Retrograd İntrarenal Cerrahi Sonrası Double-J Stent Migrasyonunu Öngören Faktörler

Abstract

Amaç: Her ne kadar etkili ve güvenli bir kullanım alanı olsa da double-J stent (DJS) kullanımı ile ilgili farklı komplikasyonlar ortaya çıkabilmektedir. Bu çalışmada böbrek taşı nedeniyle retrograd intrarenal cerrahi (RIRC) yapılan hastalarda DJS migrasyonunun klinik sonuçlarını ve migrasyon gelişimini öngören risk faktörlerini belirlemeyi amaçladık.

Gereç ve Yöntemler: Kliniğimizde Aralık 2013 ile Nisan 2020 tarihleri arasında böbrek taşı için RIRC yapılan ve işlem sonrasında DJS yerleştirilmiş olan 1258 hastanın verileri geriye dönük olarak tarandı. DJS migrasyonu ile ilişkili bağımsız risk faktörlerini öngörmek için ikili lojistik regresyon analizi kullanıldı.

Bulgular: 1258 hastadan 71’inde (%5,6) DJS migrasyonu gözlendi. Grup 1’de renal pelvis yerleşimli taşlar kaliks taşlarına oranla istatistiksel olarak daha fazlaydı (p=0,003). Hidronefroz grup 1’de %70,4 oranındayken; grup 2’de %56,2 oranında gözlendi (p=0,019). Üreteral erişim kılıfı kullanım oranı grup 1 ve grup 2’de sırasıyla %74,6 ve %57,5 idi (p=0,004). Grup 1’de modifiye Clavien-Dindo skoru 2,2±1,3 iken; grup 2’de 0,2±0,5 idi (p<0,001). Tek değişkenli ve çok değişkenli lojistik regresyon analizine göre renal pelvis yerleşimli taş olması (Tahmini rölatif risk (TRR)=2,080, %95 Güven Aralığı (GA): 1,277-3,388, p=0,003), toplayıcı sistemde derece 3-4 hidronefroz bulunması (TRR=3,732, %95GA: 1,783-7,809, p<0,001) ve üreteral erişim kılıfı kullanılması (TRR=2,387, %95GA: 1,368-4,162, p=0,002) DJS migrasyonunu öngören bağımsız risk faktörleridir.

Sonuç: RIRC sonrasında gözlenen DJS migrasyonu nadir gözlenen bir komplikasyon olmasına rağmen özellikle proksimale doğru olan migrasyon sonrasında genel anestezi gerektiren ek bir işleme yol açması nedeniyle önemli bir komplikasyondur. Yüksek derecede hidronefrozu olan, renal pelviste taşı bulunan ve üreteral erişim kılıfı kullanılan hastalarda ameliyat sonrası dönemde DJS migrasyonu olabileceği unutulmamalıdır.

Keywords

• böbrek taşı
• double-J stent
• hidronefroz
• migrasyon
• retrograd intrarenal cerrahi
• üreteral stent

Factors Predicting Double-J Stent Migration After Retrograde Intrarenal Surgery

Abstract

Objective: Although it is an effective and safe area of use, different complications may arise with the use of double-J stents (DJS). In this study, we aimed to determine the clinical results of DJS migration and risk factors predicting the occurrence of migration in patients who underwent retrograde intrarenal surgery (RIRS) for kidney stones.

Material and Methods: The data of 1258 patients who underwent RIRS for kidney stones in our clinic between December 2013 and April 2020 and had DJS inserted after the procedure were retrospectively reviewed. Binary logistic regression analysis was performed to predict independent risk factors associated with DJS migration.

Results: DJS migration was observed in 71 (5.6%) of 1258 patients. In group 1, stones located in the renal pelvis were statistically more common than calyceal stones (p = 0.003). While hydronephrosis is 70.4% in group 1; it was observed with a rate of 56.2% in group 2 (p = 0.019). Ureteral access sheath usage rate was 74.6% and 57.5% in group 1 and group 2, respectively (p = 0.004). While the modified Clavien-Dindo score in Group 1 was 2.2 ± 1.3; it was 0.2 ± 0.5 in group 2 (p <0.001). Stones located in the renal pelvis according to univariate and multivariate logistic regression analysis (odds ratio (OR) = 2.080, 95% Confidence Interval (CI): 1.277-3.388, p = 0.003), grade 3-4 hydronephrosis in the collecting system ( OR = 3.732, 95% CI: 1.783-7.809, p <0.001) and use of ureteral access sheath (OR = 2.387, 95% CI: 1.368-4.162, p = 0.002) are independent risk factors predicting DJS migration.

Conclusions: Although DJS migration observed after RIRS is a rare complication, it is an important complication since it causes an additional procedure that requires general anesthesia, especially after proximal migration. It should be kept in mind in the postoperative period that DJS migration may occur in patients with high degree of hydronephrosis, stones in the renal pelvis, and in patients with a ureteral access sheath used in surgery.

Keywords

• double-J stent
• hydronephrosis
• kidney stones
• migration
• retrograde intrarenal surgery
• ureteral stent

References

1. Lang EK, Lanasa JA, Garrett J, Stripling J, Palomar J. The management of urinary fistulas and strictures with percutaneous ureteral stent catheters. J Urol. 1979;122:736-740. doi:10.1016/s0022-5347(17)56579-9
2. Ball AJ, Gingell JC, Carter SS, Smith PJ. The indwelling ureteric stent--the Bristol experience. Br J Urol. 1983;55:622-625. doi:10.1111/j.1464-410x.1983.tb03389.x
3. Laverson PL, Hankins GD, Quirk JG Jr. Ureteral obstruction during pregnancy. J Urol. 1984;131:327-329. doi:10.1016/s0022-5347(17)50365-1
4. Saltzman B. Ureteral stents. Indications, variations, and complications. Urol Clin North Am. 1988;15:481-491.
5. Smail LC, Dhindsa K, Braga LH, Becker S, Sonnadara RR. Using Deep Learning Algorithms to Grade Hydronephrosis Severity: Toward a Clinical Adjunct. Front Pediatr. 2020;8:1. doi:10.3389/fped.2020.00001
6. Dindo D, Clavien PA. What is a surgical complication? World J Surg 2008; 32(6): 939–41.
7. Pearle MS, Pierce HL, Miller GL, Summa JA, Mutz JM, Petty BA, et al. Optimal method of urgent decompression of the collecting system for obstruction and infection due to ureteral calculi. J Urol. 1998;160:1260-4.
8. Zimskind PD, Fetter TR, Wilkerson JL. Clinical use of long-term indwelling silicone rubber ureteral splints inserted cystoscopically. J Urol. 1967;97:840-844. doi:10.1016/s0022-5347(17)63130-6

9. Finney RP. Experience with new double J ureteral catheter stent. J Urol. 1978;120:678-681. doi:10.1016/s0022-5347(17)57326-7
10. Vallejo Herrador J, Burgos Revilla FJ, Alvarez Alba J, Sáez Garrido JC, Téllez Martínez-Fornés M, Sánchez de la Muela P, et al. El catéter ureteral doble J. Complicaciones clínicas [Double J ureteral catheter. Clinical complications]. Arch Esp Urol. 1998;51:361-73.
11. Stamm WE. Guidelines for prevention of catheter associated urinary tract infections. Ann Intern Med. 1975; 82:386.
12. Warren JW, Muncie HL Jr., Hall-Craggs M. Acute pyelonephritis associated with bacteriuria during long-term catheterization: a prospective clinicopathological study. J Infect Dis. 1988;158:1341.
13. El-Faqih SR, Shamsuddin AB, Chakrabarti A, Atassi R, Kardar AH, Osman MK, Husain I: Polyurethane internal ureteral stents in treat- ment of stone patients: Morbidity related to in- dwelling times. J Urol 1991;146:1487–1491
14. Ringel A, Richter S, Shalev M, Nissenkorn I. Late complications of ureteral stents. Eur Urol. 2000;38:41-44. doi:10.1159/000020250
15. Şendoğan F, Turan T, Efiloğlu Ö, Atış RG, Çaşkurlu T, Yıldırım A. An Exploration of Factors That Cause the Spontaneous Migration of Double-J Stents After Retrograde Intrarenal Surgery. Erciyes Med J 2019; 41:398–401.
16. Hao P, Li W, Song C, Yan J, Song B, Li L. Clinical evaluation of double-pigtail stent in patients with upper urinary tract diseases: report of 2685 cases. J Endourol 2008;22: 65–70.
17. Damiano R, Oliva A, Esposito C, De Sio M, Autorino R, D’Armiento M. Early and late complications of double pigtail ureteral stent. Urol Int 2002;69:136–40.
18. Joshi HB, Stainthorpe A, Keeley FX Jr, MacDonagh R, Timoney AG. Indwelling ureteral stents: evaluation of quality of life to aid outcome analysis. J Endourol 2001;15:151–4.
19. Joshi H, Okeke A, Newns N, Keeley FX Jr, Timoney AG. Characterization of urinary symptoms in patients with ureteral stents. Urology 2002;59:511–6.
20. Breau RH, Norman RW. Optimal prevention and management of proximal ureteral stent migration and remigration. J Urol 2001;166:890-3.
21. Slaton JW, Kropp KA. Proximal ureteral stent migration: An avoidable complication? J Urol 1996;155:58-61.
22. Ho CH, Huang KH, Chen SC, Pu YS, Liu SP, Yu HJ. Choosing the ideal length of a double-pigtail ureteral stent according to body height: study based on a Chinese population. Urol Int 2009;83:70–4.