USE OF JJ STENT IN URETERSOCOPIC LITHOTRIPSY IN PATIENTS WITH URETERAL STONE: IS IT NECESSARY AND COST-EFFECTIVE?

Retrospective studies have shown that using JJ stent after uretheroscopy and lithotripsy is not necessary. At present, urethral JJ stent insertion after uretheroscopic lithotripsy is recommended by some surgeons in order to prevent urethral stricture and urethral colics. They believe that this method decreases the chances of urethral colic, urethral edema and secondary stricture. The aim of this study was, therefore to evaluate the indications for using JJ stent after lithotripsy and uretheroscopy. For this purpose, this randomized controlled trial was carried out in 1998- 2002. Two hundred and ten patients (150 males and 60 females) with mean age of 39 (ranged from 25 to 60 years) were included in this study. The criteria for selection were the size of stone and it’s location, which were determined with sonography by an expert sonographist and had a 2-week period of pain and mild hydronephrosis Patients with positive history of previous uretheroscopy or coaggulopathy were excluded from this study. All routine laboratory tests were carried out. Urine culture was normal. Ceftriaxone (1g IV) was injected in all patients 30 minutes before surgery. After successful surgery, patients were divided into two groups. JJ stent (4.8 F) was used for 30 patients. Pethidine was used when patients had severe pain. Belladona-PB was prescribed for all patients at the time of hospital discharge. Student’s T-test was used for data analysis. The results showed that the maximum and minimum size of the stones were 10mm and 7mm respectively. In 108 cases, stone was located in the left side and in 102 cases in the right side. Stone was located below the uretheropelvic junction in all cases. In 60% of cases, stone was detected below the sacroiliac joint. Size and location of the stones in both groups were same. Duration of the surgery for control and case group were 23.92±3.64 and 27±3.68 minutes respectively. Bladder irritative symptoms were 13.33% and 2.17% in case and control groups respectively. Pethidine (50mg) was injected to 15 patients in the case group (8.33%) and 2 patients in the control group (6.6%). The findings from this study suggest that the use of JJ stent not only increases the economic burden on these patients, but also it carries greater risk of bladder irritation symptoms. Furthermore, it is not recommended in patients who undergo intracorporeal lithotripsy and who do not show any complications.