Ureteral stents, first described by Zimskind in 1967, have become a critical tool in modern urology. They are widely used in various endourological procedures to drain obstructed or infected renal units and as a safety measure before or after surgeries. Despite their effectiveness, ureteral stents are not without complications. These include issues such as stent migration, obstruction, fragmentations, encrustation, and urinary tract infections. Additionally, up to 88% of patients experience stent-related symptoms (SRS), including flank pain, haematuria, and irritative bladder symptoms, with over 70% requiring analgesics for relief. To reduce the negative impact of SRS and improve patients’ quality of life (QoL), numerous modifications have been proposed. These include changes in stent design, material, and surgical techniques, especially regarding the stent’s distal end, diameter, and length. While the distal portion of the stent has been widely studied, less attention has been given to the proximal end and the effect of incomplete coiling during placement. Coiling of the proximal end is a common technique used during stent placement, but it is not always achieved on the first attempt, requiring additional time and radiation. A critical question arises: Should surgeons make additional efforts to coil the stent if the stenting is short-term, and how does the quality of the coil impact clinical outcomes? The purpose of this study was to assess the effect of coiling the proximal end of the ureteral stent on SRS in patients undergoing preoperative stenting for retrograde intrarenal surgery (RIRS). This prospective, comparative study, approved by the local ethical committee, enrolled patients undergoing ureteral stenting 7–10 days before RIRS. The inclusion criteria included patients over 18-years-old with renal stones (single or multiple), where a 6Fr, 26cm ureteral stent was placed. Exclusion criteria were patients with concomitant ureteral stones, chronic pain, or prolonged stenting over 10 days. A total of 98 patients were initially considered, but 17 were excluded due to coiling of the proximal end before RIRS, leaving 81 patients for analysis. The patients were divided into two groups: Group 1, where coiling was successfully achieved, and Group 2, where coiling was incomplete. Symptoms were assessed using a Visual Analog Scale (VAS), and patients were asked to report the severity of symptoms such as bladder pain, flank pain, haematuria, urgency, frequency, nocturia, and urge incontinence. The results showed that patients in Group 2, with incomplete coiling, experienced significantly more severe back and bladder pain compared to those in Group 1. Additionally, they required analgesia more frequently (64.9% vs. 34.1%, p=0.006) and reported more pronounced frequency and urgency symptoms. A notable finding was that patients in Group 1, with complete coiling, experienced significantly more improvement in their symptoms compared to Group 2 (52.3% vs. 29.7%, p=0.041). Most of the symptom improvement occurred on postoperative days four and five. These results suggest that achieving proper coiling of the proximal end of the stent can have a positive impact on reducing SRS and improving recovery time. While the study had limitations, such as a small sample size and the non-randomised nature of the design, the findings emphasise the importance of proximal coil coiling in reducing stent-related complications. In particular, patients with complete proximal coiling reported better outcomes regarding frequency, urgency, and pain, and had faster symptom resolution. These findings may influence clinical practices, suggesting that attention to the coiling process could improve patient experiences and outcomes after ureteral stenting.
Does coiling of the proximal end of the ureteral stent affect stent-related symptoms?
Reviewed by Asif H Ansari
Does coiling of the proximal end of the ureteral stent affect stent-related symptoms?
