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Journal of Medicine and Life 2021Double J stent is an essential tool in urology, being a basic part of many urological procedures. However, some issues related to their use still occur. Our study aimed...
Double J stent is an essential tool in urology, being a basic part of many urological procedures. However, some issues related to their use still occur. Our study aimed to evaluate an important number of procedures, the complications of ureteral stents, and their prevention and treatment retrospectively. We evaluate 50,000 procedures performed between 1996 and 2021 on 36,688 patients. According to the stenting duration, the cases were divided into short-term (less than 6 weeks - 34,213 procedures), respectively long-term stenting (more than 6 weeks - 15,757 procedures). The indications of stenting for both groups were noted. The total number of complications was 41,369. We encountered 153 cases (0.3%) of JJ stent malposition, of which 3 cases were into the retroperitoneum, one case with parenchymal perforation and hematoma. Considering the double J migrations, we found proximal migration in 427 cases (0.9%) and distal double J migrations in 352 (0.7%) cases. The obstruction of the ureteral stent, causing inefficient drainage, was encountered in 925 cases, while irritative bladder symptoms occurred in 16,326 cases (32.7%). Hematuria was observed in 5,213 cases, in 7 cases blood transfusion being necessary. Urinary tract infection was diagnosed in 7,436 cases (14.8%). Stent encrustation and calcification occurred in 832 cases, while stent fragmentation was noted in 52 cases. Double J stent complications should be promptly evaluated and treated. Encrustation and stone formation in forgotten stents often lead to serious complications and should be managed with stent removal and combined endourological techniques.
Topics: Device Removal; Humans; Retrospective Studies; Stents; Ureter
PubMed: 35126746
DOI: 10.25122/jml-2021-0352 -
Going Polymer Free and Dual Antiplatelet Free Earlier: The Coevolution of Stent and Pharmacotherapy.Journal of the American College of... Jan 2017
Topics: Drug-Eluting Stents; Hemorrhage; Humans; Polymers; Stents
PubMed: 28081826
DOI: 10.1016/j.jacc.2016.10.056 -
Current Urology Reports Apr 2018There are three technological parameters that play a key role on the performance of an ideal stent. These are its material, design and surface coating. This article... (Review)
Review
PURPOSE OF REVIEW
There are three technological parameters that play a key role on the performance of an ideal stent. These are its material, design and surface coating. This article highlights some fundamental developments that took place in these three areas of stent's technology, in order to contribute to the identification of an ideal stent.
RECENT FINDINGS
In addition to technological developments concerning stent's material, design and surface coating, the flow dynamic performance of stents has recently attracted increasing attention. Notably, it has been postulated that the local flow field in a stent is correlated with the deposition of crystals and microorganisms. These findings could potentially revolutionise future stent's designs, and complement developments made on materials and coatings. The most relevant changes in materials, designs and surface coatings of ureteric stents are reviewed in this article. These are described in the context of a specific cause of stent's failure they aim to address, with a particular focus on encrustation and biofilm formation.
Topics: Biofilms; Equipment Design; Humans; Prosthesis Failure; Stents; Ureter
PubMed: 29637309
DOI: 10.1007/s11934-018-0779-y -
Endoscopy Jul 20211: ESGE recommends placement of partially or fully covered self-expandable metal stents (SEMSs) for palliation of malignant dysphagia over laser therapy, photodynamic...
MALIGNANT DISEASE
1: ESGE recommends placement of partially or fully covered self-expandable metal stents (SEMSs) for palliation of malignant dysphagia over laser therapy, photodynamic therapy, and esophageal bypass.Strong recommendation, high quality evidence. 2 : ESGE recommends brachytherapy as a valid alternative, alone or in addition to stenting, in esophageal cancer patients with malignant dysphagia and expected longer life expectancy.Strong recommendation, high quality evidence. 3: ESGE recommends esophageal SEMS placement for sealing malignant tracheoesophageal or bronchoesophageal fistulas. Strong recommendation, low quality evidence. 4 : ESGE does not recommend SEMS placement as a bridge to surgery or before preoperative chemoradiotherapy because it is associated with a high incidence of adverse events. Other options such as feeding tube placement are preferable. Strong recommendation, low quality evidence.
BENIGN DISEASE
5: ESGE recommends against the use of SEMSs as first-line therapy for the management of benign esophageal strictures because of the potential for adverse events, the availability of alternative therapies, and their cost. Strong recommendation, low quality evidence. 6: ESGE suggests consideration of temporary placement of self-expandable stents for refractory benign esophageal strictures. Weak recommendation, moderate quality evidence. 7: ESGE suggests that fully covered SEMSs be preferred over partially covered SEMSs for the treatment of refractory benign esophageal strictures because of their very low risk of embedment and ease of removability. Weak recommendation, low quality evidence. 8: ESGE recommends the stent-in-stent technique to remove partially covered SEMSs that are embedded in the esophageal wall. Strong recommendation, low quality evidence. 9: ESGE recommends that temporary stent placement can be considered for the treatment of leaks, fistulas, and perforations. No specific type of stent can be recommended, and the duration of stenting should be individualized. Strong recommendation, low quality of evidence. 10 : ESGE recommends considering placement of a fully covered large-diameter SEMS for the treatment of esophageal variceal bleeding refractory to medical, endoscopic, and/or radiological therapy, or as initial therapy for patients with massive bleeding. Strong recommendation, moderate quality evidence.
Topics: Endoscopy, Gastrointestinal; Esophageal and Gastric Varices; Gastrointestinal Hemorrhage; Humans; Self Expandable Metallic Stents; Stents
PubMed: 33930932
DOI: 10.1055/a-1475-0063 -
Deutsches Arzteblatt International May 2020Stent thrombosis (ST) is a dreaded complication after stent implantation and is associated with a mortality between 5% and 45%. The mechanisms by which ST arises are... (Review)
Review
BACKGROUND
Stent thrombosis (ST) is a dreaded complication after stent implantation and is associated with a mortality between 5% and 45%. The mechanisms by which ST arises are complex. Because of the seriousness of this situation, all phy - sicians should have at least basic knowledge of it. In this article, we present the risk factors for ST and discuss some innovative approaches to its treatment.
METHODS
This review is based on pertinent articles retrieved by a selective search in PubMed, and on current international guidelines and expert recommendations.
RESULTS
The frequency of ST has been markedly lowered by technical advances in coronary stenting and by the implementation of modern implantation techniques, including the introduction of coverage with dual antiplatelet therapy (DAPT). Both patient-related risk factors and procedural aspects can elevate the risk of ST. The independent risk factors for ST include premature termination of DAPT (hazard ratio [HR] 26.8; 95% confidence interval [8.4; 85.4]; p <0.0001), malignant disease (odds ratio [OR]: 17.45; [4.67; 65.26]; p <0.0001), and diabetes mellitus (OR: 3.14; [1.33; 7.45]; p = 0.0093). In comparison to angiographically guided procedures, the use of intracoronary imaging techniques in patients with acute coronary syndrome lowers the frequency of ST (0.6% versus 1.2%; p = 0.005). These techniques enable the detection of many findings in the coronary arteries that are associated with the development of ST. In such cases, countermeasures such as secondary stent dilatation or prolongation of DAPT can help prevent ST.
CONCLUSION
As the pathophysiology of ST is multifactorial, research in this area presents a special challenge. Prospective clinical trials will be needed to determine whether the systematic use of imaging techniques can lower the frequency of ST.
Topics: Coronary Thrombosis; Humans; Risk Factors; Stents
PubMed: 32605709
DOI: 10.3238/arztebl.2020.0320 -
Minerva Urologica E Nefrologica = the... Jun 2018Ureteral obstructions are managed by complex surgery not always feasible for surgical field complexity or poor patient conditions. Various surgical maneuvers, as... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Ureteral obstructions are managed by complex surgery not always feasible for surgical field complexity or poor patient conditions. Various surgical maneuvers, as ureteral dilation, stenting and percutaneous nephrostomy, can be offered, but they are related to considerable failure rates and negative impact on quality of life. In selected cases, the positioning of long-term expandable metallic ureteral stents (EMUSs) may be an appropriate and successful choice.
EVIDENCE ACQUISITION
Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria, a systematic review of the literature was performed in July 2017 using PubMed, Cochrane Library, Scopus and Web of Science databases. The search was conducted by typing the following terms: "Expandable metallic ureteral stent," "Memokath ureteral stent," "Allium ureteral stent," and "Uventa ureteral stent."
EVIDENCE SYNTHESIS
Twenty studies reported the safety, efficacy and clinical outcomes related to the common available EMUSs. Most studies were single-arm, retrospective and involving a low number of clinical cases, resulting in significant difficulties with outlining indications and drawing conclusions. Available papers showed EMUSs offered a high rate of patency, a long duration and a good quality of life, even if they are associated with significant complications.
CONCLUSIONS
Since the first description of ureteral stents 50 years ago, we have faced a significant evolution in stent design. The current generation of EMUSs offers many advantages, but the onset of adverse effects is still significant and limits their use to selected cases. Further research should be addressed to the realization of prospective, multi-institutional randomized clinical trials to highlight indications to manage appropriately ureteral obstructions.
Topics: Humans; Stents; Ureter; Ureteral Obstruction
PubMed: 29595037
DOI: 10.23736/S0393-2249.18.03035-7 -
International Journal of Medical... 2024Atherosclerosis, a chronic inflammation of blood vessel walls, is a progressive pathophysiological process characterized by lipid deposition and innate adaptive immune... (Review)
Review
Atherosclerosis, a chronic inflammation of blood vessel walls, is a progressive pathophysiological process characterized by lipid deposition and innate adaptive immune responses. Arteriosclerosis often leads to narrowing of blood vessels. At present, interventional stent therapy is the main treatment method for vascular stenosis, which has the advantages of less trauma, less risk and faster recovery. However, atherosclerosis occurs in a complex pathophysiological environment. Stenting inevitably causes local tissue damage, leading to complications such as inflammation, intimal hyperplasia, late thrombosis, stent restenosis and other complications. It is urgent to optimize interventional therapy program. This article summarizes the advantages and disadvantages of absorbable metal scaffolds and the research progress of absorbable polymer scaffolds. The optimization strategy of stent is proposed. The status quo of drug coating was summarized. The prospect of new stent. To improve the therapeutic effect of arteriosclerosis.
Topics: Humans; Absorbable Implants; Stents; Thrombosis; Atherosclerosis; Inflammation
PubMed: 38169581
DOI: 10.7150/ijms.90012 -
Journal of the American College of... Feb 2014
Topics: Coated Materials, Biocompatible; Coronary Thrombosis; Drug-Eluting Stents; Humans; Myocardial Infarction; Myocardial Revascularization; Stents
PubMed: 24211501
DOI: 10.1016/j.jacc.2013.10.016 -
JACC. Cardiovascular Interventions Dec 2020
Topics: Drug-Eluting Stents; Everolimus; Humans; Network Meta-Analysis; Technology; Treatment Outcome
PubMed: 33357525
DOI: 10.1016/j.jcin.2020.10.004 -
JACC. Cardiovascular Interventions Dec 2017
Topics: Bayes Theorem; Coronary Angiography; Drug-Eluting Stents; Humans; Network Meta-Analysis; Percutaneous Coronary Intervention
PubMed: 29153500
DOI: 10.1016/j.jcin.2017.09.024