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Open Access 01-12-2016 | Research article

Developing a preoperative predictive model for ureteral length for ureteral stent insertion

Authors: Takashi Kawahara, Kentaro Sakamaki, Hiroki Ito, Shinnosuke Kuroda, Hideyuki Terao, Kazuhide Makiyama, Hiroji Uemura, Masahiro Yao, Hiroshi Miyamoto, Junichi Matsuzaki

Published in: BMC Urology | Issue 1/2016

Abstract

Background

Ureteral stenting has been a fundamental part of various urological procedures. Selecting a ureteral stent of optimal length is important for decreasing the incidence of stent migration and complications. The aim of the present study was to develop and internally validate a model for predicting the ureteral length for ureteral stent insertion.

Methods

This study included a total of 127 patients whose ureters had previously been assessed by both intravenous urography (IVU) and CT scan. The actual ureteral length was determined by direct measurement using a 5-Fr ureteral catheter. Multiple linear regression analysis with backward selection was used to model the relationship between the factors analyzed and actual ureteral length. Bootstrapping was used to internally validate the predictive model.

Results

Patients all of whom had stone disease included 76 men (59.8%) and 51 women (40.2%), with the median and mean (± SD) ages of 60 and 58.7 (±14.2) years. In these patients, 53 (41.7%) right and 74 (58.3%) left ureters were analyzed. The median and mean (± SD) actual ureteral lengths were 24.0 and 23.3 (±2.0) cm, respectively. Using the bootstrap methods for internal validation, the correlation coefficient (R2) was 0.57 ± 0.07.

Conclusion

We have developed a predictive model, for the first time, which predicts ureteral length using the following five preoperative characteristics: age, side, sex, IVU measurement, and CT calculation. This predictive model can be used to reliably predict ureteral length based on clinical and radiological factors and may thus be a useful tool to help determining the optimal length of ureteral stent.

Zimskind PD, Fetter TR, Wilkerson JL. Clinical use of long-term indwelling silicone rubber ureteral splints inserted cystoscopically. J Urol. 1967;97(5):840–4.PubMed

Borboroglu PG, Kane CJ. Current management of severely encrusted ureteral stents with a large associated stone burden. J Urol. 2000;164(3 Pt 1):648–50.CrossRefPubMed

Ho CH, Huang KH, Chen SC, Pu YS, Liu SP, Yu HJ. Choosing the ideal length of a double-pigtail ureteral stent according to body height: study based on a Chinese population. Urol Int. 2009;83(1):70–4. doi:10.1159/000224872.CrossRefPubMed

Joshi HB, Stainthorpe A, MacDonagh RP, Keeley Jr FX, Timoney AG, Barry MJ. Indwelling ureteral stents: evaluation of symptoms, quality of life and utility. J Urol. 2003;169(3):1065–9. doi:10.1097/01.ju.0000048980.33855.90. discussion 1069.CrossRefPubMed

Pollard SG, Macfarlane R. Symptoms arising from Double-J ureteral stents. J Urol. 1988;139(1):37–8.PubMed

Kawahara T, Ito H, Terao H, Yoshida M, Matsuzaki J. Ureteral Stent Encrustation, Incrustation, and Coloring: Morbidity Related to Indwelling Times. J Endourol. 2011. doi:10.1089/end.2011.0385.PubMed

Kawahara T, Ishida H, Kubota Y, Matsuzaki J. Ureteroscopic removal of forgotten ureteral stent. BMJ case reports. 2012. doi:10.1136/bcr.02.2012.5736.

Kawahara T, Ito H, Terao H, Yamagishi T, Ogawa T, Uemura H, Kubota Y, Matsuzaki J. Ureteral stent retrieval using the crochet hook technique in females. PLoS One. 2012;7(1), e29292. doi:10.1371/journal.pone.0029292.CrossRefPubMedPubMedCentral

Kawahara T, Ito H, Terao H, Yamashita Y, Tanaka K, Ogawa T, Uemura H, Kubota Y, Matsuzaki J. Ureteral stent exchange under fluoroscopic guidance using the crochet hook technique in women. Urol Int. 2012;88(3):322–5. doi:10.1159/000336870.CrossRefPubMed

10.

Slaton JW, Kropp KA. Proximal ureteral stent migration: an avoidable complication? J Urol. 1996;155(1):58–61.CrossRefPubMed

11.

Breau RH, Norman RW. Optimal prevention and management of proximal ureteral stent migration and remigration. J Urol. 2001;166(3):890–3.CrossRefPubMed

12.

Wills MI, Gilbert HW, Chadwick DJ, Harrison SC. Which ureteric stent length? Br J Urol. 1991;68(4):440.CrossRefPubMed

13.

Pocock RD, Stower MJ, Ferro MA, Smith PJ, Gingell JC. Double J stents. A review of 100 patients. Br J Urol. 1986;58(6):629–33.CrossRefPubMed

14.

Chin JL, Denstedt JD. Retrieval of proximally migrated ureteral stents. J Urol. 1992;148(4):1205–6.PubMed

15.

Kawahara T, Ito H, Terao H, Yoshida M, Ogawa T, Uemura H, Kubota Y, Matsuzaki J. Choosing an appropriate length of loop type ureteral stent using direct ureteral length measurement. Urol Int. 2012;88(1):48–53. doi:10.1159/000332431.CrossRefPubMed

16.

Pilcher JM, Patel U. Choosing the correct length of ureteric stent: a formula based on the patient’s height compared with direct ureteric measurement. Clin Radiol. 2002;57(1):59–62. doi:10.1053/crad.2001.0737.CrossRefPubMed

17.

Kawahara T, Ito H, Terao H, Yoshida M, Ogawa T, Uemura H, Kubota Y, Matsuzaki J. Which is the best method to estimate the actual ureteral length in patients undergoing ureteral stent placement? Int J Urol. 2012;19(7):634–8. doi:10.1111/j.1442-2042.2012.02998.x.CrossRefPubMed

18.

Kawahara T, Ito H, Terao H, Ogawa T, Uemura H, Kubota Y, Matsuzaki J. Changing to a loop-type ureteral stent decreases patients’ stent-related symptoms. Urol Res. 2012;40(6):763–7. doi:10.1007/s00240-012-0500-4.CrossRefPubMed

19.

Paick SH, Park HK, Byun SS, Oh SJ, Kim HH. Direct ureteric length measurement from intravenous pyelography: does height represent ureteric length? Urol Res. 2005;33(3):199–202. doi:10.1007/s00240-004-0461-3.CrossRefPubMed

20.

Lee BK, Paick SH, Park HK, Kim HG, Lho YS. Is a 22 cm Ureteric Stent Appropriate for Korean Patients Smaller than 175 cm in Height? Korean J Urol. 2010;51(9):642–6. doi:10.4111/kju.2010.51.9.642.CrossRefPubMedPubMedCentral

21.

Shah J, Kulkarni RP. Height does not predict ureteric length. Clin Radiol. 2005;60(7):812–4. doi:10.1016/j.crad.2004.08.018.CrossRefPubMed

22.

Hruby GW, Ames CD, Yan Y, Monga M, Landman J. Correlation of ureteric length with anthropometric variables of surface body habitus. BJU Int. 2007;99(5):1119–22. doi:10.1111/j.1464-410X.2007.06757.x.CrossRefPubMed

Title: Developing a preoperative predictive model for ureteral length for ureteral stent insertion
Authors: Takashi Kawahara
Kentaro Sakamaki
Hiroki Ito
Shinnosuke Kuroda
Hideyuki Terao
Kazuhide Makiyama
Hiroji Uemura
Masahiro Yao
Hiroshi Miyamoto
Junichi Matsuzaki
Publication date: 01-12-2016
Publisher: BioMed Central
Published in: BMC Urology / Issue 1/2016
Electronic ISSN: 1471-2490
DOI: https://doi.org/10.1186/s12894-016-0189-8

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Developing a preoperative predictive model for ureteral length for ureteral stent insertion

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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