Stent placement after flexible ureterorenoscopy for renal stones can improve stone-free rate on final follow-up: A retrospective single center study

Abstract

Aim: Although the advantage of ureteral double j (D/J) stenting has been shown in reducing post- operative pain after ureteroscopic surgery, its contribution to stone clearance for additional treatment has not been fully assessed. In this study we aimed to evaluate the effect of stenting on stone free rates at the end of the additional treatment.

Methods: We reviewed the medical records of all patients who underwent flexible ureterorenoscopy (FURS) for kidney stones between October 2009 and January 2015. Patients with malignant ureteral stricture, severe skeletal malformation, renal unit malformation, non-opaque renal stone or lost to follow-up were excluded. 47 of 289 patients (stenting 24 patients, non-stenting 23 patients) assessed. The perioperative and postoperative parameters and stone-free rates were compared in patients whether they had intraoperative D/J stent (group 1) or not (group 2).

Results: No differences were found between groups according to age, gender, body mass index, operation history, preoperative stenting history, shockwave lithotripsy history, ureteral stricture, stone size, access sheath rate, retreatment, or additional treatment number and stone location. Operation time was significantly higher in group 1. Those who refused additional treatment were insignificantly lower in group 1. Although the stone-free rates were similar for the two groups at the end of the first month, the stone-free rates after the additional treatments were significantly higher in group 1.

Conclusion: Stenting during FURS, improved the stone-free rate on final follow-up, if residual stones remain.

Keywords

• Stents,Kidney stone,Ureteroscopy

Böbrek taşlarına uygulanan fleksibl üreterorenoskopi sonrası stent yerleştirilmesi son takipte taşsızlık oranını arttırabilir: Retrospektif tek merkezli çalışma

Öz

Amaç: Her ne kadar üreteroskopik cerrahi sonrası üreteral çift J uçlu (Double J-D/J) stent yerleştirilmesinin postoperatif ağrıyı azaltmaktaki avantajı gösterilmiş olsa da taşların temizlenmesi ve ek işlem için hasta uyumuna etkisi tam olarak değerlendirilmemiştir. Biz bu çalışmada stent takılmasının ek tedaviler sonunda taşsızlık oranlarına olan etkisini araştırdık.

Yöntem: Kasım 2009 ve Ocak 2015 tarihleri arasında fleksibl üreterorenoskopi (FURS) uygulanan hastaların tıbbi kayıtları gözden geçirildi. Maling üreteral darlık, ileri derecede iskelet malformasyonu, böbrek malformasyonu olan hastalar ve takipten çıkan hastalar çalışmadan çıkarıldı. 289 hastanın 47’si (24 stent takılan, 23 stent takılmayan) değerlendirilmeye alındı. Operasyon sırasında D/J stent takılan (grup 1) ve takılmayan (grup 2) hastaların perioperatif ve postoperatif parametreleri ve taşsızlık oranları karşılaştırıldı.

Bulgular: Gruplar arasında yaş, cinsiyet, vücut kitle indeksi, operasyon öyküsü, operasyon öncesi stent yerleştirilmesi, şok dalga litotripsi hikayesi, üreteral darlık, taş boyutu, akses kılıfı kullanım oranı, tekrar tedavi, ek tedavi taş sayısı ve lokalizasyonu açısından fark yoktu. Stent uygulanan grupta anlamlı olarak operasyon süresi uzun izlendi. Ek tedavileri red etme oranı grup 1’de daha düşük izlendi. İlk ay sonunda taşsızlık oranları iki grup için benzer olmasına rağmen, ek tedavilerden sonra taşsızlık oranları grup 1’de anlamlı olarak yüksek izlendi.

 Sonuç: FURS sırasında stent yerleştirilmesi, rezidüel taşların kalması durumunda son takipte taşsızlık oranını arttırmaktadır. 

Anahtar Kelimeler

• stentler,böbrek taşı,üreterorenoskopi

Kaynakça

1. 1. Pengfei S, Yutao L, Jie Y, Wuran W, Yi D, Hao Z, et al. The results of ureteral stenting after ureteroscopic lithotripsy for ureteral calculi: a systematic review and meta-analysis. J Urol. 2011;186:1904-9.
2. 17. Shen P, Jiang M, Yang J, Li X, Li Y, Wei W. Use of ureteral stent in extracorporeal shock wave lithotripsy for upper urinary calculi: a systematic review and meta-analysis. J Urol. 2011;186:1328-35.
3. 16. Mogilevkin Y, Sofer M, Margel D, Greenstein A, Lifshitz D. Predicting an effective ureteral access sheath insertion: a bicenter prospective study. J Endourol. 2014;28:1414-17.
4. 15. 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. Urology. 2012;80:1214-19.
5. 14. Rubenstein RA, Zhao LC, Loeb S, Shore DM, Nadler RB. Prestenting improves ureteroscopic stone-free rates. J Endourol. 2007;21:1277-80.
6. 13. Lumma PP, Schneider P, Strauss A, Plothe KD, Thelen P, Ringert RH, et al. Impact of ureteral stenting prior to ureterorenoscopy on stone-free rates and complications. World J Urol. 2013;3:855-9.
7. 12. Chu L, Sternberg KM, Averch TD. Preoperative stenting decreases operative time and reoperative rates of ureteroscopy. J Endourol. 2011;25:751-4.
8. 11. Jones BJ, Ryan PC, Lyons O, Grainger R, McDermott TE, Butler MR. Use of the double pigtail stent in stone retrieval following unsuccessful ureteroscopy. Br J Urol. 1990;66:254-56.

9. 10. Cerruti A, Lebdai S, Martin F, Hoarau N, Chautard D, Culty T, et al. Do postoperative drainage types modify outcomes after retrograde intrarenal surgery? Prog Urol. 2015;25:331-5.
10. 9. Miernik A, Wilhelm K, Ardelt PU, Adams F, Kuehhas FE, Schoenthaler M. Standardized flexible ureteroscopic technique to improve stone-free rates. Urology. 2012;80:1198-202.
11. 8. Sanguedolce F, Liatsikos E, Verze P, Hruby S, Breda A, Beatty JD, et al. Use of flexible ureteroscopy in the clinical practice for the treatment of renal stones: results from a large European survey conducted by the EAU Young Academic Urologists-Working Party on Endourology and Urolithiasis. Urolithiasis. 2014;42:329-34.
12. 7. Picozzi SC, Ricci C, Stubinski R, Casellato S, Ratti D, Macchi A, et al. Is stone diameter a variable in the decision process of employing a ureteral stent in patients undergoing uncomplicated ureterorenoscopy and associated intracorporeal lithotripsy? World J Urol. 2013;3:1617-25.
13. 6. Song T, Liao B, Zheng S, Wei Q. Meta-analysis of postoperatively stenting or not in patients underwent ureteroscopic lithotripsy. Urol Res. 2012;40:67-77.
14. 5. Mendez-Probst CE, Fernandez A, Denstedt JD. Current status of ureteral stent technologies: comfort and antimicrobial resistance. Curr Urol. Rep 2010;11:67-73.
15. 4. Fiuk J, Bao Y, Calleary JG, Schwartz BF, Denstedt JD. The use of internal stents in chronic ureteral obstruction. J Urol. 2015;193:1092-100.
16. 3. Ozyuvali E, Resorlu B, Oguz U, Yildiz Y, Sahin T, Senocak C, et al. Is routine ureteral stenting really necessary after retrograde intrarenal surgery? Arch Ital Urol Androl. 2015;87:72-5.
17. 2. Torricelli FC, De S, Hinck B, Noble M, Monga M. Flexible ureteroscopy with a ureteral access sheath: when to stent?. Urology. 2014;83:278-81.