Osman ERGÜN, Sefa Alperen ÖZTÜRK, Kadir ERYILMAZ

DOUBLE J STENT TAKIM TEKNİĞİNİN, STENTE BAĞLI ERKEN VE GEÇ KOMPLİKASYONLAR ÜZERİNE ETKİSİ

Amaç Double J stent takımında evrensel olarak kabul görmüş bir metot yoktur. Kliniğimizde uyguladığımız metodun başarı ve komplikasyon oranlarını ortaya koyarak bizim ile aynı teknik alt yapı ve imkanlara sahip klinikler için bir öngörü ortaya koymaktır. Gereç ve Yöntem Kliniğimizde Ocak 2019 ile Ocak 2022 tarihleri arasında double J stent takılan 774 hastanın verileri geriye dönük olarak tarandı. Stente bağlı komplikasyon oranları ve stent migrasyonuna etkili olabilecek bağımsız risk faktörleri analiz edildi. Bulgular 774 hastaya 907 adet double J stent takıldı. Hastaların yaş ortalaması 54,3±20,1 (20-90) idi. Hastalara double J stent takılma nedenleri: üreter taşı (%46,5), böbrek taşı (%19,1) ve üreter darlığı (%34,4) idi. Tüm hastaların 91 (%11,8) adedinde ek müdahaleyi gerektiren ciddi stent migrasyon vardı. Sonuç Bizim çalışmamız litertürdeki double J stent takma tekniği ile stent migrasyonu arasındaki ilişkiyi araştıran ilk çalışma olma özelliğini taşımaktadır. Double J stent migrasyon oranımız (%11,8) hemen hemen güncel literatürde stent boyu çeşitli formülasyonlar ile hesaplanarak bulunan ve skopi altında takılan stentlerde görülen migrasyon oranına yakındır.

Anahtar Kelimeler:

Double J stent, Komplikasyon, Migrasyon, Teknik, Üst üriner sistem obstrüksiyonu

EFFECT OF THE 'DOUBLE J STENT PLACEMENT TECHNIQUE' ON EARLY AND LATE STENT-RELATED COMPLICATIONS

Objective Currently, there is no globally accepted method for the Double J stent placement. We aimed to reveal the success and complication rates of the approach applied in our clinic and to show a prediction for clinics with similar technical backgrounds and facilities as ours. Material and Method The data of 774 patients who had double J stent placement in our clinic between January 2019 and January 2022 were reviewed retrospectively. Stentrelated complication rates and independent risk factors affecting stent migration were analysed. Results Nine hundred and seven double J stents were placed in 774 patients. The mean age of the patients was 54.3±20.1 (20-90). The indications for double J stent placement were; ureteral stones (46.5%), kidney stones (19.1%) and ureteral stenosis (34.4%), respectively. 91 (11.8%) of all patients had severe stent migration requiring additional intervention. Conclusion Our study is the first in the literature investigating the relationship between the double J stent placement technique and stent migration. Our clinic's double J stent migration rate (11.8%) is similar to the stents placed under fluoroscopy, which were calculated with the stent length by various formulations in the current literature.

Keywords:

Double J stent, Complication, Migration, Tecnique, Upper urinary tract obstruction,

PDF

___

Tang L, Gao X, Xu B, Hou J, Zhang Z, Xu C, et.al. Placement of ureteral stent after uncomplicated ureteroscopy: do we really need it? Urology 2011;78:1248–56.
Song T, Liao B, Zheng S, Wei Q. Meta-analysis of postoperatively stenting or not in patients underwent ureteroscopic lithotripsy. Urol Res 2012;40:67–77.
Borboroglu PG, Amling CL, Schenkman NS, Monga M, Ward JF, Piper NY, et al. Ureteral stenting after ureteroscopy for distal ureteral calculi: A multi-institutional prospective randomized controlled study assessing pain, outcomes and complications. J Urol 2001;166:1651–7.
Foreman D, Plagakis S, Fuller AT. Should we routinely stent after ureteropyeloscopy? BJU Int 2014;114 (Suppl 1):6–8.
Matani YS, Al-Ghazo MA, Al-Azab RS, Bani-hani O, Rabadi DK. Emergency double-J stent insertion following uncomplicated Ureteroscopy: risk-factor analysis and recommendations. Int Braz J Urol 2013;39:203–8.
Vallejo Herrador J, Burgos Revilla FJ, Alvarez Alba J, Saez Garrido JC, Tellez Martinez-Fornes M, Sanchez de la Muela p, et al. El catéter ureteral doble J. Complicaciones clínicas [Double J ureteral catheter. Clinical complications]. Arch Esp Urol 1998;51:361-73.
Stamm WE. Guidelines for prevention of catheter associated urinary tract infections. Ann Intern Med 1975;82:386-90.
Warren JW, Muncie HL Jr., Hall-Craggs M. Acute pyelonephritis associated with bacteriuria during long-term catheterization: a prospective clinicopathological study. J Infect Dis 1988;158:1341-6.
Saltzman B. Ureteral stents. Indications, variations, and complications. Urol Clin North Am 1988;15:481-491.
Joshi HB, Stainthorpe A, Keeley FX Jr, MacDonagh R, Timoney AG. Indwelling ureteral stents: evaluation of quality of life to aid outcome analysis. J Endourol 2001;15:151–4.
Joshi H, Okeke A, Newns N, Keeley FX Jr, Timoney AG. Characterization of urinary symptoms in patients with ureteral stents. Urology 2002;59:511–6.
Riehle RA Jr. Selective use of ureteral stents after extracorporeal shock-wave lithotripsy. Urol Clin North Am 1988;15:499-506.
Zwergel T, Lindenmeir T, Wullich B. Management of acute hydronephrosis in pregnancy by ureteral stenting. J Urol 1996; 29:292–297.
Smedley FH, Rimmer J, Taube M, Edwards L. 168 double-J (pigtail) ureteric catheter insertions: A retrospective review. Ann R Coll Surg Engl 1988;70:377–379.
Damiano R, Oliva A, Esposito C, De Sio M, Autorino R, D’Armiento M. Early and late complications of double pigtail ureteral stent. Urol Int 2002; 69(2): 136–40.
Hao P, Li W, Song C, Yan J, Song B, Li L. Clinical evaluation of double-pigtail stent in patients with upper urinary tract diseases: report of 2685 cases. J Endourol 2008; 22(1): 65–70.
Oswalt, GC Jr., Bueschen, AJ, Lloyd IK. Upward migration of indwelling ureteral stents. J Urol, 1979; 122: 249-50.
Pollack HM, Banner MP. Percutaneous nephrostomy and related pyeloureteral manipulative techniques. Urol Radiol 1981;2:147-54.
Herrera M, Brawerman S, Castaneda WR, Kotula F, Amplatz K. The endocatheter ruler: a useful new device. AJR Am J Roentgenol 1982;139:828-29.
Wills MI, Gilbert HW, Chadwick DJ, Harrison SC. Which ureteric stent length?. Br J Urol 1991;68:440.
Ho CH, Chen SC, Chung SD, Lee YJ, Chen J, Yu HJ, et al. Determining the appropriate length of a double-pigtail ureteral stent by both stent configurations and related symptoms. J Endourol. 2008;22:1427-31.
Ho CH, Huang KH, Chen SC, Pu YS, Liu SP, Yu HJ. Choosing the ideal length of a double-pigtail ureteral stent according to body height: study based on a Chinese population. Urol Int 2009;83:70–4.
Breau RH, Norman RW. Optimal prevention and management of proximal ureteral stent migration and remigration J Urol. 2001;166(3):890-3.
Slaton JW, Kropp KA. Proximal ureteral stent migration: an avoidable complication? J Urol, 1996;155: 58-61.