Ureteral Stent Related Lower Urinary Tract Symptoms- A Comparative Study
Condition: Ureteral Stent-Related Symptom
MeSH terms: Lower Urinary Tract Symptoms
Study type: Observational

Summary: 
      Pigtails are inserted to relieve of pelviureteral system independent of the underlying cause.
      Pain, Lower Urinary Tract Symptoms (LUTS), hematuria and fever can be some of the early
      complications after their insertion..More than 80% of the patients mention significant amount
      of pain limiting their daily activities while 78% mentions LUTS.

      The local irritation from the pigtail in the kidney and the ureterovesical junction, the
      urine reflux through the pigtail, length and size of the pigtail are some of the factors that
      account for the Ureteral Stent Related Symptoms (USRS) .Important role also has the length of
      remaining pigtail within the bladder as well as the drainage capacity,the lack of elasticity
      and the migration within the bladder of the pigtail .Aim of this study is to correlate the
      physical properties of the pigtail (length,size) with the complications after the insertion.
    

Detailed description: 
      Ureteral stents were first described by Finney and Hepperlen. Stenting of the upper urinary
      tract was initially used for relieving upper urinary tract obstruction and for ureteral
      alignment. The first self retaining ureteral catheters were described by Gibbons , Mardis ,
      Finney and Hepperlen. Ureteral stents can be either open -end or close- end. The main
      materials used for manufacturing them are silicone, polyurethane and Percuflex.

      Pigtail are placed to prevent ureteral obstruction from stone fragments, ureteral oedema,
      hepatoma, as well as to prevent urinomas.Some of the factors that influence Ureteral Stent
      Related Symptoms ( USSQ) are the irritation to the kidney and bladder trigone, the
      vesicoureteral reflux through the pigtail ,pigtail length and the remaining tail length
      within the bladder.Early complications after pigtail insertion include pain, LUTS (lower
      urinary tract symptoms )[ increased frequency (60%), hesitancy (60%) ,dysuria (40%)] , renal
      pain ,body pain, hematuria (54%) and fever. More than 80% of the patients mention pain
      limiting their daily activities while 78% mentions LUTS. Late complications following pigtail
      insertion include pigtail migration , renal obstruction , stone formation around the pigtail
      and automatic pigtail degradation.Pigtail can also affect sexual and professional life.

      The purpose of this survey is to clarify the connection between the pigtail physical
      properties (length, size) with the complications arising from their use.The goal is to
      investigate if the use of one type of ureteral stent with particular characteristics is
      better than the others and the use of this knowledge in everyday clinical praxis.

      In this survey will be included patients with inserted pigtails. In our clinic we have access
      to pigtail sizes 6 Fr 26 cm, 5 Fr 26 cm,6 Fr 28 cm και 5 Fr 28 cm.The patients will be
      divided into 4 groups depending on the pigtail size. All the patients will have signed a
      consent form prior to their inclusion in the study. Patients having pigtail due to malignant
      disease and patients not being in the mental state to cooperate will be excluded from this
      survey. The pigtail insertion will be correlated with the potential complications using the
      Ureteral Stent Related Symptoms Questionnaire ( USSQ) which was first described by Joshi in
      2003. This questionnaire is answered by each patient the first and fourth week of pigtail
      insertion and the fourth week after pigtail removal. It includes questions covering six
      fields: urinary tract symptoms, body pain, overall health, professional performance , sexual
      performance and additional problems.
    

Intervention name(s): Pigtail Insertion
Intervention type(s): Procedure
Intervention description(s): Pigtail is inserted for any reason of ureteral obstruction except for malignant
Observational model: Cohort
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Patients with inserted pigtails due to ureteral obstruction or due to procedures such as
        URS, RIRS and PCNL
      
Keywords: pigtail; ureteral stent; USSQ; pigtail size; pigtail length; LUTS; hematuria; pain; sexual performance; daily activity; professional performance