A prospective comparative study of ureterorenoscopy with and without DJ stenting for the management of ureteric stones

Authors

  • Dinesh Prasad Department of General Surgery, SMIMER, Surat, Gujarat, India
  • Yogesh Satani Department of General Surgery, SMIMER, Surat, Gujarat, India
  • Shivam Singh Department of General Surgery, SMIMER, Surat, Gujarat, India
  • Darpen Gajera Department of General Surgery, SMIMER, Surat, Gujarat, India

DOI:

https://doi.org/10.18203/2349-2902.isj20214753

Keywords:

URS with DJ stenting, URS without DJ stenting, Ureteric Stones, Stone free rate

Abstract

Background: Urolithiasis is the most common urological disease. Surgical treatment of ureteral stones consists of four minimally invasive modalities including ESWL, URS, PCNL, and laparoscopic or robotic-assisted stone surgery. URS and ESWL are the most widely used techniques. However, the use of ureteral stents for the treatment of ureteral stones is still controversial. Herein, we did a comparative study of URS with and without DJ stenting for the management of ureteric stones. Objectives of current study were to compare prevalence of post-operative complications in patients undergoing ureterorenoscopy without ureteral stenting as compared to patients undergoing stenting procedure, to study the frequency of morbidity in patients during post -operative period in both ‘stent’ and ‘no stent’ groups. Stone free-rate, operative time, complications, hospital stay and need for re-treatment in both groups will be determined.

Methods: 50 patients with ureteric stones admitted in our hospital-SMIMER fulfilling our inclusion and exclusion criteria were randomly divided in two groups- patients in group A (25) underwent URS without DJ stenting and group B (25) underwent URS with DJ stenting.

Results: URS without DJ stenting had less operative time, less postoperative complications like pain, requirement of analgesia, hematuria, UTI, dysuria, fever, less readmission rate and less hospital stay, similar stone free rate compared to URS with DJ stenting but it requires higher surgical endoscopy skills with urological expertise.

Conclusions: Thus, after adequate training, URS without DJ stenting can be recommended as a safe alternative procedure than URS with DJ stenting for management of ureteric stones.

 

References

Boyce CJ, Pickhardt PJ, Lawrence EM, Kim DH, Bruce RJ. Prevalence of urolithiasis in asymptomatic adults: objective determination using low dose noncontrast computerized tomography. J Urol. 2010; 183(3):1017-21.

Stamatelou KK, Francis ME, Jones CA, Nyberg LM, Curhan GC. Time trends in reported prevalence of kidney stones in the United States: 1976-1994. Kidney Int. 2003;63:1817-23.

Yildirim K, Olcucu MT, Colak ME. Trends in the treatment of urinary stone disease in Turkey. PeerJ. 2018;6:e5390.

Michael O, David U, Muhammad M, Refik S, Honey RJ, Kenneth TP. The surgical management of kidney stone disease: a population based time series analysis. J Urol. 2014;192(5):1450-6.

Turk C, Petrik A, Sarica K, Seitz C, Skolarikos A, Straub M, et al. EAU guidelines on interventional treatment for urolithiasis. Eur Urol. 2016;69:475-82.

Chew BH, Seitz C. Impact of ureteral stenting in ureteroscopy. Curr Opin Urol. 2016;26:76-80.

Borboroglu PG, Amling CL, Schenkman NS, Monga M, Ward JF, Piper NY, et al. Ureteral stenting after ureteroscopy for distal ureteral calculi: a multi-institutional prospective randomized controlled study assessing pain, outcomes and complications. J Urol. 2001;166:1651-7.

Assimos D, Krambeck A, Miller NL, Monga M, Murad MH, Nelson CP, et al. Surgical management of stones: american urological association/ endourological society guideline. J Urol. 2016;196(4):1153-60.

Lancina MJA, Novás CS, Rodríguez-RGJ, Ruibal MM, Blanco DA, Fernández RE, et al. Age of onset of urolithiasis: relation to clinical and metabolic risk factors . Arch Esp Urol. 2004;57(2):119-25.

Preminger GM, Tiselius HG, Assimos DG, Alken P, Buck AC, Gallucci M, Knoll, et al. 2007 Guideline for the management of ureteral calculi. Eur Urol. 2007;52(6):1610-31.

Muhammad A, Mahboob SG, Muhammad IM, Moin A, Safdar HJ. Ureterorenoscopy and lithotripsy with and without dj insertion; experience at allied hospital, faisalabad. Ann Punjab Med Coll. 2018;12(4):25-9.

Wang H, Man L, Li G, Huang G, Liu N, Wang J. Meta-Analysis of Stenting versus Non-Stenting for the Treatment of Ureteral Stones. PLoS One. 2017; 12(1):e0167670.

Ghosh A, Oliver R, Way C, White L, Somani BK. Results of day-case ureterorenoscopy (DC-URS) for stone disease: prospective outcomes over 4.5 years. World J Urol. 2017;35(11):1757-64.

Somani BK, Giusti G, Sun Y. Complications associated with ureterorenoscopy (URS) related to treatment of urolithiasis: the Clinical Research Office of Endourological Society URS Global study. World J Urol. 2017;35(4):675-81.

Cheung MC, Lee F, Leung YL, Wong BB, Chu SM, Tam PC. Outpatient ureterscopy: Predictive factors for postoperative events. Urology. 2001;58: 914-8.

el-Faqih SR, Shamsuddin AB, Chakrabarti A, Atassi R, Kardar AH, Osman MK, et al. Polyurethane internal ureteral stents in treatment of stone patients: morbidity related to indwelling times. J Urol. 1991;146:1487-91.

Tanriverdi O, Silay MS, Kadihasanoglu M, Aydin M, Kendirci M, Miroglu C. Revisiting the predictive factors for intra-operative complications of rigid ureteroscopy a 15-year experience. Urol J. 2012;9:457-564.

Wu AK, Auerbach AD, Aaronson DS. National incidence and outcomes of postoperative urinary. Am J Surg. 2012;204:167-71.

Baldini G, Bagry H, Aprikian A, Carli F. Postoperative urinary retention: anesthetic and perioperative considerations. Anesthesiology. 2009;110:1139-157.

Assimos D, Crisci A, Culkin D, Xue W, Roelofs A, Duvdevani M, Desai M, de la Rosette J; CROES URS Global Study Group. Preoperative JJ stent placement in ureteric and renal stone treatment: results from the Clinical Research Office of Endourological Society (CROES) ureteroscopy (URS) Global Study. BJU Int. 2016;117(4):648-54.

Netsch C, Knipper S, Bach T, Herrmann TR, Gross AJ. Impact of preoperative ureteral stenting on stone-free rates of ureteroscopy for nephroureterolithiasis: a matched-paired analysis of 286 patients. Urol. 2012;80:1214-9.

Lumma PP, Schneider P, Strauss A. Impact of ureteral stenting prior to ureterorenoscopy on stone-free rates and complications. World J Urol. 2013;31:855-9.

Geavlete P, Georgescu D, Nita G, Mirciulescu V, Cauni V. Complications of 2735 retrograde semirigid ureteroscopy procedures: a single-center experience. J Endourol. 2006;20:179-185.

Rasool M, Tabassum SA, Pansota MS, Mumtaz F, Saleem MS.Ureterorenoscopic Lithotripsy; Efficacy and Complications.Is Ureteric Stenting Necessary in Every Patient? Ann Pak Inst Med Sci. 2012;8(3):161-4.

Zaki MR, Salman A, Chaudhary AH, Asif K. Rehman M. Is DJ Stenting still needed after uncomplicated Ureteroscopy lithotripsy? A Randomized Controlled Trial. PJMHS. 2011;5(1):121-4.

El Harrech Y, Abakka N, El Anzaoui J. et al, Ureteral stenting after uncomplicated ureteroscopy for distal ureteral stones: a randomized, controlled trial. Minim Invasive Surg. 2014;2014: 892890.

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Published

2021-11-26

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Original Research Articles