Андрология и генитальная хирургия. 2016; 17: 53-58
Новый метод удаления внутреннего мочеточникового стента под ультразвуковым контролем у женщин после дробления камней
https://doi.org/10.17650/2070-9781-2016-17-4-53-58Аннотация
Цель исследования – разработать быстрый, удобный и в то же время безопасный метод удаления мочеточниковых стентов у женщин после дробления камней.
Материалы и методы. С февраля 2014 г. по март 2016 г. проведено ретроспективное мультицентровое исследование, включающее 122 пациентки после дробления камней: 46 – в контрольной группе (стент был удален стандартным способом – цистоскопом 22 Сн) и 76 – в экспериментальной группе (стент был удален с помощью «спиралевидного устройства» 15 Сн под ультразвуковым контролем). Критериями исключения явились: пролапс тазовых органов ≥ II по шкале POPQ и осложненные стенты (со смещением или инкрустацией). Оценивали длительность удаления стентов, сумму баллов по визуальной аналоговой шкале боли, а также вероятность развития осложнений.
Результаты. У всех исследуемых пациентов стенты были успешно удалены. Осложнений в обеих группах не зарегистрировано. Продолжительность удаления стента в экспериментальной группе была выше, чем в контрольной, примерно на 4 с (p = 0,0056). Различие было статистически значимым, однако клинически не важным. Наиболее существенным оказалось различие в оценке по визуальной аналоговой шкале в пользу экспериментальной группы (p = 4 × 10 –5).
Заключение. Предложенный метод удаления стентов петлей под ультразвуковым контролем у женщин после дробления камней оказался более комфортным – с меньшим числом баллов по визуальной аналоговой шкале по сравнению склассическим удалением
с помощью цистоскопа, не требующим дополнительных затрат, связанных с использованием эндоскопического оборудования, стерилизацией последнего, а также рабочего времени сестры, что делает его привлекательной опцией в амбулаторной практике в неосложненных случаях, а будучи лишенным ионизирующего излучения, может быть рекомендован для удаления стентов у беременных пациенток.
Список литературы
1. Zimskind P. D., Fetter T. R., Wilkerson J. L. Clinical use of long-term indwelling silicone rubber ureteral splints inserted cystoscopically. J Urol 1967;97:840–4.
2. Finney R. P. Experience with new double J ureteral catheter stent. J Urol 1978;167: 1135–8.
3. Chew B. H., Knudsen B. E., Denstedt J. D. The use of stents in contemporary urology. Curr Opin Urol 2004;14(2):111–5.
4. Borboroglu P. G., Kane C. J. Current management of severely encrusted ureteral stents with a large associated stone burden. J Urol 2000;164(3 Pt 1): 648–50.
5. Kawahara T., Ito H., Terao H. et al. Ureteral stent encrustation, incrustation, and coloring: morbidity related to indwelling times. J Endourol 2012;26(2):178–82. DOI: 10.1089/end.2011.0385.
6. Smith A. D. Retrieval of ureteral stents. Urol Clin North Am 1982;9:109–12.
7. Evans J. W. H., Ralph D. J. Removal of ureteric stents with a flexible cystoscope. Br J Urol 1991;67:109.
8. Leenhouts H. P., Chadwick K. H. The molecular basis of stochastic and nonstochastic effects. Health Phys 1989;57(Suppl 1):343–8.
9. Alvarez-Vijande R. Removal of ureteric stents in women without cystoscope. Br J Urol 1993;72:388–9.
10. Hammer Ø., Harper D. A. T., Ryan P. D. Paleontological statistics software package for education and data analysis. Palaeontol Electron 2001;4:9–18.
11. Kawahara T., Ito H., Terao H. et al. Ureteral stent retrieval using the crochet hook technique in females. PLoS One 2012;7(1):e29292. DOI: 10.1371/journal.pone. 0029292.
12. Park S. W., Cha I. H., Hong S. J. et al. Fluoroscopy-guided transurethral removal and exchange of ureteral stents in female patients: technical notes. J Vasc Interv Radiol 2007 Feb;18(2):251–6.
13. Macaluso J. N. Jr, Deutsch J. S., Goodman J. R. et al. The use of the Magnetip double-J ureteral stent in urological practice. J Urol 1989;142(3):701–3.
14. Taylor W. N., McDougall I. T. Minimally invasive ureteral stent retrieval. J Urol 2002;168:2020–3.
15. Olweny E. O., Landman J., Andreoni C. et al. Evaluation of the use of a biodegradable ureteral stent after retrograde endopyelotomy in a porcine model. J Urol 2002;167(5): 2198–202.
16. Lange D., Chew B., Elwood C. Biomaterials in urology-beyond drug eluting and degradable-a rational approach to ureteral stent design. Available at: http://www.intechopen.com/source/pdfs/22937/InTech-Biomaterials_in_urology_beyond_drug_eluting_and_degradable_a_rational_approach_to_ureteral_stent_design. pdf.
17. Siegel A., Altadonna V., Ellis D. et al. Simplified method of indwelling ureteral stent removal. Urology 1986;28(5):429.
18. Wang J., Feng J., Hu W. et al. Preclinical Evaluation of a Newly Designed Ureteral Stent and Magnetic Retrieval Catheter for Minimally Invasive Stent Removal. Urology 2014;84(4):960–6. DOI: 10.1016/j. urology. 2014.06.024
Andrology and Genital Surgery. 2016; 17: 53-58
A new ultrasound guided method for ureteral stent removal in women after lithotripsy
https://doi.org/10.17650/2070-9781-2016-17-4-53-58Abstract
Objective: to develop a rapid, convenient and safe method for ureteral stent removal in women after lithotripsy.
Materials and methods: We conducted a retrospective multicentre study (time frame: February 2014 – March 2016) that included 122 female patients after lithotripsy: 46 of them were in the control group (where the stent was removed in a conventional way using cystoscope 22 Ch), 76 patients were in the experimental group (where the stent was removed using «spiral device» 15 Ch under ultrasound guidance). The exclusion criteria were the following: pelvic organ prolapse (stage 2 or greater according to POP-Q system), presence of stent complications (stent displacement or encrustation). We evaluated the duration of stents removal, pain intensity according to Visual Analog Scale for Pain, and the likelihood of complications.
Results. Stents were successfully removed in all patients. No complications were observed in both groups. Stent removal in the experimental group was approximately 4 sec longer than that in the control group (p = 0,0056). The difference was statistically significant, but didn»t have great clinical importance. Difference in pain intensity according to Visual Analog Scale for Pain was the most significant; patients in experimental group were found to have lower levels of pain (p = 4 × 10 –5).
Conclusion. Proposed ultrasound guided method for ureteral stent removal by a loop in women after lithotripsy appears to be more comfortable. It is characterized by lower pain intensity according to Visual Analog Scale for Pain comparing to conventional method with cystoscope; it does not imply any additional costs associated with usage of endoscopic equipment, its sterilization and working time of a nurse. Therefore, the method can be considered as a good option for outpatient practice in patients without complications; moreover it can be recommended for stent removal in pregnant women as soon as the technique does not require the use of ionising radiation.
References
1. Zimskind P. D., Fetter T. R., Wilkerson J. L. Clinical use of long-term indwelling silicone rubber ureteral splints inserted cystoscopically. J Urol 1967;97:840–4.
2. Finney R. P. Experience with new double J ureteral catheter stent. J Urol 1978;167: 1135–8.
3. Chew B. H., Knudsen B. E., Denstedt J. D. The use of stents in contemporary urology. Curr Opin Urol 2004;14(2):111–5.
4. Borboroglu P. G., Kane C. J. Current management of severely encrusted ureteral stents with a large associated stone burden. J Urol 2000;164(3 Pt 1): 648–50.
5. Kawahara T., Ito H., Terao H. et al. Ureteral stent encrustation, incrustation, and coloring: morbidity related to indwelling times. J Endourol 2012;26(2):178–82. DOI: 10.1089/end.2011.0385.
6. Smith A. D. Retrieval of ureteral stents. Urol Clin North Am 1982;9:109–12.
7. Evans J. W. H., Ralph D. J. Removal of ureteric stents with a flexible cystoscope. Br J Urol 1991;67:109.
8. Leenhouts H. P., Chadwick K. H. The molecular basis of stochastic and nonstochastic effects. Health Phys 1989;57(Suppl 1):343–8.
9. Alvarez-Vijande R. Removal of ureteric stents in women without cystoscope. Br J Urol 1993;72:388–9.
10. Hammer Ø., Harper D. A. T., Ryan P. D. Paleontological statistics software package for education and data analysis. Palaeontol Electron 2001;4:9–18.
11. Kawahara T., Ito H., Terao H. et al. Ureteral stent retrieval using the crochet hook technique in females. PLoS One 2012;7(1):e29292. DOI: 10.1371/journal.pone. 0029292.
12. Park S. W., Cha I. H., Hong S. J. et al. Fluoroscopy-guided transurethral removal and exchange of ureteral stents in female patients: technical notes. J Vasc Interv Radiol 2007 Feb;18(2):251–6.
13. Macaluso J. N. Jr, Deutsch J. S., Goodman J. R. et al. The use of the Magnetip double-J ureteral stent in urological practice. J Urol 1989;142(3):701–3.
14. Taylor W. N., McDougall I. T. Minimally invasive ureteral stent retrieval. J Urol 2002;168:2020–3.
15. Olweny E. O., Landman J., Andreoni C. et al. Evaluation of the use of a biodegradable ureteral stent after retrograde endopyelotomy in a porcine model. J Urol 2002;167(5): 2198–202.
16. Lange D., Chew B., Elwood C. Biomaterials in urology-beyond drug eluting and degradable-a rational approach to ureteral stent design. Available at: http://www.intechopen.com/source/pdfs/22937/InTech-Biomaterials_in_urology_beyond_drug_eluting_and_degradable_a_rational_approach_to_ureteral_stent_design. pdf.
17. Siegel A., Altadonna V., Ellis D. et al. Simplified method of indwelling ureteral stent removal. Urology 1986;28(5):429.
18. Wang J., Feng J., Hu W. et al. Preclinical Evaluation of a Newly Designed Ureteral Stent and Magnetic Retrieval Catheter for Minimally Invasive Stent Removal. Urology 2014;84(4):960–6. DOI: 10.1016/j. urology. 2014.06.024
