Jayaprakash Gangadharaiah1 , N. Imdad Ali2 , Paresh Sankhe3 , Ravishankar T.H.S. 4
BACKGROUND A Zimskind et al. in 1967 first described ureteral stenting, and it has become an integral part of the urological procedure since then. There are various problems associated with the procedure of DJ (Double J) stenting. Post stenting complications such as blockage of the stent (25 %), stent migration, haematuria, flank pain, stent irritating trigonal area leading to LUTS (Lower Urinary Tract Symptoms) (78 %), stent pass off, infection, formation of biofilms (11 %), and reflux. The exact mechanism causing stent-related symptoms is not known but the proposed mechanism for it is that firstly intravesical portion of the stent acts as a foreign body which irritates bladder mucosa especially at the trigonal area of the bladder and neck of the bladder. It becomes important to study the methods of measuring required length of stent; there are direct and indirect methods to do so. We wanted to study the direct method of measuring required stent length along with its effect on symptomology. METHODS A total of 43 patients who underwent DJ stenting for various reasons were included in the study. The ureteral length was measured using a ruled 5-Fr ureteral catheter under C-arm guidance. With the help of air pyelogram, the exact length of the ureter was noted endoscopically. A stent of the nearest length to the measured ureteric length was inserted. Stent-related morbidity was assessed with the help of post-operative stent related symptomatology. Length of the stent in the bladder is a major determinant of symptoms. RESULTS Of the 43 patients, 23 (53.5 %) patients underwent unilateral and 20 (46.5 %) patients underwent bilateral DJ stenting. The commonest indication for surgery was urolithiasis. 4 (9.3 %) patients had postoperative stent-related symptoms. CONCLUSIONS Choosing a double J stent by direct measurement of ureteric length can be a very useful, yet simple method to prevent post-stenting morbidity and needs further evaluation.
