SAN DIEGO, CA USA (UroToday.com) - Ureteral stent extraction strings may improve patient convenience and lower health care costs. This interesting study sought to evaluate patient preference for extraction method and determine whether extraction strings are associated with changes in quality of life, pain, or complications.
Dr. Barnes and colleagues approached all patients undergoing ureteroscopic stone surgery for potential enrollment in this IRB-approved study. Patients were excluded if they had a pre-operative urinary tract infection (UTI), planned bilateral procedure, pregnancy, or a solitary kidney. Patients were randomized to a stent with or without an extraction string. Patients with a string removed their stent at home on post-operative day 7 (POD), while those without a string were scheduled for cystoscopic retrieval POD 7-14. Symptoms were evaluated using the validated Ureteric Stent Symptom Questionnaire (USSQ) on POD 1 and 6. All patients completed a Likert pain survey following stent removal.
One hundred and forty two patients were approached for enrollment in this study, with 52 patients not meeting the inclusion criteria and 46 patients refusing participation. A total of 44 patients met the inclusion criteria and were randomized to stent with or without extraction string. Of those who refused participation, 37% preferred the string stent, while 63% did not want an extraction string.
Examining the 44 patients, randomized to the extraction string or no string groups, showed no significant difference in sex, age, BMI, or laterality across the two groups. There also was no significant difference in stent-related complications or UTIs between the 2 groups. In 3 patients (14%) in the extraction string group the stent was prematurely dislodged, but none of these patients needed the stent to be replaced. Patients in both groups reported similar urinary symptoms: pain, effect on work, or change in quality of life (p=0.78, 0.59, 0.98, 0.78, respectively).
In conclusion, this interesting study demonstrates that the usage of extraction strings on ureteral stents, following ureteroscopy, does not affect postoperative pain, complications, and quality of life. This supports the use of extraction strings to facilitate stent removal and potentially reduce health care costs by removing the need for cystoscopy for stent removal. However, one must also consider that 14% of the patients with extraction strings prematurely dislodged their stents. Accordingly, extraction strings should be used with caution in patients who have imperative indications for stenting. Further study with a larger number of patients is necessary to validate these results.
UC Irvine Medical Center UC Irvine Medical Center Presented by Kerri Barnes, MD at the American Urological Association (AUA) Annual Meeting - May 4 - 8, 2013 - San Diego Convention Center - San Diego, California USA
University of Iowa Department of Urology, Iowa City, IA USA
Reported for UroToday.com by Achim Lusch, MD and Michael Ordon, MD; UC Irvine Medical Center, Orange, CA USA