Extended double-J ureteral stent

Continent forms of urinary diversion using intestinal segments are becoming increasingly common. As this new treatment modality evolves, our instruments and mechanical devices are likewise evolving and adapting to the changing needs placed on them. We have used a new type of double-pigtail ureteral catheter in patients requiring continent urinary diversion. It allows stenting of the ureteral-intestinal anastomosis and safeguards against urinary leak or extravasation; at the same time the catheter is accessible to the outside for easy replacement, manipulation, and radiographic evaluation. The catheter has also shown to be useful for other purposes such as uretero-neo-cystostomy. This is particularly important in the pediatric population where repeated cystoscopy for stent removal or manipulation can be a significant drawback.     

DSA导向下逆行双“J”输尿管支架置换术

目的观察DSA导向下逆行双"J"输尿管支架置换术的有效性和安全性。方法选取因输尿管梗阻行DSA导向下逆行双"J"输尿管支架置换术患者21例。收集患者的临床资料,分析输尿管支架置换术的技术要点、成功率及并发症。结果共置换输尿管支架32例次,技术成功率96.88%(31/32)。术后均未见严重并发症,轻度并发症包括尿道灼痛(32/32,100%)、出血(21/32,65.63%)、尿路感染(5/32,15.63%)。结论 DSA导向下逆行双"J"输尿管支架置换术是一项安全、有效的操作技术,值得推广;膀胱内抓捕输尿管支架和经导丝引入新支架是该技术操作的关键。     

双J管内引流在尿路手术中的应用（附64例报告）

为探讨双Ｊ管内引流在尿路手术中的应用效果，于１９９０年４月～１９９４年１２月，在尿路手术中采用国产ＰＶＣ双Ｊ管内引流６４例。病种包括：复杂性尿路结石、输尿管狭窄、肾盂输尿管连接部狭窄和输尿管膀胱移植等。置管方法分手术中和内窥镜下置管二种。置管引流时间１周～２年。置管引流后，伤口漏尿、伤口感染等手术并发症减少。对置管后对上尿路的影响、置管的适应证、置管引流的时间和并发症进行了讨论。认为采用双Ｊ管内引流具有操作简便、引流效果好、并发症少等优点，宜推广使用。     

Unexpected complication: renal parenchymal perforation with double-J ureteral stent

Double-J ureteral stent is commonly used in various endourological procedures. This procedure may cause some complication. We present a case of renal parenchymal perforation due to double-J stent insertion.     

留置双J管预警系统的开发与应用

目的 及时处置泌尿外科患者留置双J管,减少相关并发症。方法 按时间段将3 260例患者分为对照组（986例）和观察组（2 274例）。对照组术后由术者登记双J管相关信息于纸质登记本;观察组开发留置双J管预警系统,嵌入医院HIS医嘱管理单元,术毕由术者登记患者双J管相关信息。两组均由护士追踪与通知患者按时返院处置双J管。结果 观察组信息登记时间显著短于对照组、延长处置双J管及相关并发症（除外双J管移位）发生率显著低于对照组（均P＜0.05）。结论 留置双J管预警系统的应用,可有效提高医护人员工作效率,降低患者留置双J管相关并发症发生率。     

The use of the Magnetip double-J ureteral stent in urological practice

The Magnetip* double J type ureteral stent has been used in a wide variety of clinical urological settings. We reviewed the use of the stent in 50 patients. In 45 patients stents were placed in conjunction with extracorporeal shock wave lithotripsy, stone manipulation, obstruction due to pregnancy or malignancy, pyeloplasty and ureteroneocystostomy. In 83 per cent of the attempts the stent was placed successfully. Retrieval with the Magnetriever* was accomplished in 86 per cent of the cases (100 per cent in female and 76 per cent in male patients). Details of stent use are described.     

Usefulness of short-term retrievable ureteral stent in pediatric laparoscopic pyeloplasty

PURPOSE: Methods of stenting after laparoscopic pyeloplasty have included indwelling Double-J stents and percutaneous nephrostomy tubes. The disadvantages of these methods are that they necessitate a second surgery for stent removal or require an external drainage bag. To circumvent these issues, the tolerance, safety and outcomes of using a Double-J ureteral stent with a dangler, permitting early office removal, was investigated in a series of pediatric laparoscopic pyeloplasties. MATERIALS AND METHODS: Medical records from a consecutive series of pediatric patients undergoing transperitoneal laparoscopic pyeloplasties were reviewed. Indications for surgery included ipsilateral flank pain with severe hydronephrosis (12 patients), recurrent pyelonephritis with severe hydronephrosis (2), and hematuria and flank pain (6). All patients were discharged home within 24 to 48 hours of the procedure with prophylactic oral antibiotics. The stent was removed by postoperative day 18 during a followup office visit. Patient tolerance of the indwelling stent, outpatient removal and success of pyeloplasty were assessed. RESULTS: A total of 20 patients underwent transperitoneal laparoscopic pyeloplasty by 1 surgeon (LAB) between 2001 and 2005. All patients underwent cystoscopy and retrograde Double-J ureteral stent placement before pyeloplasty under the same anesthesia. Mean patient age at operation was 11.3 years (median 11.3, range 4.6 to 17.2). Stents were left indwelling for a mean of 10.3 days (median 10, range 7 to 18). All patients tolerated the Double-J stent well, with 2 requiring anticholinergic therapy for mild urgency symptoms and 1 demonstrating urinary tract infection. All patients tolerated outpatient stent removal via the dangler at the office without discomfort. One patient was lost to followup. At a mean followup of 1.04 years (range 0.1 to 2.88) 17 of 19 patients (89%) had resolution of flank pain/urinary tract infections, with sonographic improvement in hydronephrosis with or without endoscopic intervention. Six patients (30%) had flank pain with or without continuous hydronephrosis and required re-stenting, and 3 also required balloon dilation. Of these 6 patients 2 (10%) had recurrent ureteropelvic junction obstruction and required open pyeloplasty. All patients are now clinically and radiologically unobstructed and asymptomatic. CONCLUSIONS: Pediatric transperitoneal laparoscopic pyeloplasty with indwelling Double-J ureteral stent with a dangler is successful and the stent is well tolerated. Whether the duration of ureteral stenting affects the surgical success will require further controlled long-term studies.     

Effectiveness of medical treatment in overcoming the ureteral double-J stent related symptoms

Background:

We investigated whether the frequency of lower urinary tract symptoms (LUTS) increased in patients in whom double-J stents were applied. We also evaluated several medical therapy protocols to treat symptoms related with ureteral stents.

Materials and Methods:

A total of 108 patients, in whom unilateral double-j stent was applied during ureteral stone treatment, were included. Before the double-J stent was applied, all patients completed storage components of the “International Prostate Symptom Score” (IPSSs), quality of life components of the IPSS (IPSS-QOL) and “Overactive Bladder Questionnaire” (OABq) forms and scores were calculated. After the procedure, cases were randomized into 5 groups, an antiinflammatory was given to Group 1, spasmolytic to Group 2, anticholinergic to Group 3 and α-blocker to Group 4. No additional drug was given to Group 5 as this control group. During the fourth week of the procedure, IPSSs, IPSS-QOL and OABq forms were again completed and scores were compared with the previous ones.

Results:

When all the cases were evaluated, the IPSSs, IPSS-QOL and OABq scores of patients in whom the double-J stent was applied were statistically significantly higher the procedure. Compared to the control group, the cases where the double-J stent was applied showed a higher IPSSs, IPSS-QOL and OABq scores and none of the medical therapies could prevent this increase.

Interpretation:

The frequency of LUTS increased in cases where the ureteral stent was applied and discomfort continued as long as the stent stayed in the body.     

Dismembered laparoscopic pyeloplasty with antegrade placement of ureteral stent: simplification of the technique

Laparoscopic pyeloplasty is an effective treatment option for ureteropelvic junction obstruction, with success rates superior to other minimally invasive approaches. We describe our technique of laparoscopic pyeloplasty with antegrade placement of ureteral stent with a laparoscopic-guided abdominal puncture. This technique decreases the use of fluoroscopy and also facilitates renal pelvis dissection and ureteropelvic anastomosis.     

Shortened pull-string simplifies office-based ureteral stent removal

A disadvantage of stent use after ureteroscopy is the need to remove the stent cystoscopically. We describe a modification that avoids the discomfort of a transurethral suture and allows easy cystoscopic extraction. This modification may also facilitate repositioning or removal of a migrated stent.