Comparison of stent-related symptoms, passive ureter dilatation and stone clearance rate using 4.5 French versus 6 French double J stenting of unfavourable ureter: a prospective randomized controlled trial in a tertiary care centre

Authors

  • Manu K. Nagabhairava Department of Urology, M. S. Ramaiah Medical College, Bengaluru, Karnataka, India
  • Tarun Javali Department of Urology, M. S. Ramaiah Medical College, Bengaluru, Karnataka, India
  • Manasa T. Department of Urology, M. S. Ramaiah Medical College, Bengaluru, Karnataka, India
  • Sandeep Puvvada Department of Urology, M. S. Ramaiah Medical College, Bengaluru, Karnataka, India
  • Amit Patil Department of Urology, M. S. Ramaiah Medical College, Bengaluru, Karnataka, India
  • Ramesh D. Department of Urology, M. S. Ramaiah Medical College, Bengaluru, Karnataka, India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20240938

Keywords:

Renal stones, RIRS, Stent diameter, Stent related symptoms, USSQ score, Ureteral stent

Abstract

Background: Retrograde intrarenal surgery (RIRS) is the standard of care for renal stones of less than 1.5 cm and less than 1000 Hounsfield units (HU). Most virgin ureters do not allow the flexible ureteroscope in the first setting. Placement of a D-J stent in the ureter dilates the ureter. Therefore, our study aimed to compare stone clearance rates and symptom complex of passive ureteral dilation following 4.5 French/Fr versus 6 French/Fr double J (DJ) stent placement.

Methods: After obtaining ethics approval and written informed consent, 100 patients satisfying the inclusion and exclusion criteria were included and data recorded. patients were randomized into group A (4.5 Fr) and group B (6 Fr). Stent was placed. After 4 weeks, symptoms were assessed by the ureteral stent symptom questionnaire (USSQ). Following retrograde intrarenal surgery (RIRS) successful passage of ureteric access sheath (UAS) and stone clearance rates were assessed.

Results: The surgical success rate, stone clearance rate was similar in the two groups (p value: more than 0.05). The USSQ score was significantly lower in group A (p value: 0.001).

Conclusions: Stent of smaller diameter (4.5 Fr) is associated with less patient discomfort with similar surgical completion rates and stone clearance.

References

Neisius A, Preminger GM. Stones in 2012: epidemiology, prevention and redefining therapeutic standards. Nat Rev Urol. 2013;10:75-7.

Candela J, Bellman GC. Ureteral stents: Impact of diameter and composition on patient symptoms. J Endourol. 1997;11:(1):45-7.

Zimskind PD, Fetter TR, Wilkerson JL. Clinical use of long-term indwelling silicone rubber ureteral splints inserted cystoscopically. J Urol. 1967;97:840-4.

Mosayyebi A, Manes C, Carugo D, Somani BK. Advances in ureteral stent design and materials. Curr Urol Rep. 2018;19:(5):1-9.

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:(7):741-5.

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;48:673-8.

Erturk E, Sessions A, Joseph JV. Impact of ureteral stent diameter on symptoms and tolerability. J Endourol. 2003;17:(2):59-62.

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;169:1060-4.

Cubuk A, Yanaral F, Ozgor F, Savun M, Ozdemir H, Erbin A, et al. Comparison of 4.8 Fr and 6 Fr ureteral stents on stent related symptoms following ureterorenoscopy: A prospective randomized controlled trial. Kaohsiung J Med Sci. 2018;34:(12):695-9.

Kim BS, Choi JY, Jung W. Does a Ureteral Stent with a Smaller Diameter Reduce Stent-Related Bladder Irritation? A Single-Blind, Randomized, Controlled, Multicenter Study. J Endourol. 2020;34(3):368-72.

Nestler S, Witte B, Schilchegger L, Jones J. Size does matter: ureteral stents with a smaller diameter show advantages regarding urinary symptoms, pain levels and general health. World J Urol. 2020;38(4):1059-63.

Diatmika A, Djojodimedjo T, Kloping YP, Hidayatullah F, Soebadi MA. Comparison of ureteral stent diameters on ureteral stent-related symptoms: A systematic review and meta-analysis. Turk J Urol. 2022;48(1):30-40.

Lee JN, Kim BS. Comparison of efficacy and bladder irritation symptoms among three different ureteral stents: A double-blind, prospective, randomized controlled trial. Scand J Urol. 2015;49:237-41.

Lee SJ, Yoo C, Oh CY, Lee YS, Cho ST, Lee SH, et al. Stent position is more important than alpha-blockers or anticholinergics for stentrelated lower urinary tract symptoms after ureteroscopic ureterolithotomy: A prospective randomized study. Korean J Urol. 2010;51:636-41.

Aggarwal SP, Priyadarshi S, Tomar V, Yadav SS, Gangkak G, Vyas N, et al. A randomized controlled trial to compare the safety and efficacy of tadalafil and tamsulosin in relieving Double J stent related symptoms. Adv Urol. 2015;2015:592175.

Oh JJ, Lee S, Cho SY, Lee SW, Cho MC, Na W, et al. Effects of naftopidil on Double-J stent-related discomfort: A multicenter, randomized, double-blinded, placebo-controlled study. Sci Rep. 2017;7:4154.

Downloads

Published

2024-04-06

How to Cite

Nagabhairava, M. K., Javali, T., T., M., Puvvada, S., Patil, A., & D., R. (2024). Comparison of stent-related symptoms, passive ureter dilatation and stone clearance rate using 4.5 French versus 6 French double J stenting of unfavourable ureter: a prospective randomized controlled trial in a tertiary care centre. International Journal of Research in Medical Sciences, 12(5), 1475–1478. https://doi.org/10.18203/2320-6012.ijrms20240938

Issue

Section

Original Research Articles