Urinary Stones Clinical Trial
Official title:
The Usefulness of Flexible Cystoscopy for Preventing Double-J Stent Malposition After Laparoscopic Ureterolithotomy
The aim of this study was to evaluate the role of flexible cystoscopy in preventing
malpositioning of the ureteral stent after laparoscopic ureterolithotomy in male patients.
From April 2009 to June 2015, 97 male patients with stones >1.8 cm in the upper ureter
underwent intracorporeal double-J stenting of the ureter after laparoscopic ureterolithotomy
performed by four different surgeons. In the last 50 patients who underwent laparoscopic
ureterolithotomy flexible cystoscopy was performed through the urethral route to confirm the
position of the double-J stent, while in the first 47 correct positioning of the stent was
confirmed through postoperative KUB.
The treatment of large upper ureteral stones is still controversial. The American Urological
Association (AUA) and the European Association of Urology (EAU) recommend that laparoscopic
stone removal may be considered in rare cases in which shockwave lithotripsy (SWL),
ureteroscopic lithotripsy (URS), and percutaneous nephrolithotomy fail or are unlikely to be
successful. In a recent meta-analysis of treatment of large proximal ureteral stones,
Torricelli et al. reported that the outcomes of laparoscopic ureterolithotomy (LUL) for
larger upper ureteral stones are favorable compared with those of URS, and LUL should be
considered as a first-line option when flexible ureteroscopy is not available. After such
surgery, many surgeons prefer placing a double-J stent, a ureteral catheter that is passed
through the ureter from the kidney to the bladder. Although double-J stent placement after
LUL remains controversial, many urologists believe that it may help prevent postoperative
urinary leakage.
Intracorporeal double-J stenting is technically difficult, and malpositioning often occurs
after surgery in clinical practice. However, the actual rate of malpositioning of stents has
not been reported yet. Although clinicians use different ways to place double-J stents
precisely, accurate stent placement before the closure of the ureteral incision might be
difficult to confirm.
Upward malpositioning of the stent after surgery may necessitate removal of the stent using
a ureteroscope. It is difficult to remove stents in the outpatient setting without
anesthesia to reduce pain and discomfort, especially in male patients.
In this study, The investigators used flexible cystoscopy through the urethral route before
closure of the ureteral incision to confirm that the double-J stent was placed correctly in
the bladder of male patients. Upon identification of upward malpositioning of the ureteral
stent, position adjustments were performed by intracorporeally manipulating the ureteral
stent through the incision site of the ureter. The aim of this study was to determine the
malpositioning rate and predicting factors associated with upward malpositioning of
intracorporeal double-J stents after LUL and to evaluate the usefulness of flexible
cystoscopy in preventing such malpositioning in male patients.
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