Improvement of quality of life of patients with internal stents by changing the shape of the stents


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Abstract

Transurethral stenting of the ureter was made in 130 patients (51 males and 79 females, aged 19-81, mean age 51.3 years) after contact ureterolithotripsy (n = 86), endoureterotomy (n = 13) and endopyelotomy (n = 31). All the patients received internal polyuretanic stents (size N 6 F) made by one company. The patients were randomized into two groups by the shape of the stent. Group 1 (n = 65) received a modified mono-pigtail stent made of the standard polyuretanic double-pigtail stent by cutting off 2-4 cm of the distal end and distal (vesical) curl. In group 2 (n = 65) stenting was made with standard double-pigtail stent. Questionnaire survey was made 2 weeks after stenting, 1 month before stent removal and 1.5 months after stent removal. In the postoperative period 12 patients of group 2 (18.5%) developed acute pyelonephritis resultant from vesicorenal reflux. In other cases pyelonephritis was managed by draining bladder with urethral catheter. In group 1 vesicoureteral reflux was absent, but in 3 cases (4.6%) there was an attack of acute pyelonephritis because of obstruction of the intramural (not intubated by the stent) part of the ureter with fragments of the crushed concrement. This attack required urgent ureterolithoextraction and removal of the stent in 2 cases, transcutaneous nephrostomy in 1 case. Mean postoperative stay in the hospital was 3.1±0.6 in group 1 and 6.7±1.2 (p = 0.001) days in group 2. The comparison of the stent-related symptoms 2 weeks after stenting and before stent removal showed that severity of the symptoms was significantly greater in group 2 vs group 1 (21.3 and 9.6, respectively). Thus, the proposed mono-pigtail stent reduces severity of stent-related symptoms 2.5 times and improves quality of life. Further prospective studies are planned for final assessment of efficacy of the modified stents and their influence on quality of life.

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