Letters to the Editor Re: Torricelli et al.: Flexible Ureteroscopy with a Ureteral Access Sheath: When to Stent? (Urology 2014;83:278-81)
of ureteral orifice? A multi-institutional randomized controlled study. World J Urol. 2011;29:731-736.
Reply by the Authors TO THE EDITOR:
TO THE EDITOR:
Though controversial, stents have often been used to prevent complications after ureteroscopy. Most ureteroscopic lithotripsy procedures are uncomplicated, in that they cause no ureteral injury and leave minimal or no residual stones, and thus, the routine use of ureteral stents is considered unnecessary.1 However, this issue is not well defined after flexible ureteroscopic procedures. This retrospective clinical study has shown that postoperative stenting after flexible ureteroscopy (URS) with a ureteral access sheath seems to decrease postoperative pain.2 It was concluded in this study that prestented patients and postoperatively stented patients had lower pain scores compared with the nonstented patients. In addition, unplanned postprocedural visits due to pain in 45 days were higher in nonstented patients; however, all stents were removed in 3-7 days postoperatively. The reason for unplanned postprocedural visits seems to be not related to stenting vs nonstenting. Ureteral stricture formation and also late complications were not assessed in this study. In a recent prospective, randomized, clinical study, irritative symptoms including hematuria were significantly more common in the stented group, whereas pain, infectious complications, unplanned visits, and urethral stricture were similar for both groups with a follow-up time up of 1 year after URS.3 To clarify this controversial issue (stenting after URS), further large, prospective, randomized, clinical studies are warranted. Mustafa Sofikerim, M.D. Department of Urology School of Medicine Acıbadem University _ Istanbul, Turkey
We appreciate the comments submitted. We agree that long-term follow-up is required to confirm that a nonstenting approach does not lead to a higher rate of ureteral stricture. However, as our conclusion is that a ureteral stent “should” be placed if a ureteral access sheath is used, we do not feel a longer follow-up is necessary to support this conclusion. With reference to the statement, “The reason for unplanned encounters seem to be not related with stenting vs nonstenting,” we respectfully disagree; unstented patients had more unplanned encounters for pain (26% vs 4%). The manuscript referenced in the letter1 pertains to rigid ureteroscopy with a 9.8F ureteroscope; indeed a very different situation than that addressed in our manuscript. Although other similar articles have supported the “selective stenting” approach for uncomplicated ureteroscopy, we reaffirm our conclusion that if a ureteral access sheath is used, a ureteral stent should be placed. Manoj Monga, M.D. Stevan Streem Center for Endourology and Stone Disease Glickman Urological and Kidney Institute Department of Urology Cleveland Clinic Cleveland, OH Reference 1. Bas¸eskioglu B, Sofikerim M, Demirtas¸ A, et al. Is ureteral stenting really necessary after ureteroscopic lithotripsy with balloon dilatation of ureteral orifice? A multi-institutional randomized controlled study. World J Urol. 2011;29:731-736.
Re: Yang et al.: Two-stage Repair With Long Channel Technique for Primary Severe Hypospadias (Urology 2014;84:198-201)
References
TO THE EDITOR:
1. Rane A, Cahill D, Larner T, et al. To stent or not to stent? That is still the question. J Endourol. 2000;14:479-483. 2. Torricelli FC, De S, Hinck B, et al. Flexible ureteroscopy with a ureteral access sheath: when to stent? Urology. 2014;83:278-281. 3. Bas¸eskioglu B, Sofikerim M, Demirtas¸ A, et al. Is ureteral stenting really necessary after ureteroscopic lithotripsy with balloon dilatation
We have read with interest the article by Yang et al about their long channel technique for the repair of proximal hypospadias.1 It describes a new technique and reports an admirably low incidence of early postoperative complications. The main supposed advantage is that the suture
ª 2014 Elsevier Inc. All Rights Reserved
0090-4295/14
985
of ureteral orifice? A multi-institutional randomized controlled study. World J Urol. 2011;29:731-736.
Reply by the Authors TO THE EDITOR:
TO THE EDITOR:
Though controversial, stents have often been used to prevent complications after ureteroscopy. Most ureteroscopic lithotripsy procedures are uncomplicated, in that they cause no ureteral injury and leave minimal or no residual stones, and thus, the routine use of ureteral stents is considered unnecessary.1 However, this issue is not well defined after flexible ureteroscopic procedures. This retrospective clinical study has shown that postoperative stenting after flexible ureteroscopy (URS) with a ureteral access sheath seems to decrease postoperative pain.2 It was concluded in this study that prestented patients and postoperatively stented patients had lower pain scores compared with the nonstented patients. In addition, unplanned postprocedural visits due to pain in 45 days were higher in nonstented patients; however, all stents were removed in 3-7 days postoperatively. The reason for unplanned postprocedural visits seems to be not related to stenting vs nonstenting. Ureteral stricture formation and also late complications were not assessed in this study. In a recent prospective, randomized, clinical study, irritative symptoms including hematuria were significantly more common in the stented group, whereas pain, infectious complications, unplanned visits, and urethral stricture were similar for both groups with a follow-up time up of 1 year after URS.3 To clarify this controversial issue (stenting after URS), further large, prospective, randomized, clinical studies are warranted. Mustafa Sofikerim, M.D. Department of Urology School of Medicine Acıbadem University _ Istanbul, Turkey
We appreciate the comments submitted. We agree that long-term follow-up is required to confirm that a nonstenting approach does not lead to a higher rate of ureteral stricture. However, as our conclusion is that a ureteral stent “should” be placed if a ureteral access sheath is used, we do not feel a longer follow-up is necessary to support this conclusion. With reference to the statement, “The reason for unplanned encounters seem to be not related with stenting vs nonstenting,” we respectfully disagree; unstented patients had more unplanned encounters for pain (26% vs 4%). The manuscript referenced in the letter1 pertains to rigid ureteroscopy with a 9.8F ureteroscope; indeed a very different situation than that addressed in our manuscript. Although other similar articles have supported the “selective stenting” approach for uncomplicated ureteroscopy, we reaffirm our conclusion that if a ureteral access sheath is used, a ureteral stent should be placed. Manoj Monga, M.D. Stevan Streem Center for Endourology and Stone Disease Glickman Urological and Kidney Institute Department of Urology Cleveland Clinic Cleveland, OH Reference 1. Bas¸eskioglu B, Sofikerim M, Demirtas¸ A, et al. Is ureteral stenting really necessary after ureteroscopic lithotripsy with balloon dilatation of ureteral orifice? A multi-institutional randomized controlled study. World J Urol. 2011;29:731-736.
Re: Yang et al.: Two-stage Repair With Long Channel Technique for Primary Severe Hypospadias (Urology 2014;84:198-201)
References
TO THE EDITOR:
1. Rane A, Cahill D, Larner T, et al. To stent or not to stent? That is still the question. J Endourol. 2000;14:479-483. 2. Torricelli FC, De S, Hinck B, et al. Flexible ureteroscopy with a ureteral access sheath: when to stent? Urology. 2014;83:278-281. 3. Bas¸eskioglu B, Sofikerim M, Demirtas¸ A, et al. Is ureteral stenting really necessary after ureteroscopic lithotripsy with balloon dilatation
We have read with interest the article by Yang et al about their long channel technique for the repair of proximal hypospadias.1 It describes a new technique and reports an admirably low incidence of early postoperative complications. The main supposed advantage is that the suture
ª 2014 Elsevier Inc. All Rights Reserved
0090-4295/14
985
