Authors (including presenting author) :
Ching LSJ(1), Chan NH(2), Cheung MH(2), So HS(3), Lam WC(3), Leung KK (3), Kan WS (2), Lam MK (3), Chan OY (2), Yau KC (3)
Affiliation :
(1) Nursing Service Divison (2) Division of Urology, Department of Surgery, Tseung Kwan O Hospital (3) Division of Urology, Department of Surgery, United Christian Hospital
Introduction :
Temporary double J ureteral stent placement is a common management after upper urinary tract stone surgery to prevent ureteral obstruction. The stent will be removed in 1-4 weeks after surgery. The removal of conventional double J ureteral stent requires a cystoscopic procedure may or may not together with local anaesthesia. On institutional aspect, the cost of stent removal by flexible cystocopy is higher, requiring an endoscopy session, with 1 doctor and 2 nursing staff, as well as cystoscope disinfection reprocessing. A magnetic tipped ureteral stent was introduced to Kowloon East Cluster (KEC) hospitals in 2019. The main body of the stent is polyurethane, which is similar to conventional ureteral stents common in market, the distal tip of the stent and retrieval device are attached with a magnet. The magnetic stent is inserted by cystoscopy in operation theatre after upper tract endourological surgery. When removal, magnetic retrieval device is inserted via urethra. The two magnets will then couple inside the bladder and stent can be removed. Urology nurse clinic of Tseung Kwan O Hospital and United Christian Hospital has been one of the pioneers in Hong Kong to perform the removal of magnetic ureteral stent.
Objectives :
This review aims to report the experience with this method, with focus on peri-procedural outcomes, and cost savings.
Methodology :
A retrospective review was performed of all patients who underwent magnetic double J stent insertion and subsequent removal in urology nurse clinic (UNC) at Tseung Kwan O hospital (TKOH) and United Christian Hospital (UCH) from 1st Aug 2019 to 31st Dec 2022. All indications for stent insertion were included. No patients were excluded or lost to follow up. Data collected included: patient demographics, duration of indwelling stent and incidence of complications.
Result & Outcome :
From Aug 2019 to Dec 2022, there were 120 patients with magnetic ureteral stent placement. 97 patients had magnetic double J stent removal in TKOH UNC whereas 23 patients in UCH UNC. 49 were female patients whereas 71 were male patients. The age range was 22 to 85, mean age 60. 119 cases were place unilateral, 77 on left side, 42 on right and 1 bilateral. The duration of ureteral stent in-situ was 5– 33 days, mean 21 days. For these 120 patients, 117 stents were removed by urology nurse, 113 were removed smoothly on single attempt, 4 of them with more than one attempt of removal. 3 failed and required removal by urologist, in which 1 was removed with magnetic retrieval device under ultrasound guidance and 2 required another session of cystoscopic removal due to stent migration into ureter. After removal of magnetic ureteral stent, 44 patients had transient light haematuria after stent removal. No other post-removal complication found after 1 week. The success rate of magnetic stent removal in UNC was 97.5% in our cohort. The overall cost of procedure is also reduced.
