#02 Click here to see the previous editions July 8, 2023
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Welcome to STENT News! In this newsletter, we will cover about the most relevant evidence in the use and development of stents, catheters and another indwelling urological devices. Stay tuned for updates and insights on this important topic.

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Dear Stent Fans. Welcome to the spring issue of Stent News.

In our second newsletter, we have three interesting scientific papers related to ureteral stents. The first addresses the very interesting issue of how patients can provide feedback to urologists in the common procedure of stent removal. The patients' point of view is crucial to improve routine procedures. In a second chosen paper, the researchers address a very significant issue, the duration of stenting and the appearance of symptomatology that leads to an unexpected visit to the emergency department after stent removal. A very interesting paper, which has a great application to daily urological activity. Thirdly, I have selected a research and development paper in the biomaterials and bioengineering areas, such as the concept of the first so-called " intelligent " stents.

I hope they will be of interest to you.

img Patients’ experience with the removal of a ureteral stent: Insights from in-depth interviews with participants in the USDRN STENTS qualitative cohort study. Urology, 2023.
Dombeck C, et al.
img 4'
https://pubmed.ncbi.nlm.nih.gov/37149059 img

Another interesting study in patients enrolled in the STENTS (STudy to Enhance uNderstanding of sTents-associated Symptoms). In this paper the researchers focus on assessing a lesser-known aspect of patients' experiences with ureteral stents - stent removal from the patients' point of view. STENTS is a prospective, observational cohort study focused on enhancing understanding of patients’ stent-associated symptoms after ureteroscopy with short-term ureteral stenting.

The study was conducted through recorded interviews, in which 38 patients spoke about stent removal. Participants were interviewed an average of 18 days following stent removal.

The most interesting findings that should help urologists to be aware of patients' opinions can be summarized as follows:

-Pain and discomfort. Almost all patients described experiencing either pain or discomfort at some point during stent removal, with slightly more reporting pain than discomfort.

-Psychological responses. Most of them described anxiety related to the procedure. Participants explained that prior expectations about stent removal influenced their feelings leading up to the procedure, with some expressing a general sense that removal would be unpleasant. Close to 30% commented on discomfort arising from lack of privacy, embarrassment, or feeling exposed.

-Medical personnel interactions. Patients ask for more information about the procedure and to be told about the discomfort associated with it.

-Symptoms the day of removal. Patients said that any pain or discomfort experienced during stent removal was of short duration, and the speed of removal was quick and easy. A third of participants stated that they experienced pain on the day of removal, with sensation as “cramps” or “spams” located in the kidneys, back or urethra.

-Symptoms in the days after removal. A majority of patients experienced complete symptom relief within a day of stent removal, a third of participants reported that they were not free from symptoms for 2-3 days.

This is the first qualitative study to explore patients' experiences with cystoscopic removal of a post-ureteroscopic ureteral stent. Significantly, patients revealed feelings of anxiety prior to stent removal, as well as discomfort due to lack of privacy, embarrassment or feeling exposed. These findings shed light on opportunities for improving provider communication about the ureteral stent removal process and its aftermath.

The most important, patients described that knowing what to expect during the procedure helped them to feel less anxious. Urologists may be able to mitigate psychological discomfort during the stent removal procedure through education and communication, with particular focus on topics that may reduce anticipatory anxiety and manage expectations for the process, including symptomatology following stent removal.

img What is the Optimal Stenting Duration After Ureteroscopy and Stone Intervention? Impact of Dwell Time on Postoperative Emergency Department Visits. J Urol. 2023.
Ghani KR et al.
img 3'
https://pubmed.ncbi.nlm.nih.gov/37285234/ img

The guidelines recommend minimizing the duration of stenting after ureteroscopy to reduce morbidity, and stents with extraction strings may be used for this purpose. The AUA guideline panel recommended 3 to 7 days of stenting following uncomplicated ureteroscopy, and stents with extraction strings may be used for this purpose.

Benefits of stents with extraction strings are lower health care costs in terms of an office visit and procedure and increased patient convenience. However, studies have shown extraction strings are associated with dislodgment. Authors assessed the relationship between stent dwell time, extraction string status and risk of postoperative emergency department visit on the day of day after stent removal.

A total of 4.437 cases of primary ureteroscopy and stenting were analyzed. 38% had an extraction string. Median dwell time with strings was significantly shorter, 5 days versus 9 days without. Significant factors impacting stent duration included string use, age, prior surgery and use of ureteral access sheath.

Procedures with a string were in younger patients, with higher frequency of previous stone surgery, lower frequency of ureteral stone location and smaller stones. Patients with string stents had a higher rate of alpha blocker postoperative prescription.

9.6% patients had a postoperative Emergency department (ED) visit within 30 days of ureteroscopy. Patients with a string had a higher visit emergency department rate on the day of stent removal or day after compared to those without a string ureteral stent, with statistical significance.

Patients with extraction string had significantly shorter dwell times. The dwell time of 0-4 days was significantly associated with an increased ED visits. There were no statistically significant increase in risk of ED visits in patients with a string if dwell times were more >5 days.

The authors' conclusions are quite straightforward in this regard, a ureteral stenting of 4 days or less is associated with an increase in postoperative ED visits around the time of stent removal. They recommended a minimum dwell time of at least 5 days.

img Electromechanically Functionalized Ureteral Stents for Wireless Obstruction Monitoring. ACS Biomater Sci Eng. 2023.
Darestani YMR, et al.
img 3'
https://pubmed.ncbi.nlm.nih.gov/37276260/ img

The authors of this experimental study assess a new ureteral stent design. Currently, an aim in the development of new ureteral stents is that in addition to their known indications to improve upper urinary tract drainage and to help as an internal scaffold, ureteral stents should have other applications. In this sense, different research groups focus their interest in developing new drug-eluting stents or stents capable of measuring some urodynamic parameters.

In the case of this experimental study, researchers evaluate a new design of “intelligent double-J ureteral stent” equipped with a micro pressure sensor and antenna circuitry to monitor kidney pressure to detect a ureteral obstruction and the resultant hydronephrosis. The size micro-sensor is: 0.85 mm high; 1.4mm wide and 1.4 mm length.

The researchers assess in an in vitro simulator test a sensor-integrated wireless biocompatible ureteral stent to continuous kidney pressure monitoring to early detection of hydronephrosis. The results of this interesting study suggest the applicability of the developed new device to the wireless sensing and detection kidney pressure, without the need for a battery.

Future use of a pressure-sensing ureteral stent will help improve patient care in a timely fashion while reducing healthcare costs by delivering a constant, low-cost pressure sensing system.

These experimental studies are opening up an exciting new development world that can improve and expand the indications for ureteral stents. Not for all patients of course, but these new lines of development will allow improvements in current stents and above all to personalize stents for patients.

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