Pigtail Suture Stents Significantly Reduce Stent-related Symptoms Compared to Conventional Double J Stents: A Prospective Randomized Trial

Andrea Bosio, Eugenio Alessandria, Simone Agosti, Federico Vitiello, Eugenia Vercelli, Alessandro Bisconti, Paolo Piana, Fabrizio Fop, Paolo Gontero, Andrea Bosio, Eugenio Alessandria, Simone Agosti, Federico Vitiello, Eugenia Vercelli, Alessandro Bisconti, Paolo Piana, Fabrizio Fop, Paolo Gontero

Abstract

Background: Double J (DJ) ureteral stents are commonly inserted after ureteroscopy (URS) procedures for stone treatment. However, stent-related symptoms are still a major issue.

Objective: To determine whether a commercially available pigtail suture stent (PSS) can reduce stent-related symptoms compared to a conventional DJ stent after uncomplicated URS.

Design setting and participants: We designed a randomized, single-blind, parallel-group trial from January to November 2020. The inclusion criteria were stone-free URS without intraprocedural complications. Patients with distal ureteral stones were excluded.

Intervention: Insertion of a PSS or DJ stent after URS.

Outcome measurements and statistical analysis: The primary endpoint was the Urinary Symptom Index score on the Ureteral Stent Symptoms Questionnaire (USSQ) 2 wk after URS. Secondary endpoints were USSQ domain scores and responses to individual USSQ questions at 2 d and 2 wk after surgery.

Results and limitations: A total of 78 patients were randomized and treated according to protocol. The Urinary Symptom Index score (p = 0.004), overall Visual Analogue Scale (VAS) score (p = 0.022), and the percentage of patients complaining of pain (63.9% vs 86.1%, p = 0.029) were significantly in favor of PSS at both 2 d and 2 wk after URS. At 2 d, the VAS score among patients with pain (p = 0.025) and the General Health Index score (p = 0.036) were significantly better in the PSS group. No severe complications occurred in either group. Study limitations are the exclusion of patients with distal ureteral stones and the limited sample size.

Conclusions: PSS significantly reduced stent-related symptoms after URS, in particular urinary symptoms and pain, compared to conventional DJ stents, and showed a good safety profile.

Patient summary: Stents are hollow tubes placed in the passage between the kidney and the bladder (ureter). The standard stent has two coiled ends (double J stent) to keep it in place in both the kidney and the bladder. We tested a commercial stent with two strings at the bladder end (pigtail suture stent) after procedures to remove stones from the upper urinary tract and found that it caused less stent-related symptoms compared to a double J stent. This trial is registered at Clinicaltrials.gov as NCT03344120.

Keywords: Double J stent; Lower urinary tract symptoms; Nephrolithiasis; Pain; Pigtail suture stents; RIRS; Stent-related symptoms; Stents; URS; Ureteroscopy; Urinary calculi.

© 2021 The Authors.

Figures

Fig. 1
Fig. 1
(A) Photograph and (B) drawing of the pigtail suture stent (PSS) used in our study. (A) The JFil PSS (ROCAMED, Monaco, MC) we used is a 16-cm-long 7Fr ureteral stent with a single renal pigtail. The distal part of the PSS ends in a fluted beak and extends in a 0.3Fr double surgical thread. (B) The illustration compares a PPS (on the left) with a conventional double J (DJ, on the right) stent. The DJ stent used in our study was a 22–28-cm-long (according to patient height) 6Fr Vortek stent (Coloplast, Humlebaek, Denmark). The distal end of the PSS body remains in the ureter, while the sutures (replacing the distal pigtail of a conventional DJ stent) extend into the bladder, allowing removal of the PSS via cystoscopy.
Fig. 2
Fig. 2
CONSORT flow chart. DJ = double J stent; PSS = pigtail suture stent; USSQ = Ureteral Stent Symptoms Questionnaire.

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Source: PubMed

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