autorino R, et al. Predictors of morbidity in patients with indwelling ureteric stents: results of a prospective study using the validated Ureteric Stent Symptoms Questionnaire. BJU Int. 2011; 107:648–654. PMID: 20590539.

19. Abt D, Mordasini L, Warzinek E, Schmid HP, Haile SR, Engeler DS, et al. Is intravesical stent position a predictor of associated morbidity? Korean J Urol. 2015; 56:370–378. PMID: 25964838.

20. Rane A, Saleemi A, Cahill D, Sriprasad S, Shrotri N, Tiptaft R. Have stent-related symptoms anything to do with placement technique? J Endourol. 2001; 15:741–745. PMID: 11697408.

21. Ho CH, Chen SC, Chung SD, Lee YJ, Chen J, Yu HJ, et al. Determining the appropriate length of a double-pigtail ureteral stent by both stent configurations and related symptoms. J Endourol. 2008; 22:1427–1431. PMID: 18613783.

22. Tang L, Gao X, Xu B, Hou J, Zhang Z, Xu C, et al. Placement of ureteral stent after uncomplicated ureteroscopy: do we really need it? Urology. 2011; 78:1248–1256. PMID: 21762964.

23. Park HK, Paick SH, Kim HG, Lho YS, Bae S. The impact of ureteral stent type on patient symptoms as determined by the ureteral stent symptom questionnaire: a prospective, randomized, controlled study. J Endourol. 2015; 29:367–371. PMID: 25153249.

24. Sanguedolce F, Millán-Rodriguez F, Santillana-Altimira JM, Fantova-Alonso A, Sánchez-Martín FM, Angerri-Feu O, et al. The Spanish linguistic validation of the ureteral stent symptom questionnaire. J Endourol. 2014; 28:237–242. PMID: 24032342.

25. Dellis AE, Keeley FX Jr, Manolas V, Skolarikos AA. Role of α-blockers in the treatment of stent-related symptoms: a prospective randomized control study. Urology. 2014; 83:56–61. PMID: 24210570.

26. Calvert RC, Wong KY, Chitale SV, Irving SO, Nagarajan M, Biyani CS, et al. Multi-length or 24 cm ureteric stent? A multicentre randomised comparison of stent-related symptoms using a validated questionnaire. BJU Int. 2013; 111:1099–1104. PMID: 22882647.

27. Davenport K, Kumar V, Collins J, Melotti R, Timoney AG, Keeley FX Jr. New ureteral stent design does not improve patient quality of life: a randomized, controlled trial. J Urol. 2011; 185:175–178. PMID: 21074809.