STONE DISEASE

Self-Retaining Ureteral Stents: Analysis of Factors Responsible For Patients’ Discomfort
El-Nahas AR, El-Assmy AM, Shoma AM, Eraky I, El-Kenawy MR, El-Kappany HA
Mansoura Urology & Nephrology Center, Mansoura, Egypt
J Endourol. 2006; 20: 33-7

• Purpose: To determine factors affecting patients’ discomfort during the period self-retaining ureteral stents are in place.
• Patients and Methods: Between April 2001 and May 2003, 58 male and 42 female patients underwent temporary double-pigtail stenting. The indications were endopyelotomy in 39 patients, ureteroscopy in 32, laparoscopic pyeloplasty in 18, and endoureterotomy in 11. The stents were silicone in 56 patients and Percuflex in 44. The median stenting period was 8 weeks (range 4-16 weeks). Patient discomfort was evaluated by a questionnaire conducted by the physician before stent removal. Tested variables were patients’ sex, side of the stent, urine culture, stent material, stent length and diameter, and stenting duration. The site of the upper coil (renal pelvis or calix), the site of the lower coil (in the same side or crossing the midline), and the shape of the lower coil (complete circle or not) were also tested. Univariate and multivariate analysis were carried out to determine significant independent variables, with P < 0.05 being significant.
• Results: Of the total, 59 patients experienced discomfort consisting of dysuria, urgency, urge incontinence, loin pain, suprapubic pain, frequency, nocturia, or gross hematuria or some combination. Significant factors associated with discomfort were a positive urine culture, crossing of the lower end of the stent to the opposite side, caliceal position of the upper coil, and longer stenting duration.
• Conclusion: Proper positioning of the coils of the stent, eradication of infection, and shorter stenting duration are advised to decrease patient discomfort during the period of ureteral stenting.
  
  
• Editorial Comment
  The authors confirm the significant impact ureteral stents have on patient comfort and quality of life, and they identify the following 3 variables that affect stent morbidity: Location! Duration! Infection! Though previous studies evaluating patient comfort have attempted to focus on stenting of a symptomatic ureteral stone or stenting after uncomplicated ureteroscopy, this study included patients undergoing a wide variety of endourological and laparoscopic procedures. Pain measurements may therefore have been confounded by urinary extravasation after endopyelotomy, port site pain, diaphragmatic irritation by carbon dioxide or other variables. In addition, the length and size of stent used was not standardized. The stent duration in this study was long - typically, we leave a ureteral stent for 4-7 days after an uncomplicated ureteroscopy and 2-3 weeks after an endopyelotomy or endoureterotomy. Noting these limitations, it is important to consider some of the simple method proposed by this study to decrease stent discomfort. Intraoperatively, one should ensure proper positioning of the stent coils such that the bladder coil does not cross midline and the renal coil is in the pelvis. Postoperatively if the patient reports discomfort it may be important to perform a urine culture and eradicate any infection. Lastly, shortening the duration of stenting should be emphasized.

Dr. Manoj Monga
Professor, Department of Urology
University of Minnesota
Edina, Minnesota, USA