SINGLE CENTRE EXPERIENCE OF ENDOUROLOGICAL MANAGEMENT OF RETAINED DOUBLE J STENTS IN THE COVID ERA
Main Article Content
Abstract
Introduction - Since their inception in 1967, Double J (DJ) stents have been widely used for the purpose of alleviation extrinsic and intrinsic obstruction. They are used as a modality of maintaining patency as well as drainage of the urinary tract as well as to facilitate the passage of small fragments post intervention. However, delayed removal or failure of follow up may lead to complications in the form of stent encrustation, migration, fracture, stone formation, adjacent organ penetration, urinary tract infections (UTI), ureteral erosion, or fistula formation. Many of these patients remain asymptomatic for months, and such forgotten stents are detected incidentally, resulting in late presentation (2). In the COVID era however, patients who had either been stented prior to or during the pandemic were unable to get their indwelling stents removed. This was due to either fear of approaching a hospital and risking exposure to COVID or an inability to travel amidst restrictions. Our study takes into account the impact of the pandemic with regards to timely stent removal.
Materials and methods – Retrospective study design, patients enrolled from a tertiary care centre. Data obtained from hospital records. The eligibility criteria included all patients above the age of 18 with a forgotten stent (>6 months in situ). All records included patients from January 2021 – December 2022. Data collection was done in accordance to SCARE 2020 criteria.
Results- Mean age of patients - 49.45 years. 10 patients were females (41.66%) and 14 were males (48.34%). Mean duration of the indwelling stents was 3.68 years (range 6 months to 14 years). 6 patients had formal secondary education, 13 had primary education and 5 were found to be illiterate. 12 patients were from rural India and poor socioeconomic backgrounds.
Out of the total patients 6 patients were unaware of indwelling stents. 14 patients cited covid as a reason for their delay in treatment. The commonest indication is DJ stent insertion for obstructive calculi - 8 patients (33%). 7 patients had undergone PCNL (29%).
5 patients required a combination of 2 endourological procedures. 12 patients required a PCNL (50%). Cystolithotrypsy was required in 7 patients.
Conclusion – 58.3% of study participants cited covid as a cause for retained DJ stents. All participants were managed endourologically.
Article Details
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References
2. Agrawal M, Gite VA, Sankapal P, et al. Retained ureteral stents, an avoidable source of morbidity: 10 years´ experience from a single tertiary care centre. Pan Afr Med J. 2022;42:68. Published 2022 May 25. doi:10.11604/pamj.2022.42.68.29935
3. Zimskind PD, Fetter TR, Wilkerson JL (1967) Clinical use of long- term indwelling silicone rubber ureteral splints inserted cystoscopically. J Urol 97:840–844
4. Patil S, Raghuvanshi K, Jain DK, Raval A. Forgotten ureteral double-J stents and related complications: A real-world experience. Mendeley. January 1, 1970. Accessed May 28, 2023. https://www.mendeley.com/catalogue/8087443d-208b-31ec-8ea9-bff29b86afe3/. Mulay, A., Kapoor, R., Sharma, S. et al. Strategy to track double-J stents placed during COVID-19 using smartphone-based stent tracker application to prevent forgotten double-J stent in a high-volume centre: a smart solution. Afr J Urol 27, 110 (2021). https://doi.org/10.1186/s12301-021-00212-3
5. Divakaruni N, Palmer CJ, Tek P, et al. Forgotten ureteral stents: Who’s at risk? Northwestern Scholars. March 17, 2016. Accessed May 28, 2023. https://www.scholars.northwestern.edu/en/publications/forgotten-ureteral-stents-whos-at-risk.
6. Nawaz H;Hussain M;Hashmi A;Hussain Z;Zafar N;Naqvi A;Rizvi A; Experience with indwelling “J.J” ureteral stents. JPMA. The Journal of the Pakistan Medical Association. Accessed May 28, 2023. https://pubmed.ncbi.nlm.nih.gov/8264090/.
7. 1. Strategy to track double-J stents placed during COVID-19 using ... Accessed May 28, 2023. https://www.researchgate.net/publication/353495179_Strategy_to_track_double-J_stents_placed_during_COVID-19_using_smartphone-based_stent_tracker_application_to_prevent_forgotten_double-J_stent_in_a_high-volume_centre_a_smart_solution.
8. Riaz A. Agha et al. The process 2020 guideline: Updating consensus preferred reporting of case series in surgery (process) guidelines. International Journal of Surgery. November 12, 2020.AccessedMay28,2023. https://www.sciencedirect.com/science/article/pii/S1743919120307792.
9. Maher Al-Hajjaj et al. Forgotten double-J ureteral stent: An analysis of 25 cases in a tertiary hospital. Annals of Medicine and Surgery. July 31, 2022. Accessed May 28, 2023. https://www.sciencedirect.com/science/article/pii/S2049080122009839#bib6.
10. Dakkak Y, Janane A. Management of encrusted ureteral stents. African Journal of Urology. September 25, 2012. Accessed May 28, 2023. https://www.sciencedirect.com/science/article/pii/S1110570412000549.
11. Keane PF;Bonner MC;Johnston SR;Zafar A;Gorman SP; Characterization of biofilm and encrustation on ureteric stents in vivo. British journal of urology. June 6, 1994. Accessed May 28, 2023. https://pubmed.ncbi.nlm.nih.gov/8032837/.
12. G; SKJ. Encrustation and Stone Formation: Complication of indwelling ureteral stents. Urology. June 25, 1985. Accessed May 28, 2023. https://pubmed.ncbi.nlm.nih.gov/4012953/.
13. S.R. El-Faqih, Polyurethane internal ureteral stents in treatment of stone patients: Morbidity related to indwelling times. The Journal of Urology. December 1, 1991. Accessed May 28, 2023. https://www.sciencedirect.com/science/article/pii/S0022534717381466.
14. Polat H, Yücel MÖ, Utangaç MM, et al. Management of forgotten ureteral stents: Relationship between indwelling time and required treatment approaches. Balkan medical journal. August 4, 2017. Accessed May 28, 2023. https://ncbi.nlm.nih.gov/pmc/articles/PMC5615961/.
15. Tunney mm. Comparative assessment of ureteral stent biomaterial ... - sciencedirect. Comparative assessment of ureteral stent biomaterial encrustation. October 23, 1995. Accessed May 28, 2023. https://www.sciencedirect.com/science/article/abs/pii/0142961296897808.
16. WOLLIN TA. Bacterial biofilm formation, encrustation, and antibiotic adsorption to ... Bacterial Biofilm Formation, Encrustation, and Antibiotic Adsorption to Ureteral Stents Indwelling in Humans. March 30, 2009. Accessed May 28, 2023. https://www.liebertpub.com/doi/10.1089/end.1998.12.101.
17. Mursi K. Stones on a forgotten double-J stent: A case report of multiple stones ... Stones on a forgotten double-J stent: a case report of multiple stones casting a multi-fractured ureteral stent. March 11, 2003. Accessed May 28, 2023. https://applications.emro.who.int/imemrf/African_J_Urol/African_J_Urol_2005_11_3_247_249.pdf.
18. Singh I, Hemal AK, Gupta NP. Severely encrusted polyurethane ureteral stents: Management and analysis of potential risk factors. Urology. October 4, 2001. Accessed May 28, 2023. https://www.sciencedirect.com/science/article/abs/pii/S0090429501013176.