Statistics And Analysis About The Application And Complication Of Indwelling Ureteral Stents In The Urologic Surgery

Background: With the development of endourology and the improvement of indwelling ureteral stent , ureteral internal drainage gradually replaces external drainage and has become the most common urological drainage way on the upper urinary tract. The application of indwelling ureteral stents in urology also becomes more to more extensive. In the majority of urological surgery, ureteral stent has become an indispensable tool for the treatment.The extensive using of ureteral stents is rely on its excellent properties. At present ureteral stents that be commonly used in clinical generally has a good song, with flexible and fixed their own role, will not move up or down in order to prevent changes in position after implantation in vivo, large diameter, thin wall, large drainage in order to ensure full drainage of urine. In order to better their own fixed, there are a variety of forms in the shape .The typical stent is designed to be J-shaped at both ends or hollow pigtail catheter. Within these excellent features, in urology, ureteral stent not only played the role of drainage for a variety of upper urinary tract obstruction drainage disease; but also played the role of ureteral stents for the treatment and prevention ureteral stricture.Although the ureteral stent in urological proved its superiority, but as a foreign body because it also occurs various of complications such as hematuria, lumbar pain ,urinary tract irritation and so on. Some serious complications can cause serious consequences, such as ectopic can completely lose its role of internal drainage and the support, while it is becoming a serious ureteral obstruction caused by foreign bodies. Because of these complications ,some scholars questioned the need for indwelling ureteral stent in surgery.Because the majority of scholars limited to a single disease, the study about the application of ureteral stent in urology is short of large sample and systematic study. In addition , because of no consensus on the ureteral stent application guidelines ,there is the phenomenon of excessive ureteral stent use. For complications of ureteral stent, most of scholars take little attention to the ureteral stent ectopic which can cause serious consequences. So a systematic study about the application of ureteral stent in urology and ureteral stent ectopic will have a great clinical significance.This experiment take a study on the patients who Indwelling ureteral stent in Urology of xiangya hospital in 2008.We try to find a ureteral stent application guidelines and analyze the reasons and precautions of the complication caused by ureteral stent. All of these, we want to provide a experimental evidence for the correct using of ureteral stent. Except these, we take focus on the ureteral stent ectopic. Try to find out the cause, summarize the precaution and work out the approach. This experiment will take a guideline for the application indications and complication precaution including ectopic about ureteral stent,Part I: Statistics and analysis about the application and complication of indwelling ureteral stents in the Urologic SurgeryObjective: To statistics the application of indwelling ureteral stents in the urologic surgery and summarize the ureteral stents indications and complications, Work out application guideline for ureteral stents and precautions of ureteral stents complications.Methods: Review the cases including renal calculus, ureteral calculus, ureteral stricture, ureteropelvic junction obstruction(UPJO) and other cases that need indwelling ureteral stents. Select 100 cases out of the kinds of cases that more than 100 cases by random ,while select the all cases that the cases are lee than 100 cases. There are 411 cases are selected into this study. We analyze the purpose of using ureteral stent in all these cases by review cases records, and summarize complication of ureteral stent by telephone , Then work out the guideline for using ureteral stent and the causes of complication and its precaution.Results:一: analyze the date by the kind of the disease 1 .Renal calculus( 100 cases): All the patient be treated by PCNL and indwelling ureteral stents .In these cases, 6 cases need the second operation, 21 cases need ESWL with ureteral stent and 8 cases need ESWL without ureteral stent.2.Rreteral calculus( 100 cases): Including 39 cases of Upper ureteral calculi, middle ureteral calculi are 12 cases and 49 cases of lower ureteral calculi. Ureteroscopic lithotripsy are performed under the lithotomic to treat these cases. In this cases, Most be indwellinged ureteral stent except 8 cases of lower ureteral calculi.3.Rreteral stricture(53 cases): 28 cases are treated by incision ureteral stricture under Transureteroscopic in which 2 cases recurrent stricture. 18 cases are treated by incision ureteral stricture through the laparoscopic in which 1 cases recurrent stricture and 7 cases by open surgery. All cases indwelling ureteral stent.4.Rreteropelvic junction obstruction(UPJO 100 cases):78 cases be treated by laparoscopic ureteropelvic angioplasty ,while others are treated by open surgery. More cases indwelling ureteral stent except 5 cases .5.0ther diseases(58 cases): 11 cases are Upper urinary tract obstruction in pregnancy . 5 cases are retroperitoneal fibrosis caused to ureteral obstruction. 8 cases ureteral pressed by retroperitoneal tumors 4 cases ureteral polyps. Other tumors (Prostate cancer, bladder cancer, uterine cancer, ovarian cancer and rectal cancer, etc).All cases indwelling ureteral stent.二: analyze the date by post-operative complications1.bladder irritation: A total of 197 cases of patients with different degrees of bladder irritation such as urinary frequency, urgency, pain while urinate2.hematuria: A total of 251 cases of patients with varying degrees of hematuria, and Most cases gradually disappeared in a week while 43 patients showed varying degrees of long-term gross hematuria, disappear after estuation3.Calculus obstruction: A total of 30 cases of patients with varying degrees of calculus More of them are with ureteral stent more than three months4.urine reflux: A total of 22 cases of patients with high fever, renal pain, the voiding phase imaging confirmed the existence of bladder urine reflux5.ectopic: A total of 28 cases are confirmed the existence of ureteral stent various forms of ectopic by KUB.Conclusion:1. Ureteral stent are widely used in urological especially in endourology.2. The main roles of ureteral stent: to lift obstruction and control infection and protect renal function.3. There is controversy about if it is necessary that indwelling ureteral after some kinds Surgery.4. The main complications include: hematuria, bladder irritation, urine reflux, ectopic, calculus formation.5. Norms of operation and reasonable post-operative care can be effective in reducing the incidence of complications.PartⅡ: The analysis and coping strategies about ureteral stents ectopicObjective: To summarize the types of ureteral stents ectopic , analyze the reasons ,and find the reasonable coping strategies.Methods: to collect cases of the ureteral stents ectopic patients included 5 cases in-patient departments in hospital and 26 cases in cystoscopy room. Then review the cases, request treatment process and matters related to observed, in order to summarize the types of ureteral stents ectopic , analyze the reasons ,and find the reasonable coping strategies. We combine with the 28 ectopic cases in part one, Divided into two groups: xiangya hospital group(Ⅰ), and other hospitals group (Ⅱ) . Analyze data by statistical software. Results: all these Ectopic cases included 20 cases upper position, 33 cases under position and 6 cases other abnormal position included parts of ureteral stents outside the ureter in 2 cases, Most of ureteral stents Falling in bladder in 2 cases, 1 cases near right atrium through inferior vena cava and ureteral stent was fracture in 1 cases. All of the cases inⅠgroup indwelling import ureteral stents while the cases inⅡgroup are 8 others are made in China, the date of groupⅠis the same with part one of this study. In group (Ⅱ) patients including 8 cases of kidney stones, four cases of ureteral calculi, ureteropelvic junction obstruction (UPJO) 11 cases, 5 cases of ureteral stricture and 3 cases of other diseases. Respectively antegrade indwelling stents 8 cases, 9 cases of retrograde indwelling stents and indwelling stents through the incision in 14 cases . 13 cases of patients are found ectopic In a week with, the others are found in one mouth, three mouths, more than three mouths are five cases, seven cases, six cases . 4 cases younger than 5 years, 12 cases younger than 18 years old, while 10 cases are younger than 60 years and 5 cases are old than 60. 6 cases intake water less than 1000ml, those in 16 cases < 2000ml,> 2000ml are nine cases .There are 15 patients more than the volume of activities, and the remaining respectively, eight cases, six cases and two cases. The placement of ureteral stents are too long in 11 cases, those of 11 cases are too short while nine cases of the right length. Conclusion:(1) The type of ureteral stent ectopic is related to surgical method and its diseases. Non-standard operation and postoperative stay too long and over-activity is the main reasons of ureteral stents ectopic.(2) Most of the ectopic ureteral stent can be pulled-out by cystoscope or ureteroscope, A small number of rare abnormality should receive special treatment.