gms | German Medical Science

Background: Despite the availability of percutaneous nephrostomies or expandable metallic ureteral stents, there are various reasons for long-term ureteral stenting with double-J stents. Only very few studies report on symptoms and tolerance and all of them are limited by the use of non-validated questionnaires. Due to this lack of data on morbidity associated with long-term stenting including the influence of biofilms, we performed this prospective observational study.

Methods: Patients with uni- or bilateral, indwelling stents (minimum of 8 weeks) were prospectively included. Reasons for stenting included benign or malign diseases. Patients could be included several times at different time points, which allowed an assessment of intra-individual variability of symptoms. Stent-associated morbidity was investigated using the Ureteral Stent Symptom Questionnaire (USSQ) at the day of intervention, correlation between total biofilm mass on the stent and the USSQ total score was defined as the primary outcome.

Results: In total 87 stent indwelling periods were investigated. The USSQ total score was below 60 in the majority of patients, some very high total scores were reported by patients with a single stent indwelling period. Median USSQ score did not differ significantly between uni- and bilateral stenting. Pain attributed to the ureteral stent was reported in only 26%. According to the USSQ general question, patients were predominantly (86%) ‘at least mostly satisfied’ with ureteral stenting, while being ‘mostly dissatisfied’ (13%) or ‘unhappy’ (1%) was reported less frequently. An increasing total stent treatment time was significantly correlated with better urinary symptoms and stent related quality of life.

Median mass of extracted biofilm was 50.45 mg per stent. In patients with bilateral stents, the biofilm mass per stent did not differ significantly. Finally, the USSQ score did not correlated significantly with the extracted biofilm mass.

Conclusion: Long-term double-J stenting provides a valuable treatment approach in selected patients. If stent associated symptoms are low during the initial indwelling period, symptoms remain stable over the course and the majority of patients is satisfied with the treatment. Nevertheless, stent-related morbidity still represents a relevant problem for many patients, which require further solution approaches. Furthermore, biofilm formation on ureteral stents does not seem to be the relevant driver of morbidity and symptoms.