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1039 Does increased ureteric stent encrustation cause greater patient morbidity and stent related symptoms?
1039
Does increased ureteric stent encrustation cause greater patient morbidity and stent related symptoms? Eur Urol Suppl 2016;15(3);e1039
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Raja A. 1 , Sherif M. 2 , Hobot J. 2 , Joshi H.1 1 University
Hospital of Wales, Dept. of Urology, Cardiff, United Kingdom, 2 Cardiff University, Dept. of Medicine, Cardiff, United Kingdom
INTRODUCTION & OBJECTIVES: Encrustation and incrustation of ureteric stents whilst in situ remains a significant problem to both clinicians and industry, with considerable resource allotted to develop encrustation-free stents. It has been suggested that the amount of en and incrustation of ureteric stent is associated with patient morbidity and stent-related symptoms, however this has never been substantiated.
Aim: To develop a novel, standardised methodology to assess stent en and incrustation utilising scanning electron microscopy and to evaluate its relationship to the patients’ quality of life (QoL) using validated outcome measures; Ureteric stent symptom questionnaire (USSQ) and the EuroQol EQ-5D. MATERIAL & METHODS: Patients undergoing placement of ureteric stent for urinary calculi were recruited (n=60). Patients completed the USSQ and EQ-5D at 1 and 3 weeks with the stent in situ and 4 weeks after removal. Parameters such as stone and biochemical analysis incl. 24hr urine results were recorded. Upon extraction, the stent was dried and cut transversely in 4 pre-defined areas. Samples were mounted and sputter coated with a gold target (EMScope). Electron micrographs were taken of the inner (4) and outer (4) surfaces of each sample. Qualitative and quantitative data was obtained. Areas of encrustation and incrustation were measured directly on the computer screen and a mean figure of in and encrustation was calculated. USSQ scores and clinical parameters were compared to levels of stent in and encrustation. RESULTS: 55 patients completed study (male 73%, female 27%). The mean age of patient was 56 (25-80). Mean number of days stent left in situ was 49 (7-150). 64 images were taken per stent (3520 observations) that validated methodology. The mean area of encrustation was 0.796mm 2 (0.03 mm2 -3.29 mm2 ) and the mean area of incrustation was 0.257 mm2 (0.002 mm2 -1.72 mm2 ). Mean luminal occlusion was 4.98% (0.04-31.6%). Urinary symptom domain mean score was 32.3 and mean pain domain score was 25.6. There was no correlation between the amount of encrustation or incrustation and any of the domains of the USSQ (Pearson correlation coefficient for urinary symptom domain and incrustation=0.021, urinary symptom domain and incrustation=0.184, pain domain score and encrustation=0.047 and pain domain score and incrustation=0.060). CONCLUSIONS: The study demonstrated lack of correlation between stent encrustations and stent induced symptoms and patient’s QoL challenging a common belief. This study has also established a valid, reproducible method to quantify en and incrustations that would be useful for the future research in the area.
Does increased ureteric stent encrustation cause greater patient morbidity and stent related symptoms? Eur Urol Suppl 2016;15(3);e1039
Print! Print!
Raja A. 1 , Sherif M. 2 , Hobot J. 2 , Joshi H.1 1 University
Hospital of Wales, Dept. of Urology, Cardiff, United Kingdom, 2 Cardiff University, Dept. of Medicine, Cardiff, United Kingdom
INTRODUCTION & OBJECTIVES: Encrustation and incrustation of ureteric stents whilst in situ remains a significant problem to both clinicians and industry, with considerable resource allotted to develop encrustation-free stents. It has been suggested that the amount of en and incrustation of ureteric stent is associated with patient morbidity and stent-related symptoms, however this has never been substantiated.
Aim: To develop a novel, standardised methodology to assess stent en and incrustation utilising scanning electron microscopy and to evaluate its relationship to the patients’ quality of life (QoL) using validated outcome measures; Ureteric stent symptom questionnaire (USSQ) and the EuroQol EQ-5D. MATERIAL & METHODS: Patients undergoing placement of ureteric stent for urinary calculi were recruited (n=60). Patients completed the USSQ and EQ-5D at 1 and 3 weeks with the stent in situ and 4 weeks after removal. Parameters such as stone and biochemical analysis incl. 24hr urine results were recorded. Upon extraction, the stent was dried and cut transversely in 4 pre-defined areas. Samples were mounted and sputter coated with a gold target (EMScope). Electron micrographs were taken of the inner (4) and outer (4) surfaces of each sample. Qualitative and quantitative data was obtained. Areas of encrustation and incrustation were measured directly on the computer screen and a mean figure of in and encrustation was calculated. USSQ scores and clinical parameters were compared to levels of stent in and encrustation. RESULTS: 55 patients completed study (male 73%, female 27%). The mean age of patient was 56 (25-80). Mean number of days stent left in situ was 49 (7-150). 64 images were taken per stent (3520 observations) that validated methodology. The mean area of encrustation was 0.796mm 2 (0.03 mm2 -3.29 mm2 ) and the mean area of incrustation was 0.257 mm2 (0.002 mm2 -1.72 mm2 ). Mean luminal occlusion was 4.98% (0.04-31.6%). Urinary symptom domain mean score was 32.3 and mean pain domain score was 25.6. There was no correlation between the amount of encrustation or incrustation and any of the domains of the USSQ (Pearson correlation coefficient for urinary symptom domain and incrustation=0.021, urinary symptom domain and incrustation=0.184, pain domain score and encrustation=0.047 and pain domain score and incrustation=0.060). CONCLUSIONS: The study demonstrated lack of correlation between stent encrustations and stent induced symptoms and patient’s QoL challenging a common belief. This study has also established a valid, reproducible method to quantify en and incrustations that would be useful for the future research in the area.