Magnetic double-J stent: Evaluation of tolerance and impact on quality of life compared to traditional double-J stent | Actas Urológicas Españolas (English Edition)

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RP, radical prostatectomy; IQR, interquartile range; BRFS, biochemical recurrence free survival." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "E. Polo Alonso, M. Ramírez-Backhaus, G. Wei, J.M. Mascarós, F. Aragón Rodriguez, Á. Gómez-Ferrer, A. Collado, A. Calatrava Fons, J. Rubio-Briones" "autores" => array:9 [ 0 => array:2 [ "nombre" => "E." "apellidos" => "Polo Alonso" ] 1 => array:2 [ "nombre" => "M." "apellidos" => "Ramírez-Backhaus" ] 2 => array:2 [ "nombre" => "G." "apellidos" => "Wei" ] 3 => array:2 [ "nombre" => "J.M." "apellidos" => "Mascarós" ] 4 => array:2 [ "nombre" => "F." "apellidos" => "Aragón Rodriguez" ] 5 => array:2 [ "nombre" => "Á." "apellidos" => "Gómez-Ferrer" ] 6 => array:2 [ "nombre" => "A." "apellidos" => "Collado" ] 7 => array:2 [ "nombre" => "A." "apellidos" => "Calatrava Fons" ] 8 => array:2 [ "nombre" => "J." 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A: Diagnostic role of platelet, neutrophil to lymphocyte rate (NLR), prostate specific antigen (PSA), PSA density, Prostate Imaging-Reporting and Data System (PI-RADS) score, systemic immune-inflammation index (SII) in detecting high-grade prostate cancer (ISUP 3, 4 and 5). B: Diagnostic role of SII combinations in detecting high-grade prostate cancer." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "G. Sonmez, T. Demirtas, S.T. Tombul, H. Akgun, A. Demirtas" "autores" => array:5 [ 0 => array:2 [ "nombre" => "G." "apellidos" => "Sonmez" ] 1 => array:2 [ "nombre" => "T." "apellidos" => "Demirtas" ] 2 => array:2 [ "nombre" => "S.T." "apellidos" => "Tombul" ] 3 => array:2 [ "nombre" => "H." "apellidos" => "Akgun" ] 4 => array:2 [ "nombre" => "A." "apellidos" => "Demirtas" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173578621000524?idApp=UINPBA00004N" "url" => "/21735786/0000004500000005/v1_202106020937/S2173578621000524/v1_202106020937/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "Original article" "titulo" => "Magnetic double-J stent: Evaluation of tolerance and impact on quality of life compared to traditional double-J stent" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "366" "paginaFinal" => "372" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "M. Diranzo-Garcia, P. Pardo-Duarte, A. Álvarez-Barrera, J.U. Juan-Escudero, M. Beltrán-Puig, A. Monzó-Cataluña, K. Rechi-Sierra, F. Sánchez-Ballester, J. Garcia-Ibáñez, E. López-Alcina" "autores" => array:10 [ 0 => array:4 [ "nombre" => "M." "apellidos" => "Diranzo-Garcia" "email" => array:1 [ 0 => "mdiranzo@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "P." "apellidos" => "Pardo-Duarte" ] 2 => array:2 [ "nombre" => "A." "apellidos" => "Álvarez-Barrera" ] 3 => array:2 [ "nombre" => "J.U." "apellidos" => "Juan-Escudero" ] 4 => array:2 [ "nombre" => "M." "apellidos" => "Beltrán-Puig" ] 5 => array:2 [ "nombre" => "A." "apellidos" => "Monzó-Cataluña" ] 6 => array:2 [ "nombre" => "K." "apellidos" => "Rechi-Sierra" ] 7 => array:2 [ "nombre" => "F." "apellidos" => "Sánchez-Ballester" ] 8 => array:2 [ "nombre" => "J." "apellidos" => "Garcia-Ibáñez" ] 9 => array:2 [ "nombre" => "E." "apellidos" => "López-Alcina" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Urología, Consorcio Hospital General Universitario de Valencia, Valencia, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Catéter doble J magnético: evaluación de la tolerancia e impacto en la calidad de vida en comparación con el catéter doble J tradicional" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 4007 "Ancho" => 3003 "Tamanyo" => 557676 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Summary of the domains assessed in the USSQ. USSQ: ureteral stent symptom questionnaire." ] ] ] "textoCompleto" => "IntroductionUpper urinary tract obstruction is a frequent cause in the urology consultation, and urinary diversion with double-J stent (DJ) placement is one of the most widely used procedures in routine practice.<a class="elsevierStyleCrossRef" href="#bib0005">1</a> There are several indications for ureteral stent placement; ureterorenoscopy (URS) for lithiasis is one of them. The purpose of stenting in the treatment of stone disease is to ensure correct upper urinary tract diversion and prevent ureteral obstruction by stone fragments or edema after surgery.<a class="elsevierStyleCrossRefs" href="#bib0005">1–4</a>Various studies have shown that ureteral stents can be detrimental to the quality of life of patients while they are DJ carriers.<a class="elsevierStyleCrossRefs" href="#bib0025">5–8</a> Among the side effects, pain, hematuria, lower urinary tract symptoms (LUTS) and increased number of urinary tract infections (UTIs), among others, have been described. In addition to the adverse effects of the use of ureteral stent, we must add the need for cystoscopy, which is an invasive procedure performed for its removal.<a class="elsevierStyleCrossRefs" href="#bib0045">9–12</a>For this reason, attempts have been made to develop the ideal DJ stent that allows removal without the need for cystoscopy.<a class="elsevierStyleCrossRefs" href="#bib0065">13–20</a> One example is the stent with a string which protrudes from the end of the urethra, when pulled on, the device is removed without the need for an endoscopy. This mechanism can be useful in those cases when the stent is expected to be removed in a few days, since a longer period of time with this type of diversion could increase the risk of UTI or early involuntary removal, in addition to negatively affecting quality of life, especially regarding the sexual sphere.<a class="elsevierStyleCrossRefs" href="#bib0065">13–17</a>Another type of device that allows extraction without endoscopy is based on the use of magnetic stents. In 1989, Macaluso et al. described the first stents with a magnetic tip, achieving satisfactory removal in 75% of men. However, due to their difficult insertion, they were not successful and their use did not become widespread.<a class="elsevierStyleCrossRef" href="#bib0090">18</a>The main objective of the present study is to compare the symptomatology and the impact on the quality of life of patients with two types of ureteral stents: a standard DJ stent vs. a magnetic DJ. In addition, as secondary objectives, the tolerance, the difficulty of the removal procedure and the complications derived from the use of both devices will be assessed.Material and methodsA comparative, prospective, randomized study was performed where 46 patients were consecutively included. All patients underwent URS for lithiasis with DJ stent placement between August 2019 and June 2020, at our center. All individuals included in the study had a negative urine culture performed one week prior to surgery. Patients with a history of double-J stent placement within the six months before surgery and those with diagnostic ureteroscopies for follow-up or suspected urothelial tumor, were excluded.The patients were divided into two groups of 23 participants. Group A had a standard Optimed® DJ stent (extra-soft polyurethane stent, 6 CH 26 cm) inserted, and group B had a Black Star® (BS) magnetic ureteral stent (polyurethane, 6 CH 26 cm of the Urotech® company) placed, which has a thread-anchored magnet at the pigtail-end on the bladder side (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). All patients had the stents removed in a period of less than four weeks. Before removal, a simple abdominal X-ray was performed to identify the stent’s location and to rule out the presence of calcification of the stent.<elsevierMultimedia ident="fig0005"></elsevierMultimedia>Stent removal in group A was performed in the urology exam room by flexible cystoscopy after application of anesthetic lubricating gel, and the procedure was performed by the same urologist with the assistance of a specialist nurse. In group B, the procedure was performed in the urology outpatient department during the first postoperative follow-up visit, by sterile bladder catheterization with a 15 Ch Tiemann magnetic tip stent, after application of anesthetic lubricating gel. The procedures were performed by the same urologist and did not require the nurse’s assistance. In all cases, the operative time was recorded.On the day of stent removal, patients in both groups previously completed the international ureteral stent symptom questionnaire (USSQ) validated in Spanish. It evaluates the symptoms and impact on quality of life related to stent use by assessing five sections: urinary symptoms, pain, general health, work performance and sexual matters (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).<elsevierMultimedia ident="fig0010"></elsevierMultimedia>Additionally, once the extraction had been performed, the patients scored from one to 10 the pain felt at the procedure using the visual analog scale (VAS).A second VAS with scores ranging from 1 to 10 (1 represented absence of difficulty and 10 represented extreme difficulty) was answered by the urologist to assess the perceived technical difficulty during the retrieval procedure in both groups.Finally, medical records were reviewed from the day of stent insertion until three weeks after removal to assess visits to the emergency room or primary care center for complications related to the ureteral stent and/or its removal.Data were collected and analyzed with SPSS version 20.0. The student's t-test was used to compare quantitative variables between the two study groups and the X2 test was employed to analyze the qualitative variables that met normality criteria. The nonparametric Mann Whitney U test was used in two of the variables analyzed in the USSQ questionnaire (work performance and sexual matters), since they did not meet the normality criteria. We considered a p-value of less than 0.05 to be statistically significant.ResultsBoth groups were homogeneous in terms of age, sex or stone location (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>The USSQ did not show statistically significant differences between the two groups in any of its sections: urinary symptoms (p = 0.618), body pain (p = 0.401), general health (p = 0.322), work performance (p = 0.359) and sexual matters (p = 0.890) (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>) (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).<elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia>The mean indwelling time was 20 (13–26) days in group A and 19 (13–24) days in group B (p = 0.192) (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>).<elsevierMultimedia ident="tbl0015"></elsevierMultimedia>The mean operative time for removal was 22.17 (13–33) minutes and 11.65 (7–25) minutes and in group A and group B, respectively. It was significantly shorter in patients using the BS stent (p < 0.001) (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>).We found statistically significant differences in terms of pain during stent removal, with less bother in group B VAS 1.52 (4 to 0) vs. group A VAS 4 (7 to 2) (p = 0.001) (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>). We found no significant differences between removal by performed by catheterization or cystoscopy on the VAS score when stratifying by sex (BS p = 0.163, Optimized p = 0.753).The VAS assessment of technical difficulty perceived by the urologist during the removal procedure showed a mean score of 3 (0–5) in group A, and a mean score of 1.61 (0–4) in group B, showing greater removal difficulty in the first group; this difference was statistically significant (p < 0.001) (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>).We performed a post hoc analysis to quantify the magnitude or effect size (ES) of the variables that had been found to be statistically significant, and we obtained the following results: mean time employed (ES = 2.20), removal VAS score (ES = 1.59), perceived technical difficulty scale (ES = 1.01).Regarding the rate of stent-related complications, we found no statistically significant differences between the two groups, neither with respect to the number of visits made to the primary care physician nor to the emergency room. In group A, two patients consulted for LUTS, one of them while the catheter was in situ and the other one after its removal. Only the second patient obtained a positive urine culture (UC) for a multisensitive Escherichia coli, which was treated with cefuroxime. As for group B, three subjects requested consultation: two due to LUTS and one for hematuria. Of the two patients consulting for LUTS, one was still carrying the stent and in the other patient, the stent had already been removed. The one who presented hematuria came to the emergency room two days after stent insertion, and it was a self-limited hematuria. None of the three cases obtained a positive UC.DiscussionUreteral stent placement is one of the most frequently performed procedures in urological practice.<a class="elsevierStyleCrossRef" href="#bib0005">1</a> Due to the symptoms derived from the devices and the need for invasive maneuvers for their removal, there is a growing interest in creating an ideal device to reduce the discomfort associated with the DJ, facilitate its removal and decrease the cost of endourological procedures.<a class="elsevierStyleCrossRefs" href="#bib0010">2–4</a>In 1989, Macaluso et al. presented the first model of magnetic stents. These were removed with the use of a device that had a complementary magnetic tip, which facilitated removal without the need for endoscopy. However, this initial prototype showed a high failure rate in removal.<a class="elsevierStyleCrossRef" href="#bib0090">18</a>Subsequently, Altarac et al. developed a DJ with a fixed magnetic tip. This stent was removed by connecting to another magnetic tip catheter after reaching the bladder by urethral catheterization. However, the lack of mobility of the magnetic end of the stent and the limited power of the magnets led to a high failure rate in the procedure, and its use was not popularized either.<a class="elsevierStyleCrossRef" href="#bib0095">19</a>Taylor et al. were the first to demonstrate the usefulness of the magnetic DJ stent as it is currently known. They performed a retrospective study including 30 patients, achieving satisfactory removal in 29 of them (97%), stating that it was a safe procedure, since cystoscopy could be used as a second option in the few cases in which the magnet failed.<a class="elsevierStyleCrossRef" href="#bib0100">20</a>In recent years, new magnetic devices have been developed that allow removal with simple bladder catheterization without errors during the procedure.<a class="elsevierStyleCrossRefs" href="#bib0090">18–20</a> The development of these new magnetic DJs allows the elimination of cystoscopy for stent removal without aggravating the expected adverse effects of standard DJs.In the same way as other series, our study confirms the presence of side effects that affect the quality of life related to standard DJ stents<a class="elsevierStyleCrossRefs" href="#bib0025">5–8</a> and magnetic ureteral stents.<a class="elsevierStyleCrossRefs" href="#bib0105">21–24</a> The symptoms and the impact on quality of life derived from the use of the device were assessed with the USSQ, without finding significant differences in any of its sections. These results agree with those obtained by O’Kelly et al., who also found no variations in any of the domains evaluated in the questionnaire.<a class="elsevierStyleCrossRef" href="#bib0105">21</a>In contrast, Farouk et al. do report statistically significant differences with higher scores in the BS stent group in terms of urinary symptoms, body pain and work performance.<a class="elsevierStyleCrossRef" href="#bib0110">22</a> In turn, in the study by Sevcenco et al., the patients carrying the BS stent exhibited greater “irritative” symptomatology in the indwelling period; in this case, they used a non-validated VAS for symptom assessment instead of the USSQ.<a class="elsevierStyleCrossRef" href="#bib0115">23</a>On the other hand, Rassweiler et al. found no differences regarding the presence of pain or LUTS. However, they described that the magnetic DJ stent was related to pain in the bladder area, in comparison with patients with traditional DJ who were more likely to present pain in the lumbar area. They attributed these variations to the distal magnetic tip.<a class="elsevierStyleCrossRef" href="#bib0120">24</a>The removal of a ureteral stent by flexible cystoscopy is a technique that, although well tolerated by most patients, is still uncomfortable or painful for many of them.<a class="elsevierStyleCrossRefs" href="#bib0045">9–12</a> When assessing the variable of pain on stent removal by means of VAS in our series, the score was significantly lower in patients with a BS stent. These results coincide with those obtained by Rassweiler et al., Sevcenco et al. and O’Kelly et al.<a class="elsevierStyleCrossRefs" href="#bib0105">21,23,24</a>. On the other hand, Farouk et al. found no significant differences between removal by magnetic tip catheter or cystoscopy. However, when stratifying patients by sex, they found that cystoscopy retrieval was less bothersome for the female sex.<a class="elsevierStyleCrossRef" href="#bib0110">22</a> In our case, we did not find any distinctions by sex.The time taken for removal as well as the difficulty of removal were lower in group B (BS stent carriers), with statistically significant differences. The ease of removal of magnetic DJ has been reported in other series.<a class="elsevierStyleCrossRefs" href="#bib0120">24,25</a>The successful removal rate with the BS was 98%. Only one patient required the performance of flexible cystoscopy for magnetic stent removal due to significant prostatic hypertrophy which did not allow the connection of the magnetic tip of the DJ to the catheter tip. These results are in line with those presented by Rassweiler et al., who observed a failure rate of 2%, and was unable to remove the magnetic stent by catheterization in one patient, due to a prostate with a large middle lobe.<a class="elsevierStyleCrossRef" href="#bib0120">24</a> Taylor et al. present similar results: in their case, they needed the cystoscope to remove the stent in one of their 30 patients due to a similar prostate condition.<a class="elsevierStyleCrossRef" href="#bib0100">20</a> On the other hand, Klingler et al. as well as Sevcenco et al., needed cystoscopy in one subject in whom the distal magnetic tip had calcified, making connection with the catheter impossible.<a class="elsevierStyleCrossRefs" href="#bib0115">23,26</a> In the first case, a slight calcification of the distal tip was also observed in two other patients, although they did not require cystoscopy since it allowed catheter connection. Coincidentally, the three patients who developed this complication presented UTI with positive UC. In our series, no one experienced calcification of the ureteral stent, probably for two reasons: first, because the indwelling time of the BS did not exceed four weeks in any case and, second, because we did not have any patient with positive UC during the indwelling period.When reviewing the complications in our series, five people visited the emergency room or the primary care physician for issues derived from the ureteral stent; all these were grade I according to the Clavien-Dindo classification.Another aspect to bear in mind regarding ureteral stents is the need for cystoscopy for their removal, which generates an additional cost as it requires an endoscopy suite, a urologist and specialist nurses.<a class="elsevierStyleCrossRef" href="#bib0135">27</a> In the case of the BS, it is removed in the follow-up visit after the intervention and can even be removed by trained nursing staff, as has been described by other authors. In this way, the use of cystoscopy is restricted for diagnostic procedures<a class="elsevierStyleCrossRef" href="#bib0120">24</a> and, therefore, by reducing the number of uses of the cystoscope, the number of repairs required is reduced in the long term. As described in other series, in our center we found decreased costs of the removal procedure in the BS DJ group.<a class="elsevierStyleCrossRefs" href="#bib0105">21,22,24</a> Given that all BS stents in this study were removed by the urologist in the postoperative visit that all patients undergo after ureteroscopy, when evaluating only the removal procedure of both stents, given the difference in price (Optimed 50 € vs. BS 80 €) and the cost of removal at the endoscopy suite (99.44 € according to the table of fees per procedure published in the Official Diary of the Autonomous Community of Valencia), there is an approximate saving of 70 € per procedure in our center.Finally, among the limitations of our study, we can highlight the limited sample size and the absence of a baseline symptom questionnaire to rule out the presence of previous symptoms unrelated to the stent.ConclusionsThe magnetic DJ is a ureteral stent which does not increase neither symptomatology nor medical complications when compared to the standard DJ. The removal procedure does not require the use of cystoscopy; therefore, it can be performed in the doctor’s or outpatient clinic, in an easy, less painful and faster way. In addition, in case of failure to achieve magnetic removal, it can be removed endoscopically without any difficulty.FundingThis work has not received any funding.Conflicts of interestThe authors declare that they have no conflicts of interest." "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:3 [ "identificador" => "xres1519032" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1377535" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1519033" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1377536" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Material and methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Conclusions" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Funding" ] 10 => array:2 [ "identificador" => "sec0035" "titulo" => "Conflicts of interest" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2020-08-17" "fechaAceptado" => "2021-01-13" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1377535" "palabras" => array:4 [ 0 => "Double-J stent" 1 => "Magnetic double-J stent" 2 => "Black Star" 3 => "USSQ" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1377536" "palabras" => array:4 [ 0 => "Catéter doble J" 1 => "Catéter doble J magnético" 2 => "Black Star" 3 => "USSQ" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "IntroductionThe placement of a ureteral stent is one of the most widely performed procedures in urology. It can have a negative impact on the patients’ quality of life, requiring a cystoscopy for its removal. The objective of this study is to evaluate the symptoms and impact on quality of life derived from the use of a magnetic double-J stent (Black Star®) and compare them to those presented in patients with a traditional double-J stent (OptiMed®). Material and methodsWe conducted a comparative, prospective, randomized study in 46 patients who underwent ureterorenoscopy with double-J stent placement between August 2019 and June 2020. Of all patients included, 23 had a traditional double-J stent placed (group A) and 23 had a magnetic double-J stent (group B) placed. We evaluated the results of the Ureteral Stent Symptom Questionnaire (USSQ) in both groups, assessed the technical difficulty related to stent removal and the pain during the procedure using the Visual Analogue Scale (VAS). We also reviewed the need for medical attention due to problems related to the stent or after its removal. ResultsThere were no statistically significant differences between groups regarding the answers in the USSQ and the complications related to the use of the stent. Group B showed less pain (1.52 vs. 4, VAS, p = 0.001) and less difficulty during removal (1.61 vs. 3, p < 0.001) associated with a shorter procedure duration (11.65 min vs. 22.17 min p < 0.001). ConclusionsThe tolerance shown by the use of magnetic double-J is comparable to the tolerance of traditional stent, since it does not cause an increase in urinary symptoms nor worsens the quality of life of patients during its use." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "IntroducciónLa colocación de un catéter doble J (DJ) es uno de los procedimientos más realizados en urología. Puede causar un impacto negativo en la calidad de vida, siendo necesaria una cistoscopia para su extracción. El objetivo de este estudio es evaluar la sintomatología e impacto en la calidad de vida derivados del uso del catéter DJ magnético (Black Star®) y compararla con la del DJ tradicional (OptiMed®). Material y métodosRealizamos un estudio comparativo, prospectivo y aleatorizado en 46 pacientes sometidos a ureterorrenoscopia (URS) en quienes se colocó un DJ entre agosto del 2019 y junio del 2020. De los pacientes incluidos, 23 llevaron un DJ tradicional (grupo A) y 23 un DJ magnético (grupo B). Valoramos en ambos grupos los resultados del cuestionario de síntomas de catéter ureteral (USSQ). Evaluamos el dolor de la extracción mediante la escala visual analógica (EVA) y la dificultad de la retirada. Revisamos la necesidad de atención médica por problemas relacionados con el catéter o surgidos tras la extracción. ResultadosNo observamos diferencias estadísticamente significativas en el cuestionario USSQ, ni en las complicaciones. El grupo B presentó: menor dolor de la extracción (EVA de 1,52 vs. 4, p = 0,001), menor dificultad en la retirada (1,61 vs. 3, p < 0,001) y menor tiempo de extracción (11,65 vs. 22,17 min p < 0,001). ConclusionesEl DJ magnético es un catéter ureteral que presenta una tolerancia equiparable a los tradicionales, ya que no genera un incremento de la sintomatología urinaria ni empeora la calidad de vida de los pacientes durante su uso." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Diranzo-Garcia M, Pardo-Duarte P, Álvarez-Barrera A, Juan-Escudero JU, Beltrán-Puig M, Monzó-Cataluña A et al. Catéter doble J magnético: evaluación de la tolerancia e impacto en la calidad de vida en comparación con el catéter doble J tradicional. Actas Urol Esp. 2021;45:366–372." ] ] "multimedia" => array:6 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 738 "Ancho" => 1500 "Tamanyo" => 46211 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "(A) Urotech Black-Star® magnetic stent. (B) Bladder side of the Urotech Black-Star® magnetic stent attached to the retrieval device." ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 4007 "Ancho" => 3003 "Tamanyo" => 557676 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Summary of the domains assessed in the USSQ. USSQ: ureteral stent symptom questionnaire." ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 971 "Ancho" => 1500 "Tamanyo" => 59814 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Graph showing questionnaire scores by domains. USSQ: ureteral stent symptom questionnaire." ] ] 3 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0020" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Variables \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Group A \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Group B \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Number of patients \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">23 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">23 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Sex \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Men, n \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 (39%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 (39%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Women, n \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14 (61%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14 (61%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Age (years), mean ± SD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">60 (±13.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">55 (±14.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.237 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">[0,1–4]</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Location, n \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.462 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Kidney \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 (17.4%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 (21.7%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Ureter \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">19 (82.6%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18 (78.2%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Both \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2608387.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Demographic characteristics of the patients and stone location." ] ] 4 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0025" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "USSQ: ureteral stent symptom questionnaire." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">USSQ \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Group A \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Group B \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Symptomatology (mean ± SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">25.9 (±8.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">27.1 (±8.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.618 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Dolor (media ± SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18.7 (±5.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">17.0 (±7.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.401 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">General condition (mean ± SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">13.1 (±4.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11.6 (±5.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.322 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Work activity (median) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 (5−14) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 (1−13) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.359 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Sexual activity (median) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (1−16) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (1−12) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.890 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2608385.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Morbidity associated with catheterization assessed with the USSQ." ] ] 5 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0030" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "VAS: Visual Analog Scale." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Variables \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Group A Mean ± SD \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Group B Mean ± SD \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Stent duration (days) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20 (±3.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">19 (±3.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.192 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Removal time (minutes) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">22.2 (±5.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11.7 (±4.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.000 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Removal difficulty scale \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 (±1.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.6 (±1.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.000 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Vas at removal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 (±1.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.5 (±1.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2608386.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Variables associated with removal." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:27 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The use of stents in contemporary urology" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "B.H. Chew" 1 => "B.E. Knudsen" 2 => "J.D. Denstedt" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/00042307-200403000-00011" "Revista" => array:6 [ "tituloSerie" => "Curr Opin Urol" "fecha" => "2004" "volumen" => "14" "paginaInicial" => "111" "paginaFinal" => "115" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15075840" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ureteric stents, far from ideal" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "D. Tolley" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0140-6736(00)02674-X" "Revista" => array:6 [ "tituloSerie" => "Lancet" "fecha" => "2000" "volumen" => "356" "paginaInicial" => "872" "paginaFinal" => "873" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11036889" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Outcomes of stenting after uncomplicated ureteroscopy: systematic review and meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "G. Nabi" 1 => "J. Cook" 2 => "J. N’Dow" 3 => "S. McClinton" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/bmj.39119.595081.55" "Revista" => array:6 [ "tituloSerie" => "BMJ" "fecha" => "2007" "volumen" => "334" "paginaInicial" => "572" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17311851" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0022202X16310569" "estado" => "S300" "issn" => "0022202X" ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "EAU guidelines on interventional treatment for urolithi- asis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C. Türk" 1 => "A. Petřík" 2 => "K. Sarica" 3 => "C. Seitz" 4 => "A. Skolarikos" 5 => "M. 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Magnetic double-J stent: Evaluation of tolerance and impact on quality of life compared to traditional double-J stent

Catéter doble J magnético: evaluación de la tolerancia e impacto en la calidad de vida en comparación con el catéter doble J tradicional

M. Diranzo-Garcia

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mdiranzo@gmail.com

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, P. Pardo-Duarte, A. Álvarez-Barrera, J.U. Juan-Escudero, M. Beltrán-Puig, A. Monzó-Cataluña, K. Rechi-Sierra, F. Sánchez-Ballester, J. Garcia-Ibáñez, E. López-Alcina

Servicio de Urología, Consorcio Hospital General Universitario de Valencia, Valencia, Spain

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          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Summary of the domains assessed in the USSQ&#46;</p> <p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">USSQ&#58; ureteral stent symptom questionnaire&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Upper urinary tract obstruction is a frequent cause in the urology consultation&#44; and urinary diversion with double-J stent &#40;DJ&#41; placement is one of the most widely used procedures in routine practice&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> There are several indications for ureteral stent placement&#59; ureterorenoscopy &#40;URS&#41; for lithiasis is one of them&#46; The purpose of stenting in the treatment of stone disease is to ensure correct upper urinary tract diversion and prevent ureteral obstruction by stone fragments or edema after surgery&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#8211;4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Various studies have shown that ureteral stents can be detrimental to the quality of life of patients while they are DJ carriers&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#8211;8</span></a> Among the side effects&#44; pain&#44; hematuria&#44; lower urinary tract symptoms &#40;LUTS&#41; and increased number of urinary tract infections &#40;UTIs&#41;&#44; among others&#44; have been described&#46; In addition to the adverse effects of the use of ureteral stent&#44; we must add the need for cystoscopy&#44; which is an invasive procedure performed for its removal&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#8211;12</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">For this reason&#44; attempts have been made to develop the ideal DJ stent that allows removal without the need for cystoscopy&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13&#8211;20</span></a> One example is the stent with a string which protrudes from the end of the urethra&#44; when pulled on&#44; the device is removed without the need for an endoscopy&#46; This mechanism can be useful in those cases when the stent is expected to be removed in a few days&#44; since a longer period of time with this type of diversion could increase the risk of UTI or early involuntary removal&#44; in addition to negatively affecting quality of life&#44; especially regarding the sexual sphere&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13&#8211;17</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Another type of device that allows extraction without endoscopy is based on the use of magnetic stents&#46; In 1989&#44; Macaluso et al&#46; described the first stents with a magnetic tip&#44; achieving satisfactory removal in 75&#37; of men&#46; However&#44; due to their difficult insertion&#44; they were not successful and their use did not become widespread&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The main objective of the present study is to compare the symptomatology and the impact on the quality of life of patients with two types of ureteral stents&#58; a standard DJ stent vs&#46; a magnetic DJ&#46; In addition&#44; as secondary objectives&#44; the tolerance&#44; the difficulty of the removal procedure and the complications derived from the use of both devices will be assessed&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material and methods</span><p id="par0030" class="elsevierStylePara elsevierViewall">A comparative&#44; prospective&#44; randomized study was performed where 46 patients were consecutively included&#46; All patients underwent URS for lithiasis with DJ stent placement between August 2019 and June 2020&#44; at our center&#46; All individuals included in the study had a negative urine culture performed one week prior to surgery&#46; Patients with a history of double-J stent placement within the six months before surgery and those with diagnostic ureteroscopies for follow-up or suspected urothelial tumor&#44; were excluded&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The patients were divided into two groups of 23 participants&#46; Group A had a standard Optimed&#174; DJ stent &#40;extra-soft polyurethane stent&#44; 6 CH 26&#8239;cm&#41; inserted&#44; and group B had a Black Star&#174; &#40;BS&#41; magnetic ureteral stent &#40;polyurethane&#44; 6 CH 26&#8239;cm of the Urotech&#174; company&#41; placed&#44; which has a thread-anchored magnet at the pigtail-end on the bladder side &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; All patients had the stents removed in a period of less than four weeks&#46; Before removal&#44; a simple abdominal X-ray was performed to identify the stent&#8217;s location and to rule out the presence of calcification of the stent&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">Stent removal in group A was performed in the urology exam room by flexible cystoscopy after application of anesthetic lubricating gel&#44; and the procedure was performed by the same urologist with the assistance of a specialist nurse&#46; In group B&#44; the procedure was performed in the urology outpatient department during the first postoperative follow-up visit&#44; by sterile bladder catheterization with a 15 Ch Tiemann magnetic tip stent&#44; after application of anesthetic lubricating gel&#46; The procedures were performed by the same urologist and did not require the nurse&#8217;s assistance&#46; In all cases&#44; the operative time was recorded&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">On the day of stent removal&#44; patients in both groups previously completed the international ureteral stent symptom questionnaire &#40;USSQ&#41; validated in Spanish&#46; It evaluates the symptoms and impact on quality of life related to stent use by assessing five sections&#58; urinary symptoms&#44; pain&#44; general health&#44; work performance and sexual matters &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">Additionally&#44; once the extraction had been performed&#44; the patients scored from one to 10 the pain felt at the procedure using the visual analog scale &#40;VAS&#41;&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">A second VAS with scores ranging from 1 to 10 &#40;1 represented absence of difficulty and 10 represented extreme difficulty&#41; was answered by the urologist to assess the perceived technical difficulty during the retrieval procedure in both groups&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Finally&#44; medical records were reviewed from the day of stent insertion until three weeks after removal to assess visits to the emergency room or primary care center for complications related to the ureteral stent and&#47;or its removal&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Data were collected and analyzed with SPSS version 20&#46;0&#46; The student&#39;s t-test was used to compare quantitative variables between the two study groups and the X<span class="elsevierStyleSup">2</span> test was employed to analyze the qualitative variables that met normality criteria&#46; The nonparametric Mann Whitney U test was used in two of the variables analyzed in the USSQ questionnaire &#40;work performance and sexual matters&#41;&#44; since they did not meet the normality criteria&#46; We considered a p-value of less than 0&#46;05 to be statistically significant&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0070" class="elsevierStylePara elsevierViewall">Both groups were homogeneous in terms of age&#44; sex or stone location &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">The USSQ did not show statistically significant differences between the two groups in any of its sections&#58; urinary symptoms &#40;p&#8239;&#61;&#8239;0&#46;618&#41;&#44; body pain &#40;p&#8239;&#61;&#8239;0&#46;401&#41;&#44; general health &#40;p&#8239;&#61;&#8239;0&#46;322&#41;&#44; work performance &#40;p&#8239;&#61;&#8239;0&#46;359&#41; and sexual matters &#40;p&#8239;&#61;&#8239;0&#46;890&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">The mean indwelling time was 20 &#40;13&#8211;26&#41; days in group A and 19 &#40;13&#8211;24&#41; days in group B &#40;p&#8239;&#61;&#8239;0&#46;192&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">The mean operative time for removal was 22&#46;17 &#40;13&#8211;33&#41; minutes and 11&#46;65 &#40;7&#8211;25&#41; minutes and in group A and group B&#44; respectively&#46; It was significantly shorter in patients using the BS stent &#40;p&#8239;&#60;&#8239;0&#46;001&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">We found statistically significant differences in terms of pain during stent removal&#44; with less bother in group B VAS 1&#46;52 &#40;4 to 0&#41; vs&#46; group A VAS 4 &#40;7 to 2&#41; &#40;p&#8239;&#61;&#8239;0&#46;001&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46; We found no significant differences between removal by performed by catheterization or cystoscopy on the VAS score when stratifying by sex &#40;BS p&#8239;&#61;&#8239;0&#46;163&#44; Optimized p&#8239;&#61;&#8239;0&#46;753&#41;&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">The VAS assessment of technical difficulty perceived by the urologist during the removal procedure showed a mean score of 3 &#40;0&#8211;5&#41; in group A&#44; and a mean score of 1&#46;61 &#40;0&#8211;4&#41; in group B&#44; showing greater removal difficulty in the first group&#59; this difference was statistically significant &#40;p&#8239;&#60;&#8239;0&#46;001&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">We performed a post hoc analysis to quantify the magnitude or effect size &#40;ES&#41; of the variables that had been found to be statistically significant&#44; and we obtained the following results&#58; mean time employed &#40;ES&#8239;&#61;&#8239;2&#46;20&#41;&#44; removal VAS score &#40;ES&#8239;&#61;&#8239;1&#46;59&#41;&#44; perceived technical difficulty scale &#40;ES&#8239;&#61;&#8239;1&#46;01&#41;&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Regarding the rate of stent-related complications&#44; we found no statistically significant differences between the two groups&#44; neither with respect to the number of visits made to the primary care physician nor to the emergency room&#46; In group A&#44; two patients consulted for LUTS&#44; one of them while the catheter was in situ and the other one after its removal&#46; Only the second patient obtained a positive urine culture &#40;UC&#41; for a multisensitive Escherichia coli&#44; which was treated with cefuroxime&#46; As for group B&#44; three subjects requested consultation&#58; two due to LUTS and one for hematuria&#46; Of the two patients consulting for LUTS&#44; one was still carrying the stent and in the other patient&#44; the stent had already been removed&#46; The one who presented hematuria came to the emergency room two days after stent insertion&#44; and it was a self-limited hematuria&#46; None of the three cases obtained a positive UC&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0110" class="elsevierStylePara elsevierViewall">Ureteral stent placement is one of the most frequently performed procedures in urological practice&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Due to the symptoms derived from the devices and the need for invasive maneuvers for their removal&#44; there is a growing interest in creating an ideal device to reduce the discomfort associated with the DJ&#44; facilitate its removal and decrease the cost of endourological procedures&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#8211;4</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">In 1989&#44; Macaluso et al&#46; presented the first model of magnetic stents&#46; These were removed with the use of a device that had a complementary magnetic tip&#44; which facilitated removal without the need for endoscopy&#46; However&#44; this initial prototype showed a high failure rate in removal&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">Subsequently&#44; Altarac et al&#46; developed a DJ with a fixed magnetic tip&#46; This stent was removed by connecting to another magnetic tip catheter after reaching the bladder by urethral catheterization&#46; However&#44; the lack of mobility of the magnetic end of the stent and the limited power of the magnets led to a high failure rate in the procedure&#44; and its use was not popularized either&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">Taylor et al&#46; were the first to demonstrate the usefulness of the magnetic DJ stent as it is currently known&#46; They performed a retrospective study including 30 patients&#44; achieving satisfactory removal in 29 of them &#40;97&#37;&#41;&#44; stating that it was a safe procedure&#44; since cystoscopy could be used as a second option in the few cases in which the magnet failed&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">In recent years&#44; new magnetic devices have been developed that allow removal with simple bladder catheterization without errors during the procedure&#46;<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">18&#8211;20</span></a> The development of these new magnetic DJs allows the elimination of cystoscopy for stent removal without aggravating the expected adverse effects of standard DJs&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">In the same way as other series&#44; our study confirms the presence of side effects that affect the quality of life related to standard DJ stents<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#8211;8</span></a> and magnetic ureteral stents&#46;<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">21&#8211;24</span></a> The symptoms and the impact on quality of life derived from the use of the device were assessed with the USSQ&#44; without finding significant differences in any of its sections&#46; These results agree with those obtained by O&#8217;Kelly et al&#46;&#44; who also found no variations in any of the domains evaluated in the questionnaire&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a></p><p id="par0140" class="elsevierStylePara elsevierViewall">In contrast&#44; Farouk et al&#46; do report statistically significant differences with higher scores in the BS stent group in terms of urinary symptoms&#44; body pain and work performance&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> In turn&#44; in the study by Sevcenco et al&#46;&#44; the patients carrying the BS stent exhibited greater &#8220;irritative&#8221; symptomatology in the indwelling period&#59; in this case&#44; they used a non-validated VAS for symptom assessment instead of the USSQ&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a></p><p id="par0145" class="elsevierStylePara elsevierViewall">On the other hand&#44; Rassweiler et al&#46; found no differences regarding the presence of pain or LUTS&#46; However&#44; they described that the magnetic DJ stent was related to pain in the bladder area&#44; in comparison with patients with traditional DJ who were more likely to present pain in the lumbar area&#46; They attributed these variations to the distal magnetic tip&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a></p><p id="par0150" class="elsevierStylePara elsevierViewall">The removal of a ureteral stent by flexible cystoscopy is a technique that&#44; although well tolerated by most patients&#44; is still uncomfortable or painful for many of them&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#8211;12</span></a> When assessing the variable of pain on stent removal by means of VAS in our series&#44; the score was significantly lower in patients with a BS stent&#46; These results coincide with those obtained by Rassweiler et al&#46;&#44; Sevcenco et al&#46; and O&#8217;Kelly et al&#46;<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">21&#44;23&#44;24</span></a>&#46; On the other hand&#44; Farouk et al&#46; found no significant differences between removal by magnetic tip catheter or cystoscopy&#46; However&#44; when stratifying patients by sex&#44; they found that cystoscopy retrieval was less bothersome for the female sex&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> In our case&#44; we did not find any distinctions by sex&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">The time taken for removal as well as the difficulty of removal were lower in group B &#40;BS stent carriers&#41;&#44; with statistically significant differences&#46; The ease of removal of magnetic DJ has been reported in other series&#46;<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">24&#44;25</span></a></p><p id="par0160" class="elsevierStylePara elsevierViewall">The successful removal rate with the BS was 98&#37;&#46; Only one patient required the performance of flexible cystoscopy for magnetic stent removal due to significant prostatic hypertrophy which did not allow the connection of the magnetic tip of the DJ to the catheter tip&#46; These results are in line with those presented by Rassweiler et al&#46;&#44; who observed a failure rate of 2&#37;&#44; and was unable to remove the magnetic stent by catheterization in one patient&#44; due to a prostate with a large middle lobe&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> Taylor et al&#46; present similar results&#58; in their case&#44; they needed the cystoscope to remove the stent in one of their 30 patients due to a similar prostate condition&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> On the other hand&#44; Klingler et al&#46; as well as Sevcenco et al&#46;&#44; needed cystoscopy in one subject in whom the distal magnetic tip had calcified&#44; making connection with the catheter impossible&#46;<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">23&#44;26</span></a> In the first case&#44; a slight calcification of the distal tip was also observed in two other patients&#44; although they did not require cystoscopy since it allowed catheter connection&#46; Coincidentally&#44; the three patients who developed this complication presented UTI with positive UC&#46; In our series&#44; no one experienced calcification of the ureteral stent&#44; probably for two reasons&#58; first&#44; because the indwelling time of the BS did not exceed four weeks in any case and&#44; second&#44; because we did not have any patient with positive UC during the indwelling period&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">When reviewing the complications in our series&#44; five people visited the emergency room or the primary care physician for issues derived from the ureteral stent&#59; all these were grade I according to the Clavien-Dindo classification&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">Another aspect to bear in mind regarding ureteral stents is the need for cystoscopy for their removal&#44; which generates an additional cost as it requires an endoscopy suite&#44; a urologist and specialist nurses&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a> In the case of the BS&#44; it is removed in the follow-up visit after the intervention and can even be removed by trained nursing staff&#44; as has been described by other authors&#46; In this way&#44; the use of cystoscopy is restricted for diagnostic procedures<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> and&#44; therefore&#44; by reducing the number of uses of the cystoscope&#44; the number of repairs required is reduced in the long term&#46; As described in other series&#44; in our center we found decreased costs of the removal procedure in the BS DJ group&#46;<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">21&#44;22&#44;24</span></a> Given that all BS stents in this study were removed by the urologist in the postoperative visit that all patients undergo after ureteroscopy&#44; when evaluating only the removal procedure of both stents&#44; given the difference in price &#40;Optimed 50 &#8364; vs&#46; BS 80 &#8364;&#41; and the cost of removal at the endoscopy suite &#40;99&#46;44 &#8364; according to the table of fees per procedure published in the Official Diary of the Autonomous Community of Valencia&#41;&#44; there is an approximate saving of 70 &#8364; per procedure in our center&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">Finally&#44; among the limitations of our study&#44; we can highlight the limited sample size and the absence of a baseline symptom questionnaire to rule out the presence of previous symptoms unrelated to the stent&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conclusions</span><p id="par0180" class="elsevierStylePara elsevierViewall">The magnetic DJ is a ureteral stent which does not increase neither symptomatology nor medical complications when compared to the standard DJ&#46; The removal procedure does not require the use of cystoscopy&#59; therefore&#44; it can be performed in the doctor&#8217;s or outpatient clinic&#44; in an easy&#44; less painful and faster way&#46; In addition&#44; in case of failure to achieve magnetic removal&#44; it can be removed endoscopically without any difficulty&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Funding</span><p id="par0185" class="elsevierStylePara elsevierViewall">This work has not received any funding&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conflicts of interest</span><p id="par0190" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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            0 => "Double-J stent"
            1 => "Magnetic double-J stent"
            2 => "Black Star"
            3 => "USSQ"
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            0 => "Cat&#233;ter doble J"
            1 => "Cat&#233;ter doble J magn&#233;tico"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">The placement of a ureteral stent is one of the most widely performed procedures in urology&#46; It can have a negative impact on the patients&#8217; quality of life&#44; requiring a cystoscopy for its removal&#46; The objective of this study is to evaluate the symptoms and impact on quality of life derived from the use of a magnetic double-J stent &#40;Black Star&#174;&#41; and compare them to those presented in patients with a traditional double-J stent &#40;OptiMed&#174;&#41;&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material and methods</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">We conducted a comparative&#44; prospective&#44; randomized study in 46 patients who underwent ureterorenoscopy with double-J stent placement between August 2019 and June 2020&#46; Of all patients included&#44; 23 had a traditional double-J stent placed &#40;group A&#41; and 23 had a magnetic double-J stent &#40;group B&#41; placed&#46; We evaluated the results of the Ureteral Stent Symptom Questionnaire &#40;USSQ&#41; in both groups&#44; assessed the technical difficulty related to stent removal and the pain during the procedure using the Visual Analogue Scale &#40;VAS&#41;&#46; We also reviewed the need for medical attention due to problems related to the stent or after its removal&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">There were no statistically significant differences between groups regarding the answers in the USSQ and the complications related to the use of the stent&#46; Group B showed less pain &#40;1&#46;52 vs&#46; 4&#44; VAS&#44; p&#8239;&#61;&#8239;0&#46;001&#41; and less difficulty during removal &#40;1&#46;61 vs&#46; 3&#44; p&#8239;&#60;&#8239;0&#46;001&#41; associated with a shorter procedure duration &#40;11&#46;65 min vs&#46; 22&#46;17 min p&#8239;&#60;&#8239;0&#46;001&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">The tolerance shown by the use of magnetic double-J is comparable to the tolerance of traditional stent&#44; since it does not cause an increase in urinary symptoms nor worsens the quality of life of patients during its use&#46;</p></span>"
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            "identificador" => "abst0005"
            "titulo" => "Introduction"
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          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Material and methods"
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          2 => array:2 [
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n</span><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">La colocaci&#243;n de un cat&#233;ter doble J &#40;DJ&#41; es uno de los procedimientos m&#225;s realizados en urolog&#237;a&#46; Puede causar un impacto negativo en la calidad de vida&#44; siendo necesaria una cistoscopia para su extracci&#243;n&#46; El objetivo de este estudio es evaluar la sintomatolog&#237;a e impacto en la calidad de vida derivados del uso del cat&#233;ter DJ magn&#233;tico &#40;Black Star&#174;&#41; y compararla con la del DJ tradicional &#40;OptiMed&#174;&#41;&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y m&#233;todos</span><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Realizamos un estudio comparativo&#44; prospectivo y aleatorizado en 46 pacientes sometidos a ureterorrenoscopia &#40;URS&#41; en quienes se coloc&#243; un DJ entre agosto del 2019 y junio del 2020&#46; De los pacientes incluidos&#44; 23 llevaron un DJ tradicional &#40;grupo A&#41; y 23 un DJ magn&#233;tico &#40;grupo B&#41;&#46; Valoramos en ambos grupos los resultados del cuestionario de s&#237;ntomas de cat&#233;ter ureteral &#40;USSQ&#41;&#46; Evaluamos el dolor de la extracci&#243;n mediante la escala visual anal&#243;gica &#40;EVA&#41; y la dificultad de la retirada&#46; Revisamos la necesidad de atenci&#243;n m&#233;dica por problemas relacionados con el cat&#233;ter o surgidos tras la extracci&#243;n&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">No observamos diferencias estad&#237;sticamente significativas en el cuestionario USSQ&#44; ni en las complicaciones&#46; El grupo B present&#243;&#58; menor dolor de la extracci&#243;n &#40;EVA de 1&#44;52 vs&#46; 4&#44; p&#8239;&#61;&#8239;0&#44;001&#41;&#44; menor dificultad en la retirada &#40;1&#44;61 vs&#46; 3&#44; p&#8239;&#60;&#8239;0&#44;001&#41; y menor tiempo de extracci&#243;n &#40;11&#44;65 vs&#46; 22&#44;17 min p&#8239;&#60;&#8239;0&#44;001&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">El DJ magn&#233;tico es un cat&#233;ter ureteral que presenta una tolerancia equiparable a los tradicionales&#44; ya que no genera un incremento de la sintomatolog&#237;a urinaria ni empeora la calidad de vida de los pacientes durante su uso&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Diranzo-Garcia M&#44; Pardo-Duarte P&#44; &#193;lvarez-Barrera A&#44; Juan-Escudero JU&#44; Beltr&#225;n-Puig M&#44; Monz&#243;-Catalu&#241;a A et al&#46; Cat&#233;ter doble J magn&#233;tico&#58; evaluaci&#243;n de la tolerancia e impacto en la calidad de vida en comparaci&#243;n con el cat&#233;ter doble J tradicional&#46; Actas Urol Esp&#46; 2021&#59;45&#58;366&#8211;372&#46;</p>"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Urotech Black-Star&#174; magnetic stent&#46; &#40;B&#41; Bladder side of the Urotech Black-Star&#174; magnetic stent attached to the retrieval device&#46;</p>"
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                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Variables&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Group A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Group B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Number of patients</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">23&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Men&#44; n&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#40;39&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#40;39&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14 &#40;61&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14 &#40;61&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Age &#40;years&#41;&#44; mean&#8239;&#177;&#8239;SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">60 &#40;&#177;13&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">55 &#40;&#177;14&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;237&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#91;0&#44;1&#8211;4&#93;</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Location&#44; n</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;462&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Kidney&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;17&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;21&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Ureter&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19 &#40;82&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18 &#40;78&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Both&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  """
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Symptomatology &#40;mean&#8239;&#177;&#8239;SD&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&#46;1 &#40;&#177;8&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;618&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dolor &#40;media&#8239;&#177;&#8239;SD&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18&#46;7 &#40;&#177;5&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&#46;0 &#40;&#177;7&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;401&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">General condition &#40;mean&#8239;&#177;&#8239;SD&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#46;1 &#40;&#177;4&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#46;6 &#40;&#177;5&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;322&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Work activity &#40;median&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;5&#8722;14&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;1&#8722;13&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;359&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sexual activity &#40;median&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;1&#8722;16&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;1&#8722;12&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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