Non-cystoscopic Removal of Retained Ureteral Stents With Mild Sedation in Children

doi:10.1016/j.urology.2016.03.026

Urology

Volume 94, August 2016, Pages 255-258

https://doi.org/10.1016/j.urology.2016.03.026 Get rights and content

Introduction

We present a novel noncyctoscopic procedure in removing retained ureteral stents that requires minimal sedation and significantly reduces operation time and costs compared to the cystoscopy-based procedure.

Technical Considerations

We used a simple self-made device, which was made of an Fr5 feeding tube and a monofilament suture to remove the stents. Although the success rate is very high with this new procedure, it is important to point out that approximately 13% of our patients required 2 to 3 trials to remove the stents. Another potential problem is that the feeding tube may tie a knot when it is in the bladder, which could pose a risk of urethral injury when the knot is pulled out.

Conclusion

The noncystoscopic procedure we have established has less operation time and costs less. This procedure provides an alternative solution in removing retained ureteral stents in child patients compared to conventional cystoscopy-based procedure.

Section snippets

Materials and Methods

The randomized trial was designed to compare the noncystoscopic and cystoscopic procedures of RUS in child patients. The trial was approved by the Institutional Review Board of Shanghai Xinhua Hospital. The trial enrolled patients admitted to the Department of Pediatric Surgery, Shanghai Xinhua Hospital, between May 2012 and March 2015 based on the following criteria: urinary system ultrasonography indicating a properly placed stent, and blood and urinary laboratory tests indicating no

Results

A total of 277 patients, 195 boys and 85 girls, aged 1 month to 11 years, were enrolled for the trial. The mean time for the stents left in place before removal was 3.27 weeks (range 3-4weeks). All stents were removed successfully, except 1 stent from the noncystoscopic group, which was removed by cystoscopy. We excluded this case from the results presented in this report. Mean operation time for cystoscopy, including time for instrument preparation, was 12.57 minutes for the Boy group and

Discussion

Stents had been widely used in various pediatric urologic surgeries, such as pyeloplasty (open or laparoscope), ureteral reimplantation, and ureteroscopic lithotripsy. Although it is debatable whether ureteral stents should be placed to help urinary drainage following pyeloplasty, stenting is still favored by many pediatric urologists. It is reported that stenting could reduce hospital stay, decrease postoperative morbidities and the need for additional procedures, and result in quicker

Conclusion

We present an attractive solution to manage retained ureteral stents. The novel procedure does not use cystoscopy and does not need general anesthesia. It requires less preoperation preparation, less operation time, and less medical expenses. The new procedure is simple and reliable.

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Cited by (7)

Noncystoscopic Removal of Double-J Stent in Women: Feasibility and Safety
2024, Urology
To evaluate the feasibility and safety of a simple noncystoscopic method previously applied in children for removing double-J stents applied in women by comparing the hospitalization time, operation time, costs, complications, and success rate.
One hundred eighty women who underwent either cystoscopic or noncystoscopic double-J stent removal in a randomized manner. They were randomly assigned 1:1 to groups of cystoscopic double-J stent removal (n = 90) or noncystoscopic double-J stent removal (n = 90). The age ranged from 19 to 72 years. After the removal of the double-J stent, the operation time, costs, complications, and success rate were compared between the two groups.
The operation time of the noncystoscopic group was lower than that of the cystoscopic group (6.0(5.0,7.0) minutes vs 2.0(2.0,3.0) minutes, P < .001). The hospitalization costs of the noncystoscopic group were significantly shorter than that of the cystoscopic group (1361.2(1331.4,1379.2) Yuan vs 873.9(868.5,896.1) Yuan, P < .001). There were no complications such as infection and massive bleeding in the two groups during and after the operation. Most noncystoscopic double-J stent removal can succeed in less than three attempts (88/90). All patients in the noncystoscopic group used this technique to remove the double-J stent.
Noncystoscopic removal of double-J stent has the advantages of short operation time and low hospitalization costs. It is a safe and feasible minimally invasive method to replace cystoscopic removal of the double-J stent.
Current Status of Ureteric Stents on Extraction Strings and Other Non-cystoscopic Removal Methods in the Paediatric Setting: A Systematic Review on Behalf of the European Association of Urology (EAU) Young Academic Urology (YAU) Urolithiasis Group
2022, Urology
Citation Excerpt :
Four studies evaluated magnetic retrieval device, which use a magnet attached to the distal end of the stent which can be withdrawn with a magnetic retrieval device.13-16 Three studies implemented use of modified feeding tubes with a suture loop attached the end to snare to the distal end of the stent.17-19 One study described outcomes using a urethral sound to “drag” the stent out and another study had developed a novel method of attaching the urinary catheter to the stent itself so that it all could be removed at once post operatively.20,21
Ureteric stents are an important tool in urology and have a wide range of indications. While they offer a number of advantages, limitations remain despite modern advancements. These include discomfort, migration and encrustation. Standard removal is via cystoscopy but in the paediatric setting this mandates general anaesthetic, which holds disadvantages. Alternative removal methods include use of extraction strings and magnetic retrieval devices, which can be performed in the outpatient setting. This systematic review evaluates the safety and efficacy of different non-cystoscopic methods for stent removal in the paediatric setting.
Double J stent removal in paediatric patients by Vellore Catheter Snare technique: a randomised control trial
2019, Journal of Pediatric Urology
Citation Excerpt :
These problems were found obviated by the VeCS technique. Non-cystoscopic removal using a snaring device has been described in a retrospective study with satisfactory results, although analysis suggested increasing age to be a significant factor for failure in this series [19]. The magnetic stent and its extraction devices, although popular in the West in the adult population [20], are not widely available for use in India and are expensive.
Double J (DJ) stents placed at the end of paediatric urological procedures require another cystoscopy under general anaesthesia for removal. The second author developed a reproducible technique for snaring the DJ stent using an infant feeding tube (6-Fr or 8-Fr) and a 3-0 polypropylene suture per urethra. Having demonstrated the proof of concept, ethical clearance was obtained for an institutional randomised controlled trial.
The aim of the study was (1) to describe the Vellore Catheter Snare (VeCS) technique for DJ stent removal, (2) to study the efficacy of the technique and (3) to compare the costs of VeCS technique with cystoscopy on an intention-to-treat basis.
The study design was that of a randomised control trial with parallel groups as a non-inferiority study.
Forty children with unilateral indwelling DJ stents were enrolled from January to August 2018. They were randomised by unequal allocation (1:3) to cystoscopic and VeCS technique removal arms. The VeCS technique and cystoscopy were successful in 86.67% (26/30) and in 100% (10/10) cases, respectively, with no statistically significant difference in the outcome (p = 0.223). The average cost for cystoscopic removal of the stent was INR 14,579 and was INR 5636.5 for the VeCS technique (on an intention-to-treat basis).
While per-urethral catheterisation is an outpatient/ward procedure in children, cystoscopy is not. Other techniques such as extraction strings and magnetic stents with their extraction device were found to have certain disadvantages. The VeCS technique, using common disposables, circumvented the need for inpatient admission, disinfected equipment usage and operation theatre time in 87% children, thereby reducing the costs incurred by the patient.
The VeCS technique for DJ stent removal is a practical low-cost safe alternative to cystoscopic removal of DJ stents in children. Although the technique has a high success rate, it still needs the backup option of cystoscopy under general anaesthesia.
A Novel Retrieval Technique for Ureteral Stents Under Ultrasound Guidance in Male Patients
2017, Urology
Citation Excerpt :
Ureteral stents are typically removed under local anesthesia by using cystoscopy with grasping forceps.9 In an attempt to eliminate the need for cystoscopy and make stent retrieval easier, various novel techniques have been introduced.12-16 Taylor and McDougall, and Wang et al used a magnetic retrieval catheter to attract a stainless steel bead attached to the tip of the stent without fluoroscopy or cystoscopy.17,18
To simply retrieve double-J stents in male patients under ultrasound guidance, a novel technique is developed and evaluated for efficiency, safety, and tolerability.
Fifty-six male patients, ranging in age from 23 to 65 years old, were recruited from March to December 2015. Thirty patients (32 stents) underwent double-J stent retrieval by ultrasound guidance and 26 patients (28 stents) underwent cystoscopy retrieval separately. Clinical outcomes were compared between groups. Hematuria and leukocytosis were assessed every day postoperatively. A visual analog pain scale on a scale of 0-10 was used to assess procedure-related pain.
In the experimental group, 87.5% of ureteral stents were successfully removed. Using our novel technique without any local anesthesia, male patients experienced less pain compared with the cystoscopy group significantly (P < .001). The majority of complications were microscopic hematuria (39.28%), less than that in the cystoscopy group (69.23%, P = .027). Meanwhile, only few patients have leukocytosis in both groups (14.3% vs 11.5%, P > .05). Average procedure time was 7.35 ± 2.59 minutes longer than that of the standard group (5.13 ± 1.29 minutes; P < .001). However, it had been improved with increasing experience (r = 0.618, P < .001). In addition, this novel technique is cost-effective for clinical practice.
This is the first study to assess the possibility of ultrasound-guided retrieval technique in male patients. The safety and success rate of this new technique is similar to that of a conventional procedure. Whereas it is tolerable and cost effective for male and disabled patient bear with lithotomy position.
Feasibility and Safety of a Simple Non-cystoscopic Double-J Tube Removal Technique in Children
2021, Frontiers in Pediatrics
Trans-urethral snare stent removal: a novel, self-constructed innovation for simultaneous ureteral stent removal and safety guidewire insertion
2021, ANZ Journal of Surgery

View all citing articles on Scopus

: Financial Disclosure: The authors declare that they have no relevant financial interests.

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Surgical Techniques in UrologyNon-cystoscopic Removal of Retained Ureteral Stents With Mild Sedation in Children

Introduction

Technical Considerations

Conclusion

Section snippets

Materials and Methods

Results

Discussion

Conclusion

J Urol

J Pediatr Urol

J Urol

Retrograde percutaneous access for kidney internal splint stent catheter placement in pediatric laparoscopic pyeloplasty: avoiding stent removal in the operating room

J Endourol

Surgical Techniques in Urology
Non-cystoscopic Removal of Retained Ureteral Stents With Mild Sedation in Children