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Insertion of double J (DJ) stents is one of the most commonly performed procedures in urology. One of its major drawbacks is stent related symptoms (SRS) which has generated a lot of research in drugs, stent design and materials. One such development was the loop-tail (LT) stent. In this study the researchers have performed a prospective, randomised controlled trial comparing conventional DJ stents with LT stents after elective flexible ureteroscopy for renal stones. They randomised 34 patients in each group between January 2018 and February 2020 out of which they analysed 31 patients in the LT group and 32 patients in the DJ group. The authors used the Urinary Symptom Index score from the Ureteric Stent Symptom Questionnaire (USSQ) as the primary endpoint which was measured at four weeks after stent insertion. They also evaluated the same parameters at two days after stent insertion and four weeks after stent removal. They found that the USSQ scores between the two groups at four weeks were not significantly different (p=0.982). In addition, the Pain Index Score (p=0.169), and all other domains of the questionnaire showed no significant difference. The number of patients complaining of pain (87.1% vs. 88.9%, p=0.834), ceased sexual activity (41.2% vs. 37.5%, p=0.829) and requirement of painkillers (p=0.684) were also not different between the LT and DJ groups respectively. The comparison of similar parameters at two days and eight weeks after stent insertion also did not show any significant differences between LT and DJ groups. These findings have highlighted the need for rationalising the use of ureteric stents after routine ureteroscopy, which appears to be the most reasonable approach to reduce the burden of SRS while the search for the ideal stent continues.

Loop-tail stents fail in reducing stent-related symptoms: results of a prospective randomised controlled trial.
Bosio A, Alessandria A, Agosti SC, et al.
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Karthik Rajan

Morriston Hospital, Swansea, Wales.

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