Transurethral guidewire loop for manipulation and extraction of stent: A novel, innovative, video-endoscopic technique in ureteral stent removal

Abstract

Background: Ureteral stent removal is one of the most common procedures performed in urology. Herein, we describe a novel technique for stent removal using transurethral guidewire loop for manipulation and extraction of stents method. We aimed to evaluate the role, feasibility, cost, operative time, and complications of the method. A review of the literature outlining the innovations in ureteral stent removal was also performed.

Materials and methods: Cystoscopic stent removal was performed using transurethral guidewire loop for manipulation and extraction of stents in all sequential cases. Variables including sex, age, stent type, duration, reason for stent insertion, type of anesthesia (general/local), cystoscopic stent removal time, and documentation of postprocedural complications were tabulated. In addition, using the search term “novel innovation in ureteral stent removal,” various databases (PubMed, EMBASE, Cochrane Library, SCOPUS, and Web of Science) were searched.

Results: Transurethral guidewire loop for manipulation and extraction of stents was successfully performed in all patients assessed on the first attempt. The patients comprised both sexes. The procedure was well tolerated under local anesthesia (4 of 5 cases), whereas general anesthesia was used in 1 case as the patient was booked for subsequent ureteroscopy under the same anesthetic. The procedure time was <27 seconds in all the cases assessed. No significant complications were noted. Fifteen studies involving novel innovations were included in the critical appraisal.

Conclusions: Transurethral guidewire loop for manipulation and extraction of stents is a simple, cost-effective, and innovative alternative for removing ureteral stents. It may be easily applied instead of a conventional ureteral stent grasper. Published innovative trends in ureteral stent removal have evolved over time, including advancements in stent design, retrieval devices, and the use of fluoroscope-free and cystoscope-free techniques.

Keywords

Novel innovation / Endourology / Stent removal / Transurethral loop / Transurethral guidewire loop for manipulation and extraction of stents

Acknowledgments

We acknowledge NuAngle (South Africa) for consumable sponsorship. We also thank Isa and Muhammad Adam for their photographic assistance.

Statement of ethics

Local institutional ethics committee approval was obtained, with a Human Research Ethics Committee (Medical) Clearance Certificate (M200595—18/06/2020). Written informed consent was obtained from all participants in this study. All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Conflict of interest statement

No conflict of interest has been declared by the author.

Funding source

Study was self-funded in its entirety.

Author contributions

AA: Participated in research design, performance of the research, data analysis, writing of the manuscript, and final review and editing of the manuscript for publication;

MP: Participated in data analysis, writing of the manuscript, research design, writing of the manuscript, and final review and editing of the manuscript for publication.

Data availability

The datasets generated during and/or analyzed during the current study are not publicly available, but are available from the corresponding author on reasonable request.

References

[1] Finney RP. Experience with new double J ureteral catheter stent. J Urol 1978; 120(6):678-681.

[2] Sali GM, Joshi HB. Ureteric stents: Overview of current clinical applications and economic implications. Int J Urol 2020; 27(1):7-15.

[3] Hadaschik BA, Paterson RF, Fazli L, Clinkscales KW, Shalaby SW, Chew BH. Investigation of a novel degradable ureteral stent in a porcine model. J Urol 2008; 180(3):1161-1166.

[4] Goddard JC. Open prostatectomy. Urol NEWS 2012; 16(6).

[5] Chee SP, Chan NS. Suture snare technique for scleral fixation of intraocular lenses and capsular tension devices. Br J Ophthalmol 2018; 102(10):1317-1319.

[6] Adam A, Sookram J, Bhattu AS, Wadee R, Perera M, Lawrentschuk N. Trans-urethral snare of bladder tumor (TUSnBT) with stone basket retrieval: A novel time-saving technique in the endoscopic management of papillary bladder lesions. Curr Urol 2018; 11(4):189-195.

[7] Adam A, Bhattu AS, Lawrentschuk N. Trans-urethral snare stent removal: A novel, self-constructed innovation for simultaneous ureteral stent removal and safety guidewire insertion. ANZ J Surg 2021; 91(4):571-577.

[8] Moher D, Liberati A, Tetzlaff J, Altman DG; PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. PLoS Med 2009; 6(7):e1000097.

[9] Wetton CW, Gedroyc WM. Retrograde radiological retrieval and replacement of double-J ureteric stents. Clin Radiol 1995; 50(8):562-565.

[10] Taylor WN, McDougall IT. Minimally invasive ureteral stent retrieval. J Urol 2002; 168(5):2020-2023.

[11] Park SW, Cha IH, Hong SJ, et al. Fluoroscopy-guided transurethral removal and exchange of ureteral stents in female patients: Technical notes. J Vasc Interv Radiol 2007; 18(2):251-256.

[12] López-Huertas HL, Polcari AJ, Hugen CM, Farooq AV, Turk TM. A novel technique for the removal of minimally encrusted ureteral stents. J Endourol 2010; 24(1):9-11.

[13] Söylemez H, Sancaktutar AA, Bozkurt Y, Atar M, Penbegül N, Yildirim K. A cheap minimally painful and widely usable alternative for retrieving ureteral stents. Urol Int 2011; 87(2):199-204.

[14] Kawahara T, Ito H, Terao H, et al. Ureteral stent retrieval using the crochet hook technique in females. PLoS One 2012; 7(1):e29292.

[15] Kawahara T, Ito H, Terao H, et al. Ureteral stent exchange under fluoroscopic guidance using the crochet hook technique in women. Urol Int 2012; 88(3):322-325.

[16] Mistry K, Pal P, Chitale S. A simple two-stage “bailout” technique for the removal of an unyielding ureteric stent. Urology 2013; 82(1):242-244.

[17] Wang J, Feng J, Hu W, et al. Preclinical evaluation of a newly designed ureteral stent and magnetic retrieval catheter for minimally invasive stent removal. Urology 2014; 84(4):960-966.

[18] Kajbafzadeh AM, Nabavizadeh B, Keihani S, Hosseini Sharifi SH. Revisiting the tethered ureteral stents in children: A novel modification. Int Urol Nephrol 2015; 47(6):881-885.

[19] Lin H, Xu M, Jiang D, et al. Non-cystoscopic removal of retained ureteral stents with mild sedation in children. Urology 2016;94:255-258.

[20] Rassweiler MC, Michel MS, Ritter M, Honeck P. Magnetic ureteral stent removal without cystoscopy: A randomized controlled trial. J Endourol 2017; 31(8):762-766.

[21] Shao H, Liu P, Zhang H, Chen C, Lin X. Noncystoscopic removal of retained ureteral stents in children: A retrospective study from a single-center. Medicine (Baltimore) 2018; 97(1):e9540.

[22] Jing T, Zhang C, Jiang L. A novel retrieval technique for ureteral stents under ultrasound guidance in male patients. Urology 2017;106:226-230.

[23] Sundaramurthy S, Joseph Thomas R, Herle K, Jeyaseelan, Mathai J, Jacob Kurian J. Double J stent removal in paediatric patients by Vellore Catheter Snare technique: A randomised control trial. J Pediatr Urol 2019; 15(6):661.e1-661.e8.

[24] Adam A, Lawrentschuk N, Bhattu AS, Nagdee J. Efficacy of the novel, innovative, single-use grasper integrated flexible cystoscope for ureteral stent removal: A systematic review. ANZ J Surg 2021; 91(12):2599-2605.

[25] Childers CP, Maggard-Gibbons M. Understanding costs of care in the operating room. JAMA Surg 2018; 153(4):e176233.

[26] Oliver R, Wells H, Traxer O, et al. Ureteric stents on extraction strings: A systematic review of literature. Urolithiasis 2018; 46(2):129-136.

[27] Nagele U, Praetorius M, Schilling D, Stenzl A, Anastasiadis AG. Comparison of flexible grasping forceps and stone basket for removal of retracted ureteral stents. J Endourol 2006; 20(6):418-422.

[28] Murthi GV, Cuckow P. Cystoscopic removal of a JJ stent using a suture ‘lasso’. BJU Int 2005; 96(3):439.

[29] Patki P. Cystoscopic removal of a JJ stent using a suture ‘lasso’. BJU Int 2006; 97(2):414.

[30] Hutton KA, Sau I. Cystoscopic removal of a JJ stent using a suture 'lasso'. BJU Int 2005; 96(9):1424.