Introduction

1. Complications of Double-J Stent of the Ureter: Single Centre Experience M S Al Marhoon, O Shareef, K Prasad Sultan Qaboos University - Oman Introduction Conclusions Results • Indications for stent placement (Fig.1) • On univariate analysis significant factors • affecting complications were patient sex (P < 0.001), indication for stenting (P = 0.008), stent duration interval (P = 0.002), stent length (P = 0.046), and positive urine culture post stenting (P < 0.001) • affecting the outcome after stenting (improved or not) were patient age (P = 0.002), sex (P = 0.009), indication for stenting (P < 0.001), stent duration interval (P < 0.001), stent length (P = 0.02), stent diameter (P = 0.002), and positive urine culture pre (P = 0.016) and post (P = 0.013) stenting • On multivariate analysis, the significant independent factors (Table 1) • affecting the improved outcome was age (P = 0.014) (Fig. 2) • affecting complications was the stent length (P = 0.016) (Fig. 3) • Ureteral stents have been first described by Zimskind et al in 1967 • Reported major complications in the literature after ureteral stent placement include: • vesico-ureteric reflux • urinary infection, Pyuria, incontinence • inadequate relief of obstruction • ureteral erosion or fistulization • forgotten stent, necrosis • Stent fracture, encrustation • Stent migration, malposition • Longer stents are associated with increased complications • The older the patient the more likely to have poor outcome after stenting • Stent size did not affect complications or outcome • Future prospective multicenter studies with larger number of patients are needed to affirm the present conclusions Migration Stent fracture Fig.1: Stent Indications Fig. 3: Longer stents increase the complications Malposition Encrustation Table1: Factors affecting patient’s complications and outcome (Multivariate analysis) Objectives References To determine factors affecting the development of complications and the outcome of stenting • Dyer RB, Chen MY, Zagoria RJ, Regan JD, Hood CG, Kavanagh PV: Complications of ureteral stent placement. Radiographics 2002;22:1005-1022. • Denstedt JD, Reid G, Sofer M: Advances in ureteral stent technology. World J Urol 2000;18:237-242. • Ringel A, Richter S, Shalev M, Nissenkorn I: Late complications of ureteral stents. EurUrol 2000;38:41-44. • Kulkarni R, Bellamy E: Nickel-titanium shape memory alloy Memokath 051 ureteral stent for managing long-term ureteral obstruction: 4-year experience. J Urol 2001;166:1750-1754. • Sountoulides P, Kaplan A, Kaufmann OG, Sofikitis N: Current status of metal stents for managing malignant ureteric obstruction. BJU Int 1-8-2010. • El-Nahas AR, El-Assmy AM, Shoma AM, Eraky I, El-Kenawy MR, El-Kappany HA: Self-retaining ureteral stents: analysis of factors responsible for patients' discomfort. J Endourol 2006;20:33-37. • Rane A, Saleemi A, Cahill D, Sriprasad S, Shrotri N, Tiptaft R: Have stent-related symptoms anything to do with placement technique? J Endourol 2001;15:741-745. • Erturk E, Sessions A, Joseph JV: Impact of ureteral stent diameter on symptoms and tolerability. J Endourol 2003;17:59-62. • Akay AF, Aflay U, Gedik A, Sahin H, Bircan MK: Risk factors for lower urinary tract infection and bacterial stent colonization in patients with a double J ureteral stent. IntUrolNephrol 2007;39:95-98. Fig. 2: Older patients are more likely to have poor outcome after stenting Methods • 220 patients (133 males and 87 females) with a mean age of 39.5 ± 15.4 years who underwent fixation of self-retaining ureteral stents in our center were included in the study • Univariate and multivariate analyses were carried out to determine significant variables affecting the development of complications and the outcome of stenting (condition improved or not improved) Correspondent: Dr. Mohammed S Al Marhoon, Urology Division, Department of Surgery, College of Medicine & Health Sciences, Sultan Qaboos University, P.O. Box 35, Al-Khoud 123, Sultanate of Oman, e-mail: mmarhoon@squ.edu.om