Ureteral Catheterization in Uncomplicated Ureterolithotripsy: A Randomized, Controlled Trial
Department of Urology, Mohammadi Hospital, Hormozgan University of Medical Sciences, Bandar Abbas, Iran. European Urology
(Impact Factor: 13.94).
09/2007; 52(3):836-41. DOI: 10.1016/j.eururo.2007.01.042
To evaluate short-term ureteral catheterization in patients undergoing ureteroscopic lithotripsy for ureteral calculi.
Patients (n = 140) with ureteral calculi who were candidates for ureterolithotripsy were enrolled. Stone size was 5-10mm. The operation was performed with an 8-9.8F semirigid ureteroscope without active dilatation and stones were fragmented with a 1F pneumatic lithotrite. Uncomplicated cases (109 patients) were randomized to catheterized (C) and noncatheterized (NC) groups. In the 54 C group patients, a polyurethane catheter (5F) was passed through the ureter after lithotripsy with the end attached to a Foley placed in urethra, which was removed after 24h. Postoperatively, all patients were evaluated for flank and suprapubic pain, renal colic, irritative urinary symptoms, peritonism, frequency of analgesic usage, urinary tract infection, duration of hospitalization, postdischarge visits (due to renal colic/pain), readmission, and residual stone rates.
On the first postoperative day, the percentage of patients experiencing flank pain and renal colic was significantly higher in the NC group (76% and 45%) compared with the C group (20% and 2%); 67% of NC patients required analgesic administration during hospital stay versus 20% of C patients (p<0.001). Suprapubic pain and urethral irritation were reported by 13% and 37% of C patients, respectively, and 5% and 4% of NC patients. However, peritonism was developed more often in NC patients (27% vs. 13%). Hospital stay was 1 d for all patients. Three days postoperatively, 40% of NC patients complained of at least one episode of flank pain compared with 7% of C patients (p<0.001). Incidence of urinary tract infections was 4% in NC and 7% in C group patients. Postdischarge visits were necessary in 20% of NC patients and 5% of C patients. No patient in either group required readmission. No complaints were reported nor residual stones discovered on 2-wk follow-up radiographs in either group.
Short-term ureteral catheterization in uncomplicated ureteroscopy and lithotripsy has a role in reducing early postoperative morbidities. It may also decrease pain and colic after discharge.
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- "In consensus, a trial identified higher complication outcome when using lithotripsy (4.1%)  . The most notable complication, i.e. ureteral perforation, has been reduced to an incidence less than 5%, and long-term complications such as stricture formation also reduced to an incidence of 2% or less . This is incompatible with reports that have shown that lithotripsy is the most efficient and has a role in reducing early postoperative morbidities    . "
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ABSTRACT: Objective: To review our 5 years' experience with ureteroscopy treatment of distal ureteric calculi. Patients and methods: We reviewed the medical records of 136 patients who underwent ureteroscopic procedures for the treatment of distal ureteric calculi from February 2007 to October 2012. Patient and stone characteristics, treatment modality and outcome were assessed. Procedure's duration, status "stone free" and hospital stay were also evaluated. The mean clinical and radiological follow-up period was 31.8 months for 74.2% of eligible patients. Results: The stone free rate following an initial ureteroscopy was 79.4. The ultimate success rate for stone removal after "second look" improved to 95.9%. The mean operative duration was 51. minutes.The intraoperative complication rate was 8.6%, the postoperative complication rate was 7.5%, and the mean hospital stay was 1.1 days.We could detect one ureteric stricture and one vesico-ureteric reflux (0.9% for each). A significant ureteric perforation was detected in 4.1% and ureteric perforation in 0.7% of the study group.We could find that the longer the operative duration, the greater the complications.Stone impaction and size were also found associated with higher morbidity. Conclusion: Growing skills and experience of ureteroscopy will lead to a significant increase in the success rate and also reducing serious complications.
Available from: Seung Wook Lee
- "Djaladat et al equally divided 109 patients who underwent URS into two groups: patients who received a 5 Fr. polyurethane ureteral catheter left indwelling for 24 hours (n=54) and a noncatheterized group (n=55) . They reported that flank pain and renal colic on the first postoperative day were significantly higher in the noncatheterized group. "
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ABSTRACT: The aim of this study was to evaluate whether long-term, postoperative ureteral stenting is necessary after ureteroscopic removal of stones (URS) during an uncomplicated surgical procedure.
We prospectively examined 54 patients who underwent URS for lower ureteral stones from February 2010 to October 2010. Inclusion criteria were a stone less than 10 mm in diameter, absence of ureteral stricture, and absence of ureteral injury during surgery. We randomly placed 5 Fr. open-tip ureteral catheters in 26 patients and removed the Foley catheter at postoperative day 1. The remaining 28 patients received double-J stents that were removed at postoperative day 14 by cystoscopy under local anesthesia. All patients provided visual analogue scale (VAS) pain scores at postoperative days 1, 7, and 14 and completed the storage categories of the International Prostate Symptom Score (IPSS) at postoperative day 7.
The VAS scores were not significantly different on postoperative day 1 but were significantly smaller in the 1-day ureteral catheter group at postoperative days 7 and 14 (p<0.01). All of the storage categories of the IPSS were significantly lower in the 1-day ureteral stent group (p<0.01). The ratio of patients who needed intravenous analgesics because of severe postoperative flank pain was not significantly different between the two groups (p=0.81). No patients experienced severe flank pain after postoperative day 2, and no patients in either group had any other complications.
One-day ureteral catheter placement after URS can reduce postoperative pain and did not cause specific complications compared with conventional double-J stent placement.
Available from: PubMed Central
- "Nonetheless; we believe that a 24-hour catheterization is useful in the prevention of possible postoperative obstruction and/or renal colics due to severe mucosal edema, a leftover stone particle, or a blood cloth within the ureter. The literature readily confirms this algorithm (13-15). The studies in which routine postoperative drainage was considered unnecessary dealt mainly with double-J endoprostheses, which are usually removed 1-2 weeks after the procedure (16-18). "
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ABSTRACT: To observe the influence of operating urologist's education and adopted skills on the outcome of ureterorenoscopy treatment of ureteral stones.
The study included 422 patients (234 men, 55.4%) who underwent ureterorenoscopy to treat ureteral stones at the Urology Department of Clinical Hospital Center Split, Croatia, between 2001 and 2009. All interventions were carried out with a semi-rigid Wolf ureteroscope and an electropneumatic generator used for lithotripsy. The operating specialists were divided into two groups. The first group included 4 urologists who had started learning and performing endoscopic procedures at the beginning of their specialization and the second group included 4 urologists who had started performing endoscopic procedures later in their careers, on average more than 5 years after specialization.
Radiology tests confirmed that 87% (208/238) of stones were completely removed from the distal ureter, 54% (66/123) from the middle ureter, and 46% (28/61) from the proximal ureter. The first group of urologists completed significantly more procedures successfully, especially for the stones in the distal (95% vs 74%; P = 0.001) and middle ureter (66% vs 38%; P = 0.002), and their patients spent less time in the hospital postoperatively.
Urologists who started learning and performing endoscopic procedures at the beginning of their specialization are more successful in performing ureteroscopy. It is important that young specialists receive timely and systematic education and cooperate with more experienced colleagues.
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