A Study on the role of DJ stenting in ureteric calculi patients after intracorporeal lithotripsy.

INTRODUCTION : An ureteric stent, is a tube that is placed inside the ureter to treat and also to prevent urinary obstruction . The stent length ranges from 24 to 30 cm in adults. Cystoscopic placement is the common method used tor stenting. Stents used in ureter are called double J, double pig-tail ,DJ or JJ stents. The term stent was first coined by Charles T Stent (1807–1885), an English dentist. Stents are commonly indicated in urology for draining urine from the kidney to the bladder. Stenting is mostly done in the ureter for stone disease during definitive procedures like ureteroscopy and extracorporeal shock wave lithotripsy. Advances in instrumentation of ureter have made ureteroscopy less morbid that the stent placed following the procedure remains the main source of concern to the patient. The stent that remains in situ usually causes the symptoms of urinary tract infection, pain in the suprapubic region and flank due to urinary reflux, frequency, urgency, dysuria and hematuria. An ureteric stent, is a tube that is placed inside the ureter to treat and also to prevent urinary obstruction . The stent length ranges from 24 to 30 cm in adults. Cystoscopic placement is the common method used tor stenting. Stents used in ureter are called double J, double pig-tail ,DJ or JJ stents.An attempt has been made in this study to evaluate the stent related symptoms after semirigid ureteroscopy and intracorporeal lithotripsy for mid, lower and distal vesico ureteric junction calculi , and a comparison has been made between stented and non stented patients. AIM : To evaluate the efficacy and complications of Double J stenting in ureteric calculi patients, who underwent semi rigid ureteroscopy and pneumatic lithotripsy. MATERIALS AND METHODS : It is a prospective study conducted from October 2011 to February 2013. A total of 70 patients were enrolled in the study. Inclusion criteria: Patients who underwent semirigid ureteroscopy for uncomplicated ureteric calculi. Only uncomplicated vesico ureteric junction calculi, lower ureteric calculi and mid ureteric calculi were included in the study. Exclusion criteria: Patients with upper ureteric calculi. Calculi associated with impaction and edema made out during ureteroscopy. Calculi associated with difficult entry of ureteroscope into the ureteric orifice. Patients who underwent balloon dilatation of the ureteric orifice. Patients with residual stone fragments in the ureter, post procedure. CONCLUSION : Stenting of the ureter has its own side effects of irritative voiding symptoms, pain, hematuria, urinary tract infection, fever. Stenting of the ureter following ureteroscopy has to be done taking factors like stone site, size, degree of impaction, bleeding, associated edema, difficulty encountered in negotiating the ureteric orifice into consideration. The side effects and complications associated with stenting of the ureter should be weighed against the advantages offered by stenting, depending on the intra operative ureteroscopy findings. Routine placement of ureteral stent is not necessary in uncomplicated cases of ureteric calculi following ureteroscopy, the decision being made on the basis of intra operative findings, where the risks clearly outweigh the benefits offered by stenting. The option of not stenting the patient following ureteroscopy should be considered for lower and distal ureteric calculi than proximal ureteric calculi, clearly the decision being based on intra operative findings. Stented patients need yet another invasive procedure for stent removal, which increases patient morbidity as well as the overall cost of the procedure.