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Urinoma (collection of urine) formation secondary to extracorporeal shock wave lithotripsy (ESWL) is one of the rare complications encountered postprocedure and co-existence of urinoma with steinstrasse is a rare and challenging scenario to manage in the setting of obstructive uropathy. ESWL is known for being noninvasive for breaking kidney and ureteric stones. Urinoma is a collection of urine outside the collecting system in the retroperitoneum or perirenal space. Early detection and management are necessary to prevent complications related to urinoma and steinstrasse. This case report is about a patient who developed urinoma and steinstrasse in the setting of obstructive uropathy after sessions of ESWL on the right side and was managed with a nephrostomy tube and trans-ureteral lithotripsy on the right side and percutaneous nephrolithotomy on the left side after 1 month.

Double-j stents are commonly used in many urological procedures to facilitate the drainage of renal systems postoperatively. Their usage has revolutionized the world of urological interventions but if left forgotten present serious complications. We report a case of an old man who was diagnosed with bilaterally fragmented DJ stents in situ in our urology department following his sessions of extracorporeal shock wave lithotripsy for chronic encrustations. These stents were placed after complete breakdown of bilateral ureteral stones through ureterorenoscopy and laser lithotripsy.

Ureteral stents play a vital role in urologic surgeries, aiding in urinary flow maintenance, obstruction alleviation and facilitating healing. However, when stents are forgotten, they can lead to encrustation, resulting in significant patient morbidity and posing challenges for urologists Stent-related complications have been shown to increase with the duration of time the stent is left in place. This report details the clinical presentation, diagnostic process, and treatment of a 68-year-old male patient had a neglected stent placed 18 years ago after extracorporeal shockwave lithotripsy. He presented with severe stent encrustation, a solitary giant bladder stone, and renal stones. The patient underwent a cystolithotomy to remove the bladder stone followed by an ultrasound-guided percutaneous nephrolithotomy with pneumatic lithotripsy in a separate procedure. Preventive strategies such as implementing a stent registry, enhancing patient education, and encouraging follow-up appointments are crucial to avoid such complications. [ABSTRACT FROM AUTHOR]

Aim: To evaluate certain factors that may affect the decision-making process for the rational management approach in cases presenting with bilateral ureteral stones. Methods: A total of 153 patients presenting with bilateral ureteral stones from 6 centers were evaluated and divided in three groups. Group 1 (n:21) Patients undergoing DJ stent insertion in one ureter and ureterorenoscopic (URS) lithotripsy for the contralateral ureteral stone. Group 2 (n:91), URS lithotripsy for both ureteral stones and Group 3 (n:41) patients undergoing bilateral DJ stent insertion. The outcomes of the procedures and the relevant patient as well as stone related factors have been comparatively evaluated in three groups. Results: While associated UTI rates and serum creatinine levels were significantly higher in bilateral DJ group, previous URS history was found to be significantly higher in cases undergoing bilateral URS than those undergoing bilateral DJ stenting. URS was performed significantly more often in cases with lower ureteral stones and DJ stenting seems to be more rational approach in upper ureteral stones. In patients with lower ureteral stones, larger and harder stones, endourologists tended to perform URS as the first option. Conclusions: Decision making for a rational approach in cases with bilateral ureteral stones my be challenging. Our findings demonstated that serum creatinine levels, associated UTI, location and the hardness of the stone and previous ureteroscopy anamnesis could be important factors in making a decision between JJ stenting and ureteroscopic stone extraction in emergency conditions. [ABSTRACT FROM AUTHOR]

Objective: To evaluate effects of 7 days oral antibiotic prophylaxis versus no antibiotics in the patients with DJ stents after 3 days iv antibiotic on discharge with respect to urinary tract infection and stent related symptoms. Material and methods: A prospective randomized study in 90 patients being stented post PCNL/URSL. Group A: no oral antibiotics was given at the time of discharge, Group B: 7 days of oral antibiotic was given at the time of discharge. Patients were followed up and outcomes were assessed in the form of lower urinary symptoms (LUTS), urine culture and sensitivity at 1 and 3 weeks and DJ stent culture and sensitivity on removal at 3 weeks. Results: There was no significant difference in age, gender, type of surgery (PCNL/URSL), duration of DJ stent between the two groups. Patients in group A and Group B have comparable UTI and stent related symptoms at 1 and 3 weeks respectively (p = 0.95 and p = 0.916 respectively). Similarly, there were no marked difference in urine culture at 1 and 3 weeks, respectively between two groups (p = 0.71 and p = 0.63, respectively). Overall there were no significant differences in Urinary symptoms, urine culture/sensitivity at 1 and 3 weeks and also DJ stent culture and sensitivity on removal at 3 weeks between the two groups. Conclusion: The incidence of UTI and stent related symptoms are same in both the groups. Therefore, prescribing oral antibiotics on discharge in selected patient with DJ stent has no added benefit and should be avoided. [ABSTRACT FROM AUTHOR]

Double J (DJ stent) is commonly used in urology practices. Short- and long-term complications of indwelling catheters are increasingly noted resulting in significant morbidity and at times mortality. Retained and broken DJ stent is however rare complication with few cases reported in the literature. We present a case of neglected retained and broken DJ stent in a 55-year-old male who had undergone percutaneous lithotripsy (PCNL) 4 years back presenting with recurrent abdominal pain and was misdiagnosed as peptic ulcer disease at various centers. Radiological investigations including ultrasound, radiographs, and computer tomography helped in identifying the retained and broken DJ stent. Patient improved with conservative management and left against medical advice for definite treatment. Patient education and ensuring proper follow-up can reduce the likelihood of complications associated with DJ stents.

Objective: To validate the Indonesian version of the urinary stent related health (UriSteRH) questionnaire. Material & Methods: The Indonesian version of the UriSteRH was developed with multistep process by urologist, two nursing lecturers and two independent translators. A total 13 patients with indwelling DJ Stent completed the Indonesian UriSteRH questionnaires on the 30th day after Stenting. The reliability of the Indonesian version was evaluated using Cronbach’s alpha test. Domain structures were examined by using Pearson correlation coefficient (R). Results: Urinary pain, body pain, physical activity, social life, mental health, sexual activity and quality of life showed good internal consistency. There were strong correlations of physical activity (r=0.851) and social life (r=0.815) with the quality of life (r=0.736). In addition, there were moderate correlation of mental health general (r=0.676) related to urinary pain (r=0.612) and body pain (r=0.567). However, sexual activity had a lower correlation (r=0.456). Conclusion: The Indonesian version of UriSteRH is a reliable and valid instrument to evaluate health and quality of life in patients with indwelling DJ Stent. Keywords: DJ Stent, indonesian validation, questionnaire, urinary stent related health .

Background: Extracorporeal shock wave lithotripsy (ESWL) has become the first-line treatment for stones in the upper urinary tract measuring 0.05).There was no significant difference between the two groups in regard to clearance according to the size of the stones. A total of 9.3%(28/300) of patients did not have a successful outcome and were termed as ESWL failures. Post- ESWL complications were significant between the both groups in terms of hematuria and ureteric colic. All the ureteric colic patients had a stone size larger than 13 mm, P=0.0005, which was more in the non-stented (Group B) patients. Most of the lower urinary tract symptoms were seen in stented (Group A) patients, P

Urinoma (collection of urine) formation secondary to extracorporeal shock wave lithotripsy (ESWL) is one of the rare complications encountered postprocedure and co-existence of urinoma with steinstrasse is a rare and challenging scenario to manage in the setting of obstructive uropathy. ESWL is known for being noninvasive for breaking kidney and ureteric stones. Urinoma is a collection of urine outside the collecting system in the retroperitoneum or perirenal space. Early detection and management are necessary to prevent complications related to urinoma and steinstrasse. This case report is about a patient who developed urinoma and steinstrasse in the setting of obstructive uropathy after sessions of ESWL on the right side and was managed with a nephrostomy tube and trans-ureteral lithotripsy on the right side and percutaneous nephrolithotomy on the left side after 1 month., (© 2024 The Authors. Published by Elsevier Inc. on behalf of University of Washington.)

This case report describes the successful management of a knotted ureteric stent in a 57-year-old male with diabetes mellitus, who presented with left flank pain and lower urinary tract symptoms after seven months of stent placement. Initial imaging revealed migration and encrustation of the stent, along with knotting at the proximal end. As rigid cystoscopy to attempt stent retrieval met resistance, a semirigid ureteroscope was used to laser transect the stent, allowing for the insertion of a new stent. Following this, extracorporeal shock wave lithotripsy was performed to target the knotted portion, successfully facilitating its unknotted migration. Final imaging confirmed the appropriate positioning of both stents, enabling their subsequent removal without complications. This case underscores an effective, innovative approach to managing complex ureteric stent complications., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Al Dehneen et al.)

Double-j stents are commonly used in many urological procedures to facilitate the drainage of renal systems postoperatively. Their usage has revolutionized the world of urological interventions but if left forgotten present serious complications. We report a case of an old man who was diagnosed with bilaterally fragmented DJ stents in situ in our urology department following his sessions of extracorporeal shock wave lithotripsy for chronic encrustations. These stents were placed after complete breakdown of bilateral ureteral stones through ureterorenoscopy and laser lithotripsy., (© 2024 The Authors. Published by Elsevier Inc. on behalf of University of Washington.)

Background: Extracorporeal shock wave lithotripsy (ESWL) has become the first-line treatment for stones in the upper urinary tract measuring <2cm. It is the minor invasive treatment for calculi of the upper urinary tract. Aims and Objectives: This study aims to identify the effect of the presence and absence of a ureteric stent on the outcome of ESWL in patients with proximal ureteric stones. Materials and Methods: This was a prospective cohort study done on 300 patients and wasdivided into two equal groups of 150 each. Group A patients were selected for ESWL with DJ stent, and Group B patients were for ESWL without DJ stent. Noncontrast CT KUB was done as a functional study along with plainX-ray KUB and ultrasound before the intervention. All treatments were done with Direx Compact XL (electromagnetic generator) device as an outpatient procedure. Patients were followed up radiographically at 15 days, 1 month, 2 months, and in 3 months. Hematuria, steinstrasse, fever, ureteric colic, lower urinary tract symptoms (LUTS), stone clearance, number of ESWL sessions, and secondary procedures were recorded for each group. DJ stent was taken out when the stone disappeared or at the end of 3 months. Variables were compared with Chi-square test. Results: The overall stone-free rate at 3 months was 90.6% (272/300). Clearance after the first sitting, second sitting, and the third sitting wasnot significant between the two groups(P>0.05). There was no significant difference between the two groups in regard to clearance according to the size of the stones. A total of 9.3%(28/300) of patients did not have a successful outcome and were termed as ESWL failures. Post-ESWL complications were significant between the both groups in terms of hematuria and ureteric colic. All the ureteric colic patients had a stone size larger than 13 mm, P=0.0005, which was more in the non-stented (Group B) patients. Most of the lower urinary tract symptoms were seen in stented (Group A) patients, P<0.0001 significant between the two groups, and dysuria was also significant between the two groups with P=0.0033. Conclusion: Pre-ESWL ureteral stenting provides no additional benefit over no stent in situ, although ureteral stents are associated with more irritative symptoms. [ABSTRACT FROM AUTHOR]

In the case of advanced stage gynecological disorders, most patients have a disturbance in the upper urinary tract. Most patients with uterine cervical carcinoma are already in stage 3B and require urine diversion. The purpose of this study is to find and determine the profile of gynecological disorders that require urine diversion, the type of urine diversion, and urine diverted output in patients with cervical carcinoma. This descriptive analytical retrospective study was conducted at Dr. Soetomo Hospital, Surabaya, Indonesia, between 2012 and 2015. The samples of this study were all patients with gynecological disorders who underwent retrograde DJ stent procedures, underwent ureterocutaneostomy and nephrostomy at the Integrated Central Surgery Building, Dr. Soetomo Hospital, Surabaya, for three years between 2012 and 2015. Data was collected based on the medical record number of patients with gynecological disorders who underwent urine diversion procedures and were recorded in the book on the operation schedule. We find that the most common cause of gynecological abnormalities in kidney obstruction is cervical carcinoma. There are three types of urine diversions used, namely DJ stent, percutaneous nefropyelostomy, and ureterocutaneostomy, with DJ as the most commonly performed. Urine diversion can improve creatinine without being influenced by the type of diversity.

Objective: To determine the difference in pain intensity between the administration of a combination of tramadol and intraurethral lidocaine gel with only lidocaine gel during the removal of DJ stents. Material & Methods: This study was a prospective randomized clinical trial with 22 patients that were divided into 2 groups. Group 1 was given a combination of tramadol and lidocaine gel urethral injection 3 to 5 minutes before DJ stent removal, whereas group 2 was given lidocaine gel urethral injection 3-5 minutes before the removal. The inclusion criteria in this study was all patients with a DJ stent placement with 1 to 3 months prior to release who were willing to participate. The Wong-Baker scale was used directly to determine the scale of pain during the procedure. Mann Whitney analysis was used to analyze the findings. Results: Most patients in group 1 are shown to have a pain rating of 2. There are 2 patients with a high pain rating scale of 6 and 7. In group 2, most patients claimed that the procedure was painless. The average Wong-Baker pain scale in group 1 (2.9) compared to group 2 (0.36) was significantly different. Conclusion: The combination of intraurethral tramadol and 2% lidocaine gel can significantly decrease pain during DJ stent removal more effectively than sole intraurethral 2% lidocaine gel based on the Wong-Baker pain scale.

Ureteral stents play a vital role in urologic surgeries, aiding in urinary flow maintenance, obstruction alleviation and facilitating healing. However, when stents are forgotten, they can lead to encrustation, resulting in significant patient morbidity and posing challenges for urologists Stent-related complications have been shown to increase with the duration of time the stent is left in place. This report details the clinical presentation, diagnostic process, and treatment of a 68-year-old male patient had a neglected stent placed 18 years ago after extracorporeal shockwave lithotripsy. He presented with severe stent encrustation, a solitary giant bladder stone, and renal stones. The patient underwent a cystolithotomy to remove the bladder stone followed by an ultrasound-guided percutaneous nephrolithotomy with pneumatic lithotripsy in a separate procedure. Preventive strategies such as implementing a stent registry, enhancing patient education, and encouraging follow-up appointments are crucial to avoid such complications., Competing Interests: No competing financial interests exist., (Published by Oxford University Press and JSCR Publishing Ltd. © The Author(s) 2024.)

Intravascular migration of DJ stent is a rare complication that needs immediate attention to prevent severe complication. We reported a rare case of intravascular migration of DJ stent in a patient with retroperitoneal fibrosis. The DJ stent was removed by cystoscopy with no complication.

Duplication of renal system is one of the commonest renal anomalies. It is infrequently associated with renal calculus, ureterocele and vesico ureteric reflux. We report a 29-year male with right complete duplex system having upper moiety multiple ureteric calculi and lower moiety inferior renal calculus. Single sitting fURS was done and calculi in both systems were tackled one at a time. Calculi were dusted with holmium laser and double J stent placed in upper moiety ureter. Calculus management in anomalous kidney is challenging. Single sitting flexible ureterorenoscopy is feasible option in duplex renal system with low burden calculi.

DJ stents are widely used in urological procedures and interventions. One of the main problems associated with DJ stent is encrustation and stone formation. The main risk factor for Forgotten, encrusted and calcified (FECal) stent is duration of the stent placement. In addition to high index of suspicion, Imaging like U/S and CT scan are important diagnostic modality. Multiple endourologic and open procedure may be needed for management of fecal stent. This case report is to discuss a 23 years old female patient with a neglected stent after right pyelolithotomy was done 6 years back. The presence of the stent was identified incidentally after she visited local health facility for recurrent LUTS. The CT scan shows fragmented and encrusted stent with in the bladder and pelvis, stones in stent coils and isolated lower pole stone. She was managed by a procedure of cystolithotomy and right PCNL in separate sessions. Common complication of DJ stent placement especially if left for long duration is encrustation, stent migration, fragmentation and stone formation. Patient or relatives unawareness about the stent placement is the most important cause for neglecting stent. Multiple Endourologic procedures may be needed for the management of FECal stent. However some resource limited settings do combination of endourologic and open surgery. Minimizing the duration of the stent especially for patient with risk factors is advised to decrease encrustation. Since management of FECal stent is challenging both for patient and urologists, prevention is the way to tackle it. Multiple procedures may be required to manage FECal stent. • Neglected stent is a rare occurrence but carries huge challenges in urology practices. • Due to delayed diagnosis and management FECal stents are troublesome and may cause irreversible kidney damage. • The diagnosis solely relies on detailed patient evaluation and computed tomographic imaging studies. • Multiple procedures involving both open and endoscopic interventions are needed to manage the condition. [ABSTRACT FROM AUTHOR]

Background: Double J (DJ) stents are basic and commonly used tools in urology. They are self-retaining at both renal pelvis and bladder used in upper urinary tract obstruction, infection caused by hydronephrosis, safety concerns (post endourological procedures) and renal failure secondary to ureteral obstruction. Despite advances in technology, ideal stent has not been invented yet leading to LUTS lower urinary tract infections after stent placement with incidence of 50%-70% postoperatively. Our study was undertaken to analyse early complications of DJ stenting postoperatively at our centre. Methods: Prospective study on postoperative patients with DJ stent in situ for various indications. Follow up of patients attending surgery department was taken. Detailed history and clinical examination with symptoms of complications were recorded at 2nd and 4th postoperative week from time of placement of double-J ureteral stent till its removal. Results: Total 87 patients, with mean age 42.89 ± 14.69 years and M:F 2.49:1 underwent DJ stenting for various indications. Majority of patients had complications like flank/suprapubic pain (47.12%) followed by urgency (42.52%) and haematuria (37.93%) in 2nd postoperative week which were managed conservatively, which reduced to significant rate till 4th post-op week. Major complications like stent migration/encrustations were not seen in any patient. Conclusion: DJ stents have become routine and essential part of urological procedures. Patients must be well informed and counselled about the potential early complications such as frequency, urgency, incontinence and pain along with late complications post stenting. [ABSTRACT FROM AUTHOR]

Background: Indwelling double J ureteral stents are used routinely in the resolution of ureteral obstruction caused by different etiologies. Evaluation of urinary symptoms related to double-J stent indicate that these affect 73-90% of patients. Aim of this study is to evaluate the effect of tamsulosin on the DJ related complications to improve the quality of life and render symptom free life. Material and Methods: Quasi experimental study was carried out in the department of urology in College of Medical Science, teaching hospital Chitwan, Nepal from 15th March 2017 to 15th March 2018. A total of 80 post operative patients were included in this study and were randomized into Group A and B with 40 patient in each group. Stent related symptoms, quality of life and IPSS (International prostate symptom score) were evaluated at the time of discharge and at the time of DJ removal. Pain was evaluated with the help of VAS at the time of discharge and at the time of DJ removal. Data were entered in MS-Excel and were imported to EZR software Version 3.4.1 for analysis. A p-value of less than 0.05 was considered significant. Results: Median age was 30.5 in Tamsulosingroup and24years in placebo group. (p=0.68).At the time of discharge significant difference was noted in IPSS (p

Aim: To compare drainage outcomes from double J stent and percutaneous nephrostomy stent for upper urinary tract obstruction and to research factors determining the stent method to be used. Upper urinary tract obstruction may be caused by ureter and kidney stones internally or by local advanced-stage pelvic organ cancers externally and this may lead to sepsis or obstructive uropathy. It is necessary to drain the kidney immediately before definitive treatment of stone patients and prevent increased morbidity and mortality in cancer patients. Materials and Methods: A total of 213 patients with upper urinary tract obstruction and drainage using double J stent and percutaneous nephrostomy catheter were retrospectively assessed. Demographic, operative-postoperative data and predictive factors for stent selection were assessed. Results: The groups were different in terms of age and gender demographically, as well as disease duration before the procedure, comorbid diseases, causative factors, hydronephrosis degree and stone size (p <0.05). The groups were different in terms of operational data, operation time, auxiliary time, complications and definitive treatment for stones (p <0.05). Independent predictive factors for stent selection were stone size (Odds ratio:1.3), obstructive duration before the procedure (Odds ratio:1.1), causative factors (Odds ratio:38.1), and hydronephrosis degree (Odds ratio:10.5). Conclusion: For patients with long duration of obstruction and high degree of hydronephrosis, with obstruction caused by local advanced pelvic cancer and large ureter stones and with sepsis, percutaneous nephrostomy drainage should be chosen instead of double J stent drainage. [ABSTRACT FROM AUTHOR]

Introduction The aim of this study was to investigate the effect of 50 mg mirabegron once daily in relieving ureteral double-J (DJ) stent-related discomfort after ureteroscopy (URS) or retrograde intrarenal surgery (RIRS). Material and methods A total of 210 patients who underwent DJ ureteral stent insertion after URS or RIRS were randomized 1:1 to receive either no treatment (Group B) or mirabegron 50 mg once daily (Group A) during the stenting period. At time of stent removal, all patients were evaluated for stent-related symptoms using the Arabic translated and validated ureteral stent symptom questionnaire (USSQ). The severity of stent-related symptoms (SRS) was compared between the two groups. Results The mean age was 46.6 ±8.2 years in Group A and 44.7 ±9.4 (26-64) years in the control group (p = 0.13). The stone characteristics, stent size, and position were similar in both groups. Compared to the control group, the mirabegron group had significantly lower daytime frequency, nocturia and urgency (p = 0.028, p = 0.008 and p = 0.012, respectively). As for stent-related pain, Group A had significantly less flank and abdominal pain (p = 0.007 and p = 0.001, respectively). The mirabegron versus control group showed significant difference in mean analgesics use and quality of life (QoL) scores during the stenting period (p = 0.005 and p = 0.003, respectively). Three patients (2.9%) in Group A encountered minor adverse effects (two experienced dry mouth and one presented with constipation). Conclusions For patients with indwelling DJ stent, postoperative mirabegron 50 mg use was effective and well-tolerated for the treatment of lower urinary tract symptoms and stent-related pain. [ABSTRACT FROM AUTHOR]

This prospective study was aimed to evaluate the impact of an indwelling ureteral double‐J stent on the sexual health of Indian men undergoing ureteroscopy. The first phase of the study included 30 men who were not counselled prior to stenting about possible sexual dysfunction, while in the next phase, 60 men were counselled about this. These 60 patients were assessed by a 6‐point questionnaire: five questions from the International Index of Erectile Function‐5 (IIEF‐5) and an additional 6th question to assess pain during erection/ejaculation. Patients answered the questionnaire prior to ureteroscopy, at the time of stent removal and then 4 weeks after stent removal. A higher proportion of men in the second phase attempted sexual activity (68.3% vs. 26.7%; p <.001). Significant changes were noted in the total IIEF‐5 score (mean 23.16 before vs. 15.65 after, p <.001) and individual IIEF‐5 components: erection confidence (4.59 vs. 2.76, p =.017), maintenance ability (4.67 vs. 2.43, p =.006) and intercourse satisfaction (4.61 vs. 2.31, p <.001) and also the 'pain' question (2.83 post‐stenting vs. 0.37 pre‐stenting, p <.001). Most patients had a recovery of scores at 4 weeks after stent removal. Thus, ureteral DJ stenting leads to significant but temporary sexual dysfunction and patients need to be counselled regarding this. [ABSTRACT FROM AUTHOR]

BACKGROUND & OBJECTIVE: There is disagreement in the use of ureteral double-J stent before the extracorporeal shock wave lithotripsy (ESWL), although most of the urologists suggest using stent in shock wave lithotripsy technique for stones bigger than 20mm, for preventing the risk of developing steinstrasse. To compare the success of ESWL with and without DJ stenting in proximal ureteric stone. METHODOLOGY: A total of 60 patients form both genders, between 15 to 55 years of age, with a single proximal ureteric stone, were included. Patients with solitary functioning kidney, multiple stones, pregnancy, pyonephrosis and sepsis were excluded. In Group-A, ESWL without DJ stenting was completed while in Group-B, ESWL with DJ stent placement was done. In all patients, at least 4 sessions were done fortnightly. Patients were followed regularly and final success was noted after one month of completion of ESWL sessions. RESULTS: The mean age was 36.85 ± 8.61 years. From 60 patients, 29 (48.33%) were men and 231 (51.67%) were women.Mean body mass index (BMI) was 28.30±2.20 kg/m . The average size of the stone was 12.47 ± 2.57 mm. Success (according to stone removal) of Group-A (ESWL without DJS) was seen in 26 (86.67%) patients while in Group-B (ESWL with DJS) was seen in 16 (53.33%) patients with P-value of 0.005. CONCLUSION: This study concluded that success (in terms of stone clearance) of extracorporeal shock wave lithotripsy (ESWL) without DJ stenting is higher compared to with DJ stenting in upper ureteric stone.

BACKGROUND & OBJECTIVE: There is disagreement in the use of ureteral double-J stent before the extracorporeal shock wave lithotripsy (ESWL), although most of the urologists suggest using stent in shock wave lithotripsy technique for stones bigger than 20mm, for preventing the risk of developing steinstrasse. To compare the success of ESWL with and without DJ stenting in proximal ureteric stone. METHODOLOGY: A total of 60 patients form both genders, between 15 to 55 years of age, with a single proximal ureteric stone, were included. Patients with solitary functioning kidney, multiple stones, pregnancy, pyonephrosis and sepsis were excluded. In Group-A, ESWL without DJ stenting was completed while in Group-B, ESWL with DJ stent placement was done. In all patients, at least 4 sessions were done fortnightly. Patients were followed regularly and final success was noted after one month of completion of ESWL sessions. RESULTS: The mean age was 36.85 ± 8.61 years. From 60 patients, 29 (48.33%) were men and 31 (51.67%) were women. Mean body mass index (BMI) was 28.30±2.20 kg/m2. The average size of the stone was 12.47 ± 2.57 mm. Success (according to stone removal) of Group-A (ESWL without DJS) was seen in 26 (86.67%) patients while in Group-B (ESWL with DJS) was seen in 16 (53.33%) patients with P-value of 0.005. CONCLUSION: This study concluded that success (in terms of stone clearance) of extracorporeal shock wave lithotripsy (ESWL) without DJ stenting is higher compared to with DJ stenting in upper ureteric stone. [ABSTRACT FROM AUTHOR]

Objective: To determine the rate of stone clearance after extracorporeal shockwave lithotripsy (ESWL) for renal stones in adult patients with renal insufficiency. Subjects and methods: This is a cross-sectional descriptive study of 117 adult patients who underwent ESWL. The indications for ESWL were determined by the stone size and serum creatinine. All adult patients including males and females (≥18 years) with renal stones ≤2 cm in size and serum creatinine between 1.5–5.0 mg/dl were included in the study. All patients underwent ureteral double J (DJ) stent placement before ESWL. The initial success of treatment was assessed on the basis of plain radiographic imaging and ultrasonography which was performed 1 month after ESWL. Final stone clearance was evaluated at 3 months after the first ESWL session. Data were analyzed using SPSS version 18.0. Results: A total of 117 patients underwent ESWL in this study. Out of these, 88 (75.2%) were males and 29 (24.8%) females with a male to female ratio of 3.0:1. The mean age was 38.2 ± 14.1 years. The mean serum creatinine and stone size were 2.4 ± 0.8 mg/dl and 1.4 ± 0.3 cm, respectively. The overall frequency of stone clearance after ESWL for renal stones was 70.9% (83/117) in patients with renal insufficiency. The rate of stone clearance was 76.4% (42/55) in cases with serum creatinine of 1.5–2 mg/dl, 69% (20/29) in patients with serum creatinine of 2.1–3 mg/dl, 70.4% (19/27) in patients with serum creatinine of 3.1–4 mg/dl and 33.3% (2/6) in those with serum creatinine of 4.1–5 mg/dl (p = 0.175). Conclusion: Our results show that ESWL may be used as the first line of management for renal stones in patients with mild to moderate renal insufficiency.

Background: Placement of ureteral stents has been standard after the endoscopic procedures because it relieves obstruction caused by the stone and facilitates urine drainage. Bacterial colonization in the stent plays an essential role in the pathogenesis of stent-associated infections. The goal of this study was to determine the frequency, type of pathogens, and the significance of risk factors that may affect bacterial colonization of ureteral stents after endourology procedures in urinary stone patients. Methods: Thirty patients underwent percutaneous nephrolithotomy or ureterorenoscopy for renal and ureteric stones were enrolled in this study. Urine specimens were collected for culture examination before stent insertion and on removal. The stents were then removed based on the clinical decision via the cystoscope, and three distal tip segments of the stents were sent for culture examination. Results: Four patients (13.3%) before stent insertion and 11 patients (36.7%) before stent removal had positive urine cultures. Eighteen (60%) stents were positive for the culture. Diabetes mellitus (DM) (P = 0.018) and chronic kidney disease (CKD) (P = 0.040) had a significant difference in increasing the risk of bacterial colonization. Pseudomonas aeruginosa was the most common pathogen isolated from the stent culture. Conclusion: An indwelling ureteral stent carries a significant risk of bacterial colonization both on patients with DM and also CKD. P. aeruginosa appears as the most common bacteria in stent culture due to immunocompromised factors of these patients. [ABSTRACT FROM AUTHOR]

In the case of advanced stage gynecological disorders, most patients have a disturbance in the upper urinary tract. Most patients with uterine cervical carcinoma are already in stage 3B and require urine diversion. The purpose of this study is to find and determine the profile of gynecological disorders that require urine diversion, the type of urine diversion, and urine diverted output in patients with cervical carcinoma. This descriptive analytical retrospective study was conducted at Dr. Soetomo Hospital, Surabaya, Indonesia, between 2012 and 2015. The samples of this study were all patients with gynecological disorders who underwent retrograde DJ stent procedures, underwent ureterocutaneostomy and nephrostomy at the Integrated Central Surgery Building, Dr. Soetomo Hospital, Surabaya, for three years between 2012 and 2015. Data was collected based on the medical record number of patients with gynecological disorders who underwent urine diversion procedures and were recorded in the book on the operation schedule. We find that the most common cause of gynecological abnormalities in kidney obstruction is cervical carcinoma. There are three types of urine diversions used, namely DJ stent, percutaneous nefropyelostomy, and ureterocutaneostomy, with DJ as the most commonly performed. Urine diversion can improve creatinine without being influenced by the type of diversity. [ABSTRACT FROM AUTHOR]

Ureteral DJ stents have been used widely for years in urology practice. With increased use, complications have been increased and forgotton stents have started to cause problems. The most common complications are early pain and irritative symptoms. Late complications are bacterial colonization and stone formation because of the biofilm covering the stents. Treatment for a forgotten stent varies on many factors, such as stent localization and stone formation. In this article, we aimed to discuss our clinic approach on two different cases in light to current literature. [Cukurova Med J 2015; 40(Suppl 1): 58-63]

Aim: To assess the efficacy, safety, and morbidity of tubeless percutaneous nephrolithotomy (PCNL) and compare it with conventional PCNL. Materials and Methods: This is a comparative study carried out at NIMS, Jaipur. 102 patients underwent PCNL in two groups between 2016 and 2017. One group of 54 patients underwent PCNL with nephrostomy placement (standard PCNL) while the second group of 48 patients underwent PCNL without nephrostomy tube and D-J stent (TUBELESS PCNL). Results: 54 patients who underwent conventional PCNL with nephrostomy tube & DJ stent had mean age of 31.4 years and mean stone size of 3.1 cm. The mean operative time was 40 mins with mean hospital stay was 3.2 days and mean analgesic requirement is 150 mg of diclofenac. 48 patients who underwent tubeless PCNL had mean age of 33.9 yrs and mean stone size of 2.8 cm. The mean operative time was 31 mins with mean hospital stay of 2.8 days. Mean analgesic requirement was 85 mg of diclofenac. Decrease in haemoglobin was, however, almost same in both the groups. Conclusions: This study demonstrates that percutaneous nephrolithotomy without nephrostomy is a safe and well tolerated procedure in selected patients. We believe that tubeless percutaneous nephrolithotomy may be considered as the accepted standard of care for selected cases and it is possible to reserve placement of a nephrostomy tube for specific indications. [ABSTRACT FROM AUTHOR]

Objectives: To determine whether short‐term stenting using an external ureter catheter following ureterorenoscopic stone extraction provides a better outcome in comparison to double‐J stent ureteral stenting. Methods: Between August 2014 and August 2015, 141 patients initially managed with a double‐J stent insertion were prospectively randomized to ureter catheter for 6 h vs double‐J stent insertion for 5 days after stone extraction via ureteroscopy retrograde surgery (including flexible ureteroscopy retrograde surgery) in a single academic center. Endoscopic procedures were performed by nine surgeons. Exclusion criteria were acute urinary tract infection, a solitary kidney, or a stone mass more than 25 mm. Study endpoints were ureter‐stent related symptoms and pain assessed by a validated questionnaire (ureteral stent symptom questionnaire) and visual analogue scale before and 4 weeks after surgery. Results: Overall stone‐free rate was more than 90%. Mean operative time was 24 min (range 5–63). Groups did not differ in terms of age, body mass index, and stone size. Patients who received short‐term ureter catheter showed a significantly higher quality of life. In the ureter catheter group, the urinary index score (16.8 vs 27.8; P < 0.0001), the pain score (9.7 ± 1.3 vs 20.2 ± 1.5; P < 0.0001), and general health index (15.3 ± 0.7 vs 8.5 ± 0.6; P < 0.0001) were significantly lower. Consultation of a physician and antibiotic treatment were rarely needed (1.3 ± 0.1 vs 1.6 ± 0.1; P = 0.017). Conclusion: A short‐term ureter catheter insertion for 6 h following ureteroscopy retrograde surgery stone removal is a safe procedure and superior to double‐J stent insertion with regard to urinary symptoms, pain, quality of life, and stent related symptoms. Patients treated with a short‐term ureter catheter recover more quickly, return to work earlier, and need less doctor visits. Most patients would recommend a ureter catheter, and would prefer this strategy in case of future stone treatments. [ABSTRACT FROM AUTHOR]

Background: Double J stent is a tube placed in the lumen of the ureter to maintain its patency. Double J coils at proximal and distal ends makes it self-retaining by securely anchoring it at renal pelvis and at bladder levels. Materials and methods: A total of 661 patients operated for ureteric calculus from June 2014 to September 2017 at Jeevan Hospital, Omni Hospital, Healthcare Hospital and Evya Hospital Hyderabad, Telangana were studied. Jeevan Hospital was selected to follow strict indications for DJ stenting after ureteroscopic stone removal. Other hospitals were selected for routine DJ stenting after ureteroscopic stone removal. 378 cases were operated in Jeevan hospital and only 54 cases required DJ stenting. Results: Over all the rate of ureteral stenosis was seen in 4 patients (0.60%) of which 2 were from stented group and 2 (0.30%) were from non-stented group and 2 (0.30%) patients required ureteroneocystostomy, 1 patient required ureteroneocystostomy with psoas hitch and one patient was on DJ stent and was on follow up. Conclusion: Stent could be safely avoided in 85.7% of cases following strict indications for stenting. Complications like ureteral stricture are not limited to non-stented group. Judicious use of stent makes many patients symptom free, and makes them to resume duties early and sexual activity early. [ABSTRACT FROM AUTHOR]

Prophylactic double J (DJ) stent insertion has been adopted as a routine procedure in renal transplant patients for internal urinary diversion and for protecting ureteroneocystostomy anastomosis. The timely and early removal of stent has been proved to reduce the occurrence of stent-associated complications such as migration, encrustation, and infection. The most commonly used procedure of stent removal via retrograde cystoscopic approach can sometimes be technically very difficult leaving antegrade approach as another alternative to open surgery as the last resort. Here, we describe a case of antegradely removed impacted DJ stent by pushing it free into the urinary bladder followed by cystoscopic removal.

A 30-year-old lady underwent a Boari flap repair for post-hysterectomy mid-ureteric stricture. The upper end of the double J stent inserted during the procedure was misplaced in the supra-renal inferior venal cava. Cystoscopic stent removal could be performed uneventfully, while the stricture was managed by endoureterotomy.

Introduction: Ureteral stent placement is an increasingly common procedure in urological practice. They are used for both prevention and treatment of ureteral obstruction. Despite improved design and materials, many patients still develop stent-related symptoms which commonly affect quality of life and sometimes necessitate early removal. Tamsulosin improves stent-related symptoms and quality of life. But such study has not been conducted in Nepalese context. In the present study, the effect of Tamsulosin in improving double-J stent-related symptoms and quality of life following ureteral stent placement was studied. Methods: This study was carried out in the Department of Urology and Kidney Transplant Surgery, Tribhuvan University Teaching Hospital, Kathmandu, Nepal from February 2015 to January 2016. Forty six patients were included in the study and randomized into Tamsulosin (T) group and Control (C) group each having 23 patients. In addition to standard postoperative care, Tamsulosin group received 0.4 mg Tamsulosin daily for 2 weeks and Paracetamol on demand and control group received only Paracetamol (1gram/dose). Stent related symptoms and quality of life was assessed by International prostate symptom score (IPSS) at discharge (day2) and at the time of DJ stent removal (2 weeks). Pain was evaluated by visual analog scale (VAS) and analgesic requirement was documented. Data were analysed using Statistical Package for the Social Sciences (SPSS) 20, chisquare test and Student’s t- test was used. A p-value of

Purpose: We developed and validated the German version of the Ureteral Stent Symptoms Questionnaire (USSQ) for male and female patients with indwelling ureteral stents. Methods: The German version of the USSQ was developed following a well-established multistep process. A total of 101 patients with indwelling ureteral stents completed the German USSQ as well as the validated questionnaires International Prostate Symptom Score (IPSS) or International Consultation on Incontinence Questionnaire (ICIQ) and the Short Form Health Survey (SF-36). Patients completed questionnaires at 1 and 2-4 weeks after stent insertion and 4 weeks after stent removal. Statistical analyses were performed to assess the psychometric properties of the questionnaire. Results: The German version of the USSQ showed good internal consistency (Cronbach's α = .72-.88) and test-retest reliability [intraclass correlation coefficient (ICC) = .81-.92]. Inter-domain associations within the USSQ showed substantial correlations between different USSQ domains, indicating a high conceptual relationship of the domains. Except from urinary symptoms and general quality of life, German USSQ showed good convergent validity with the corresponding validated questionnaires. All USSQ domains showed significant sensitivity to change ( p ≤ .001). Conclusion: The new German version of the USSQ proved to be a reliable and robust instrument for the evaluation of ureteral stent-associated morbidity for both male and female patients. It is expected to be a valid outcome measure in the future stent research. [ABSTRACT FROM AUTHOR]

The placement of ureteral DJ stents is currently regarded as a common and indispensable urologic tool (Dyer et al., 2002 [1]). However, using them can lead to complications. Infection, stent migration, encrustation, stone formation, and stent fragmentation are some of these complications (Mahmood et al., 2018 [2]). Stent-related complications are inversely associated with time (Lombardo et al., 2022 [3]). In this case report, we present multimodal therapy, which also includes open surgery and endourologic procedures for the removal of severely encrusted DJ stents. A 22-year-old male who underwent nonspecific flank surgery 15 years ago, had a stent placed, and was lost to follow-up. He had severe stent encrustation at the presentation. He also had a solitary bladder stone and many pelvic stones discovered. Initially, cytolithotrity and semirigid ureteroscopy with laser lithotripsy were performed, and the encrusted stent was removed. Subsequently, an open cytolitotomy was done. Followed by an ultrasound-guided PCNL at which time the remaining stones were removed. The patient was followed for eighteen months and has been in better condition. The key risk factor for the development of encrustation has been shown repeatedly to be the duration of stent indwelling time (Lombardo et al., 2022 [3]). In the absence of clear guidelines for the removal of retained stents, this problem has been approached with a variety of treatment modalities (Bidnur et al., 2016 [4]). A stepwise approach with combined endo -urology and open surgery can be used for the management. Forgotten and neglected DJ stentsfor a long time can cause multiple complications. The best treatment is the prevention of this complication with a stent registry and increase awareness among the patients and their attendants. • Encrustation of forgotten stents associated with large stone burden is a serious problem. • A forgotten, encrusted & calcified stent was defined as a stent that can't be cystoscopically removed during the first try. • To treat an encrusted stent, a progressive strategy combining endo-urology and open surgery can be used. • The key risk factor for the development of encrustation has been shown repeatedly to be duration of stent indwelling time. [ABSTRACT FROM AUTHOR]

Objective: To investigate the impact of preoperative double J (DJ) stent insertion on outcomes of retrograde semi-rigid ureteroscopy (URS) in patients with upper small and medium sized ureteral stones., Methods: Between April 2018 and September 2019, we retrospectively reviewed the medical register of Hillel Yaffe tertiary reference Centre (HYMC) for patients who had undergone retrograde semi-rigid URS for urolithiasis. Patients were separated into two groups depending on whether they accepted the DJ stent placement before URS (Group A) or not (Group B). Operating time, stone clearance rate, number of 'rescue' DJ stents, duration of 'rescue' stents, complication rate and requirement for repeat URS were compared between groups., Results: 318 procedures undertaken in 290 patients were included (Group A, 83 procedures in 80 patiants; Group B, 235 procedures in 210 patients). By comparison with the non-stented group, patients in the preoperative DJ stented group had a higher stone clearance rate, lower complication rate, less need for postoperative 'rescue' DJ stent, lower duration of 'rescue' stent and lower re-operative URS requirement, including application of a flexible URS., Conclusion: Facilitated semi-rigid URS with upstream DJ stenting for small and medium size ureteral stones has favourable periprocedural outcomes compared with primary URS.

Background: DJ stents are routinely used in urological procedures. Rarely these may dislodge or migrate. Case Series: Here we report proximal migration of DJ stent in three children with pelvi-ureteric junction (PUJ) obstruction treated with dismembered pyeloplasty. Ureteroscopy and retrieval of migrated DJ stents were performed in each of these patients. Conclusion: Proximal migration of DJ stent, though rare, can cause significant morbidity and complicates it's removal. Proper size and positioning of stent is required for pediatric patients. [ABSTRACT FROM AUTHOR]

Introduction: Ureteral stent placement is an increasingly common procedure in urological practice.They are used for both prevention and treatment of ureteral obstruction. Despite improved design and materials, many patients still develop stent-related symptoms which commonly affect quality of life and sometimes necessitate early removal. Tamsulosin improves stent-related symptoms and quality of life, and can be applied in routine clinical practice. In the present study, the effect of Tamsulosin in improving double-J stent-related symptoms and quality of life following ureteral stent placement was studied. Methods: This RCT was carried out in the Department of Surgery, Tribhuvan University Teaching Hospital, Kathmandu, Nepal from February 2015 to January 2016. Forty six patients were included in the study and randomized into Tamsulosin(T) group and Control(C) group each having 23 patients. In addition to standard postoperative care, Tamsulosin group received 0.4mg Tamsulosin daily and Paraceramol on demand and control group received only Paracetamol. Stent related symptoms and quality of life was assessed by IPSS at discharge (day2) and at the time of DJ stent removal (2 weeks). Pain was evaluated by VAS and analgesic requirement was documented. Data were analysed using SPSS 20, chi-square test and Student’s t- test was used. A p-value of

DJ stent is considered as a boon by the urologist but without proper knowledge it turns to be curse for the patient. We report a case of a 34 year old man who developed vesical calculus secondary to DJ stent in a short span of 6-8 months. He underwent cystolithotomy for removal of the vesical calculus along with the DJ stent. Journal of College of Medical Sciences-Nepal, 2013, Vol-9, No-3, 55-59 DOI: http://dx.doi.org/10.3126/jcmsn.v9i3.10224

Urolithiasis means calculus in urinary system. It is a rare condition in pregnancy which can have devastating results for the mother in the form of pyonephrosis and septicaemia and to the foetus in the form of IUGR and prematurity. This is a rare case report of a 27-year old female patient who presented with perinephric abscess and hydronephrosis at 22 weeks of pregnancy. With proper evaluation and management, pregnancy continued till term with good perinatal outcome.

Emphysematous pyelonephritis is a life threatening, necrotizing upper urinary tract infection associated with gas within the kidney and/or perinephric space. To prevent mortality from this fulminant infection, early diagnosis is essential. CT scan should be done early in patients with suspected emphysematous pyelonephritis. Here, we present a case of Type II Diabetes Mellitus complicated with left obstructive ureteric calculi, diagnosed on CT scan to have extensive bilateral emphysematous pyelonephritis of class 4. We treated conservatively with antibiotics and DJ stent. The patient responded and a repeat CT scan was done after 4 weeks which showed no evidence of emphysematous pyelonephritis.