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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.
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![img](img/doctor_uti.png) |
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. |
4' |
https://pubmed.ncbi.nlm.nih.gov/37149059
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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.
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![img](img/doctor_uti.png) |
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. |
3' |
https://pubmed.ncbi.nlm.nih.gov/37285234/
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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.
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