Introduction: Double J ureteral stents are being used in urological practice for more than 25 years and in the recent years indications have continued to expand. Thus the complications and side effects of ureteral stents are also more frequent than previously reported. In addition to the severe complications resulting from forgotten or intentionally left stents for longer durations in ureters, they might also cause physical and emotional side effects due to bothering symptoms. The majority of the uncomfortable symptoms are related to urinary tract and these symptoms have severe negative impact on patients' general health status and quality of life. In this study, we evaluated the symptoms bothering the patient and impairing the quality of life due to stents.
Materials and Methods: One hundred and twenty eight men and 79 women who were treated with ureteral double J stents were recruited. The patients were followed with a questionnaire consisting of 14 questions concerning urgency, incontinence, painful voiding, incomplete emptying, urethral pain, hematuria, sleep disturbance, need for analgesics, overall weakness, social life enjoyment, sexual dysfunction, getting permission from work/school, urinary tract infection and the need for extra antibiotics at 1 and 4 weeks after stent insertion and 1 week after stent removal. In addition to the presence or absence of a symptom, the frequency of the symptom, when it is present, was also asked based on a subjective classification [occasionally (25%), sometimes (50%), most of the time (75%), all of the time (100%)]. The symptoms of each period are compared by statistical analysis.
Results: The mean age was 40.1 (range: 8-80) years. The indications for double J insertion were nephro-ureterolithiasis (n: 184), pregnancy related hydronephrosis (n: 8), malignancy (n: 7), ureteropelvic junction obstruction (n: 5), ureterovesical junction obstruction (n: 2), perforation (n: 1). There was no history of previous double J stent insertion in any patient. Double J stents were inserted to the right, left and both ureters in 92, 100 and 15 patients respectively. All double J stents used in the study were made up of polyethylene and except for 4 patients' stents with 6F diameter and 26 cm length were inserted. In the 4 pediatric patients 4.8 F diameter and 16 cm length double J stents were used. There was no change in the social life enjoyment with stent placement or removal. All other symptoms increased with the increased duration of the stent and decreased with the removal. The most significant two symptoms at the post insertion one week were painful voiding (43%) and urgency (41%) resulting from irritation of the stent. Also these two symptoms were significantly high (73%) at the fourth week.
Conclusion: The results of our study indicates that ureteral stents have negative impact on general health status, sexual functions, school/work performance and quality of life in addition to the increased urinary tract related symptoms, and these negative effects increase with the duration of the stent. Therefore, the indications and durations of the ureteral stents must be revisited in the light of the quality of life, and unnecessary insertions and longer durations should be avoided.