Symptom and cost evaluation of ureteric stent extraction using strings versus flexible cystoscopy at a single high-volume centre

Abstract

Background:

This study evaluated ureteric stent symptoms using a modified ureteric stent symptom questionnaire (USSQ) for patients undergoing stent removal by either flexible cystoscopy, or manual, healthcare worker lead string extraction.

Methods:

Patients completed a stent symptom questionnaire derived from the USSQ. Mean data were compared between groups using paired Student’s t-tests. Data are presented as mean ± SD with associated p-values. A departmental cost analysis was undertaken.

Results:

Ninety patients completed questionnaires, 30 undergoing flexible cystoscopy and 60 string extraction. Six stents with strings were removed early (days 1–5, 6.67%, four female and two male). There were no adverse events recorded for this group. Men undergoing string extraction had significantly less pain (2.47 ± 1.88) compared to men undergoing flexible cystoscopic removal (5.67 ± 2.27, p < 0.001). There was no significant difference in pain scores for women undergoing string and flexible cystoscopic stent removal (3.56 ± 2.56 versus 3.66 ± 3.14, p > 0.90). The mean duration of stents left in situ was significantly less in the string group (10.1 ± 5.3 versus 26.5 ± 14.1 days, p < 0.001). Urinary tract infection rates did not differ between the string and the cystoscopy groups (3.7% ± 0.19 versus 2.78% ± 0.46, p > 0.90). The haematuria rates were 32.14% ± 0.47 and 66.67% ± 0.5, respectively (p < 0.001). In our study, 60 flexible cystoscopies were avoided, saving over £67,000 at the institution within our study period.

Conclusions:

In our small study, stents removed with strings reduced pain scores in men, the duration of an indwelling ureteric stent, and cost to the health service.

Level of evidence:

2b