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Purpose: We review the recent publications on developing engineering and pharmaceutical agents to alleviate stent related symptoms, and examine basic science studies that may support a particular approach., Materials and Methods: Data on randomized controlled trials for relief of stent related symptoms were analyzed. Studies involving engineering and pharmacological agents to resolve stent related morbidity were assessed separately., Results: A variety of physical characteristics of stents, including materials, diameter, length and shape, have been modified to reduce stent related symptoms. Numerous studies have been conducted to engineer the ideal stent without clear and definite conclusions. There are mixed results with materials and negative results with shape. Appropriate stent length appears to be important but decreased diameter has not been shown to help. A recent study using a ketorolac eluting stent showed no significant benefit. Even with the best material and length it appears that patients still have significant stent related symptoms. To relieve stent related symptoms several classes of oral medications have been proposed for off-label use based on intuition or experience. Recently prospective, randomized, placebo controlled trials have been performed, along with basic science studies regarding the pharmacology of the ureter. They showed a clear and consistent beneficial effect of alpha1-blockers in patients with indwelling ureteral stents., Conclusions: Although there have been many advances in stent composition, construction geometry and design, the ideal stent has yet to be engineered. By contrast, the oral administration of alpha-blockers has shown the greatest reduction in stent morbidity., (Copyright © 2010 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.)

Purpose: Ureteral stents are composed of different polymers and it is unclear if stent composition influences patient comfort. We compared the impact of stents composed of firm and soft polymer on patient health related quality of life., Materials and Methods: A total of 130 patients requiring insertion of ureteral stents during the treatment of urinary calculi were randomized to receive a stent composed of firm (Percuflex, group 1) or soft (Contour, group 2) polymer. Patients were asked to complete the Ureteric Stent Symptoms Questionnaire, a validated instrument, at weeks 1 and 4 with the stent in situ and 4 weeks after its removal, this served as the main outcome measure. Additional assessments included difficulty in stent insertion and the need for early stent removal., Results: There were 78 men and 38 women in total (61 in group 1 and 55 in group 2) with a mean age of 51 years (range 22 to 79) and no difference in age between the 2 groups (p = 0.9). Comparison of the results of the Ureteric Stent Symptoms Questionnaire survey at weeks 1 and 4 with stent in situ revealed no significant differences in the domain scores of urinary symptoms (p = 0.9 and p = 0.8), pain (p = 0.8 and p = 0.6) and general health (p = 0.6 and p = 0.4). Similarly, there were no differences in the number of days with reduced activities, work performance (p = 0.7) and sexual dysfunction between the 2 groups. A similar number of patients (8 and 7 in groups 1 and 2, respectively) required stent removal earlier than planned due to stent related symptoms., Conclusions: This randomized study showed no difference in the impact on patient quality of life between ureteral stents composed of firm or soft polymer.

Objectives: To determine the optimal method of treatment for ureteric stones causing complete obstruction, treated by insertion of a JJ stent or a nephrostomy tube, followed by extracorporeal shock wave lithotripsy (ESWL) or by urgent in situ ESWL if readily available., Patients and Methods: The study comprised a retrospective analysis of 82 consecutive patients who presented with ureteric stones causing complete obstruction. Twenty-six had a percutaneous nephrostomy (PCN, group 1) and 40 had a JJ stent (group 2) placed to relieve the obstruction, and the stones were subsequently treated by ESWL. Sixteen patients underwent urgent in situ ESWL without recourse to either a JJ stent or a PCN (group 3). The choice of the procedure was not determined by stone size, site or other factors, but mainly by the attending surgeon's preference or the availability of urgent ESWL. The success rate was measured by the disintegration of the stone and spontaneous passage after ESWL; failure was defined as the need for additional procedure(s) for stone extraction., Results: Urgent in situ ESWL (group 3) had a median (95% confidence interval) success rate of 81 (54-96)%, compared with 70 (53-83)% in group 2 and 54 (33-73)% in group 1., Conclusion: If facilities are available, urgent in situ ESWL appears to be the choice of treatment for obstructing ureteric stones. If such facilities are not available, a JJ stent may offer better success than a PCN. A prospective controlled trial is necessary to confirm these findings.