The optimal stent pusher position to achieve successful ureteral stent insertion under fluoroscopic guidance

doi:10.1016/j.ajur.2022.11.006

Asian Journal of Urology, 2024, 11 (2): 311-315 doi: 10.1016/j.ajur.2022.11.006

Regular Papers: Original Articles

Current Issue | Archive | Adv Search

The optimal stent pusher position to achieve successful ureteral stent insertion under fluoroscopic guidance

Makoto Taguchi^a,b,*(

),Kaneki Yasuda^a,Hidefumi Kinoshita^b

^aDepartment of Urology, Osaka Saiseikai Izuo Hospital Based on Social Welfare Organization “Saiseikai” Imperial Gift Foundation Inc., Osaka, Japan
^bDepartment of Urology and Andrology, Kansai Medical University, Hirakata, Osaka, Japan

Abstract
Related Citation (15)

Download:

HTML

PDF (782KB)
Export: BibTeX | EndNote (RIS)

Abstract

Objective: To examine factors to predict the optimal stent pusher position when inserting ureteral stents under fluoroscopy.

Methods: We retrospectively reviewed 327 patients who underwent ureteral stent insertion. We considered the pubic bone as a useful anatomical landmark to insert ureteral stents under fluoroscopic guidance. Thus, we categorized patients into three groups (proximal, middle, and distal groups) according to the position of the radiopaque tip of the push catheter when inserting the ureteral stent. Success was defined as a completely curled ureteral stent tail. We compared stent insertion success rates among the three groups. A multivariate analysis was performed to identify the factors affecting stent insertion success.

Results: In men, 36 (63.2%) cases were deemed successful in the proximal group compared with 40 (80.0%) cases in the middle group and 12 (20.7%) cases in the distal group (p<0.001). In women, 26 (45.6%) cases were deemed successful in the proximal group compared with 54 (98.2%) cases in the middle group and 38 (76.0%) cases in the distal group (p<0.001). With the multivariate analysis, the stent pusher position was the most significant factor influencing successful stent insertion (men: odds ratio 6.00, 95% confidence interval 2.66-13.51, p<0.001; women: odds ratio 37.80, 95% confidence interval 4.94-289.22, p<0.001).

Conclusion: The position of the stent pusher affects stent insertion success. The middle of the pubic symphysis is the optimal position for the radiopaque tip of the pusher when inserting ureteral stents under fluoroscopic guidance.

Key words： Stent Cystoscopy Fluoroscopy Ureter

Received: 11 April 2022 Available online: 20 April 2024

Corresponding Authors: * Department of Urology and Andrology, Kansai Medical University, Hirakata, Osaka, Japan. E-mail address: taguchim@takii.kmu.ac.jp (M. Taguchi).

	Service
	E-mail this article
	Add to citation manager
	E-mail Alert
	Articles by authors
	Makoto Taguchi
	Kaneki Yasuda
	Hidefumi Kinoshita

TRENDMD:

Cite this article:

Makoto Taguchi,Kaneki Yasuda,Hidefumi Kinoshita. The optimal stent pusher position to achieve successful ureteral stent insertion under fluoroscopic guidance[J]. Asian Journal of Urology, 2024, 11(2): 311-315.

URL:

http://www.ajurology.com/EN/10.1016/j.ajur.2022.11.006 OR http://www.ajurology.com/EN/Y2024/V11/I2/311

Classification of the position of the radiopaque tip of the push catheter and definition of successful stent insertion: (A-C) The pubic symphysis was divided into three equal parts: (A) In the proximal group, the radiopaque tip of the push catheter was on the proximal side of the pubic symphysis; (B) In the middle group, the radiopaque tip of the push catheter was in the middle of the pubic symphysis; (C) In the distal group, the radiopaque tip of the push catheter was on the distal side of the pubic symphysis; (D) A completely curled ureteral stent tail indicated successful stent insertion; (E) Stent migration indicated stent insertion failure; (F) Stent remaining in the urethra indicated stent insertion failure.

The distance from the inferior border of the pubic symphysis to the ureteral orifice.

The demographics of patients in each group.

Univariate and multivariate analysis demonstrating factors predicting successful stent placement.

[1]	Zimskind PD, Fetter TR, Wilkerson JL. Clinical use of longterm indwelling silicone rubber ureteral splints inserted cystoscopically. J Urol 1967; 97:840e4. doi: 10.1016/s0022-5347(17)63130-6 pmid: 6025928
[2]	Uthappa MC, Cowan NC. Retrograde or antegrade doublepigtail stent placement for malignant ureteric obstruction? Clin Radiol 2005; 60:608e12. doi: 10.1016/j.crad.2004.11.014 pmid: 15851050
[3]	McFarlane JP, Cowan C, Holt SJ, Cowan MJ. Outpatient ureteric procedures: a new method for retrograde ureteropyelography and ureteric stent placement. BJU Int 2001; 87:172e6. pmid: 11167637
[4]	Yedlicka JW, Aizpuru Jr R, Hunter DW, Casta?eda-Zú?iga WR, Amplatz K. Retrograde replacement of internal double-J ureteral stents. Am Journal Rev 1991;156:1007e9.
[5]	Park SW, Cha IH, Hong SJ, Yi JG, Jeon HJ, Park JH, et al. Fluoroscopy-guided transurethral removal and exchange of ureteral stents in female patients: technical notes. J Vasc Intervent Radiol 2007; 18:251e6. doi: 10.1016/j.jvir.2006.12.722
[6]	Chang RS, Liang HL, Huang JS, Wang PC, Chen MC, Lai PH, et al. Fluoroscopic guidance of retrograde exchange of ureteral stents in women. AJR Am J Roentgenol 2008; 190:1665e70. doi: 10.2214/AJR.07.3216
[7]	Chia SJ, Heng CT, Chan SP, Foo KT. Correlation of intravesical prostatic protrusion with bladder outlet obstruction. BJU Int 2003; 91:371e4. doi: 10.1046/j.1464-410x.2003.04088.x pmid: 12603417
[8]	Mardis HK, Hepperlen TW, Kammandel H. Double pigtail ureteral stent. Urology 1979; 14:23e6. pmid: 452213
[9]	de Baere T, Denys A, Pappas P, Challier E, Roche A. Ureteral stents: exchange under fluoroscopic control as an effective alternative to cystoscopy. Radiology 1994; 190:887e9. pmid: 8115645
[10]	Kawahara T, Ito H, Terao H, Yamashita Y, Tanaka K, Ogawa T, et al. Ureteral stent exchange under fluoroscopic guidance using the crochet hook technique in women. Urol Int 2012; 88:322e5. doi: 10.1159/000336870 pmid: 22433181
[11]	Jeong YB, Doo AR, Park HS, Shin YS. Clinical significance of ureteral stent removal by flexible cystoscopy on pain and satisfaction in young males: a prospective randomised control trial. Urolithiasis 2016; 44:367e70. doi: 10.1007/s00240-015-0833-x pmid: 26520434
[12]	Slaton JW, Kropp KA. Proximal ureteral stent migration: an avoidable complication? J Urol 1996; 155:58e61. pmid: 7490898
[13]	Giannarini G, Keeley FX Jr, Valent F, Manassero F, Mogorovich A, Autorino R, et al. Predictors of morbidity in patients with indwelling ureteric stents: results of a prospective study using the validated Ureteric Stent Symptoms Questionnaire. BJU Int 2010; 107:648e54. doi: 10.1111/bju.2011.107.issue-4
[14]	Taguchi M, Yoshida K, Sugi M, Matsuda T, Kinoshita H. A ureteral stent crossing the bladder midline leads to worse urinary symptoms. Cent European J Urol 2017; 70:412e7. doi: 10.5173/ceju.2017.1533 pmid: 29410895
[15]	Hwang I, Kim SO, Yu HS, Hwang EC, Jung SI, Kang TW, et al. A preliminary study of the variability in location of the ureteral orifices with bladder filling by fluoroscopic guidance: the gender difference. Int Urol Nephrol 2013; 45:639e43. doi: 10.1007/s11255-013-0463-6 pmid: 23657614
[16]	Dellis AE, Skolarikos AA, Nastos K, Deliveliotis C, Varkarakis I, Mitsogiannis I, et al. The impact of technique standardization on total operating and fluoroscopy times in simple endourological procedures: a prospective study. J Endourol 2018; 32: 747e52. doi: 10.1089/end.2018.0265 pmid: 29845884