Dean G. Assimos, MD, is professor of urology, department of urology, Wake Forest University School of Medicine, Winston-Salem, NC
Several approaches have been taken to attenuate lower urinary tract symptoms and improve quality of life in the stented patient.
Several approaches have been taken to attenuate lower urinary tract symptoms and improve quality of life in the stented patient, a number of which are reported in this issue of Urology Times. Recent modifications in stent design and composition have not worked, as Lingeman et al have demonstrated (J Urol 2009; 181:2581-7). Use of a drug-eluting stent, as reported by Krambeck et al, had minimal impact, with benefits seen only in younger males (see, "Degradable and drug-eluting stents: Mixed results"). Perhaps a different drug or panel of drugs might improve results. The anticipated cost of a drug-eluting stent is a downside, particularly in the current economic setting.
Urologists should consider using alpha-blockers in stented patients, as randomized, controlled trials have demonstrated a reduction in bothersome symptoms (J Endourol 2008; 22:651-6; J Urol 2009; 181:170-6). Further, ureteral stenting may not be necessary after an uncomplicated ureteroscopic procedure (BMJ 2007; Epub Feb. 20).
Maintenance of stent patency in patients who require prolonged stenting for management of diseases causing ureteral obstruction has been a challenge, as stent failure is common. The use of metallic stents has yielded mixed results. The potential for economic savings is of interest, as described by Lopez-Huertas et al, and will need to be confirmed by others (see, "Metallic stent may be viable option in select patients").
Stent failure may be due to encrustation, extensive external compression of the ureter, and changes in collecting system/ureteral dynamics. Implanting stents with agents that attenuate encrustation is being investigated, and hopefully will have future clinical utility.