Katherine M Fischer1, Michael Louie2, Phillip Mucksavage3. 1. Department of Urology, Hospital of the University of Pennsylvania, Philadelphia, USA. 2. Department of Urology, University of California Irvine Health, Irvine, USA. 3. Department of Urology, Hospital of the University of Pennsylvania, Philadelphia, USA. Phillip.Mucksavage@uphs.upenn.edu.
Abstract
PURPOSE OF REVIEW: Ureteral stent placement is a very common urologic procedure and a necessary component of many minimally invasive surgeries including ureteroscopy. Despite its widespread use, stent placement results in bothersome urinary symptoms and pain in approximately 80% of patients. This review discusses the proposed mechanisms underlying ureteral stent-related symptoms and current approaches to symptom management and the evidence to support them. RECENT FINDINGS: Though it has been extensively studied, the exact cause of stent-related symptoms remains unknown but is likely related to irritation of the bladder by the distal curl of the stent and reflux of urine through the stent up to the renal pelvis and transmission of high pressures associated with this. Recent research has focused on trying to modify stents including the creation of drug eluting stents as well as preventing symptoms with intravesical instillation of medications in the operative room at the time of placement. Some of these approaches show promise, but anticholinergic and alpha-blocking medications remain the only treatments for stent-related symptoms with reasonable evidence to support them. Current evidence suggests that a multimodal approach to stent-related symptoms and pain with alpha-blockers, anticholinergic medications, and anti-inflammatory and narcotic pain medications is likely the most effective. Further research is needed to better investigate many novel techniques for decreasing stent-related symptoms. This continues to be an important area of research given the need for ureteral stents in urology and the high prevalence of patient discomfort related to stent placement.
PURPOSE OF REVIEW: Ureteral stent placement is a very common urologic procedure and a necessary component of many minimally invasive surgeries including ureteroscopy. Despite its widespread use, stent placement results in bothersome urinary symptoms and pain in approximately 80% of patients. This review discusses the proposed mechanisms underlying ureteral stent-related symptoms and current approaches to symptom management and the evidence to support them. RECENT FINDINGS: Though it has been extensively studied, the exact cause of stent-related symptoms remains unknown but is likely related to irritation of the bladder by the distal curl of the stent and reflux of urine through the stent up to the renal pelvis and transmission of high pressures associated with this. Recent research has focused on trying to modify stents including the creation of drug eluting stents as well as preventing symptoms with intravesical instillation of medications in the operative room at the time of placement. Some of these approaches show promise, but anticholinergic and alpha-blocking medications remain the only treatments for stent-related symptoms with reasonable evidence to support them. Current evidence suggests that a multimodal approach to stent-related symptoms and pain with alpha-blockers, anticholinergic medications, and anti-inflammatory and narcotic pain medications is likely the most effective. Further research is needed to better investigate many novel techniques for decreasing stent-related symptoms. This continues to be an important area of research given the need for ureteral stents in urology and the high prevalence of patient discomfort related to stent placement.
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