A Customized Reinforced 8-French Ureteral Stent with End-Piece to Decrease Ureteral Obstruction and Alleviate Stent-Related Symptoms: Evaluation of 92 Patients with 319 Ureteral Stent Procedures

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Abstract
Introduction: The most common method for releasing renal obstruction consists of the placement of an indwelling double-pigtail stent. However, adequate insertion of the stent through an obstructed ureter does not necessarily guarantee renal decompression. Most studies have concluded that the stiffness and lumen diameter of stents are major factors for maintaining their patency. Nonetheless, such stents are also poorly tolerated, severely impairing the patients’ quality of life. We aimed to evaluate the efficiency and tolerance of a customized reinforced 8-French stent in a consecutive series of 92 patients. Materials and Methods: Ninety-two consecutive patients with ureteral obstruction were fitted with a customized stent derived from the same reinforced 8-French double-pigtail stent (8F, Superglide Tumor DD Ureter Stent, Teleflex Medical, Ireland). The stent was modified by truncation and adjustment of its length to that of the patient’s ureter, and the bladder loop was replaced with an end-piece. A ureteral stent procedure (USP) was performed every six months. Stent failure with ureteral obstruction was defined by the presence of renal colic or renal failure with increased serum creatinine or hydronephrosis confirmed by computerized tomography or ultrasound with/without pyelonephritis. Obstruction of the stents in less than six months motivated the switch to 8-French tandem stents. The Ureteral Stent Symptom Questionnaire (USSQ) was used to evaluate the results. Results: During the study period, 319 USPs were separately analyzed. The procedure was bilateral in 32.6% (428 ureteral units) of cases, and a tandem procedure was used in 21.7%. Stent failure with obstruction occurred in 5.0% (16/319) of USPs after a mean of 4.7 ± 2.4 months. Of the 69 patients with malignant disease, 43 (62.3%) died, with mean survival of 29.8 ± 25.7 months after the first USP. We encountered no difficulties in placing the customized stents. The results of the USSQ suggested the effectiveness of the customized stent in attenuating stent-related symptoms. Conclusion: Our results confirm that ureteral stent obstruction decreases with a larger lumen and a stiffer stent. The absence of repeated obstructions appears to improve the survival of patients with malignant disease, but this finding requires validation in a prospective randomized controlled trial. Future stents should integrate these important stent characteristics.

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