Challenges around Double-J stent removal

Although stents are commonly used at the urologist’s preference and as a safety net for clinical cases, the dwell time should be kept to a minimum to reduce stent side-effects and related complications. The stent removal should be expedited and ideally be done in the outpatient clinic. One such device which can help to remove the stent is the Isiris^® α single-use dedicated flexible cystoscope with an in-built stent removal grasper. It allows for prompt removal of the ureteral stent without a dedicated assistant.

According to our experience*, Isiris α significantly reduces stent dwell time from 27 to 15 days, procedural time from 14 to 2 minutes, staffing and cost associated with it. On one hand, it allows the stent removal to be done in an outpatient setting. This allows avoiding agenda pressure of the operating theatre or endoscopy room on stent removals, thus managing short dwell times as expected. On the other hand, this also indirectly reduces the organizational pressure in operating theatre and endoscopy rooms and decreases the cost of the procedure. As a single use scope, there is no cost related to re-processing of a reusable scope or graspers, and no cross-infection risk. This is especially useful in patients with renal transplant who need stent removal after their transplant surgery.

As a result of using the Isiris α system, more endoscopy slots and operating theatre slots can be created which can help deal with other diagnostic and therapeutic urological procedures. This gives us more capacity for the diagnostic cystoscopy time which is needed for cancer diagnostics and follow-up. Knowing that prolonged dwell times may be associated with more UTIs and encrustation risk, and that early stent removal leads to fewer emergency and hospital admissions, the capability of Isiris α scope system to allow shorter dwell times is very welcome.

Stent removal is usually done as an isolated procedure when performed using a reusable scope as it requires a camera-stack system. In our experience with use of Isiris α in an outpatient clinic setting, there is no need for this set-up, and the immediate post-operative follow-up can also be done at the same session, thereby saving time and cost to both the patient and the organization.

The clinical experience of using Isiris α has also been rated favourably with an overall satisfaction as ‘good or very good’ by 90-92% of urologists*. Isiris α stent removal system was shown in our unit to have multitude of benefits, and previous scientific evidence confirms these findings. These relate to patient benefits by reducing stent dwell time, which is expected to increase their quality of life, reduce their visits to the hospital for side-effects or complications, and having the follow-up at the same time as their stent removal is convenient*. The hospital and organizational benefits relate to better use of resources such as operating theatre and endoscopy rooms, which decreases the waiting times of other diagnostic and therapeutic procedures, reduces cost of stent removal and readmissions from complications related to prolonged stent dwell time.

Although stent usage should be minimised, the use of Isiris α seems to be helpful in patients who have a stent inserted, and this would be beneficial to surgeons and patients alike.

*Pietropaolo A, Hughes T, Tear L, Somani BK. Comparison of ureteric stent removal procedures using reusable and single-use flexible cystoscopes following ureteroscopy and lasertripsy: A micro costing analysis. Cent European J Urol. 2020; doi: 10.5173/ceju.2020.0159