Indications and early complications of double – J ureteric stents as seen at Kenyatta national hospital.

Abstract

INTRODUCTION: Double - J ureteric stents have been in use in urological practice to facilitate drainage of urine to the bladder since the 1960s. The benefits of DJ ureteric stents in individual patients are clear, but indwelling stents still have problems to the patients while being placed, while in situ and subsequently during their removal. Early DJ ureteric stenting complications include urinary tract infections, fevers, hematuria, ureteric stent migration, irritative urinary symptoms loin and suprapubic discomfort to name just but a few. STUDY OBJECTIVES: The study objectives were to establish the indications, early complications, and factors associated with development of early complications of DJ ureteric stents as seen in Kenyatta National Hospital. METHODOLOGY Study design: This was a hospital based prospective cohort study among patients undergoing DJ ureteric stenting in Kenyatta National Hospital. Study setting: The study was carried out at Kenyatta National Hospital department of surgery (both adults and pediatrics), department of obstetrics & gynaecology, department of microbiology and department of radiology Study Population; This involved all patients in Kenyatta National Hospital undergoing DJ ureteric stenting, who consented for the study or whose parents/guardians consented for the study having met the inclusion criteria. Materials and Method: Categorical and Non-Categorical data from 32 patients was collected clinically, from laboratory and radiology departments by use of pre-prepared and a pre-tested data collection tool. Patients were followed for six weeks post DJ ureteric stenting and reviewed and evaluated every two weeks in order to establish any early complication. Data analysis: Data was entered and managed in Microsoft Excel spread-sheet. The captured raw data was entered into a password protected database, and correlated with hard copies of the same to ensure accuracy. Data entry and analysis was done using SPSS version 23.0,Chicago Illinois. Upon completion of entry, the hard copy forms were used to clean and verify correctness of the entered data and then stored safely in the lockable cabinet. RESULTS: The major indications for ureteric stenting in Kenyatta National Hospital were adjunct to surgery – secondary to renal calculi and in PUJO at 21.9%. The early complications of DJ ureteric stenting were minimally evident as all our patients; 100%, got grade-1Clavien-Dindo complication. Univariate and multivariate data analysis with calculation of p-value to establish the factor(s) associated with early complication was not done for all our patients developed complications. SIGNIFICANCE OF THE STUDY: The study will be useful to the urologist locally, regionally and internationally on what to expect in terms of early complications of DJ ureteric stents and will enable better characterization of DJ ureteric stenting morbidity associated with various DJ stents designs and biomaterials, give an idea of the possible factors associated with early complications of DJ ureteric stenting and how to overcome them. The study will also allow comparison of various different surgical techniques (stenting methods), which is very vital due to the relative lack of randomized trials in the urological armamentarium of literature.