Implementing a Ureteric Magnetic Stent in the Kidney Transplant Setting: Report of 100 Consecutive Cases

Comparison of Magnetic and Conventional Double-J Stent Following Kidney Transplantation: A Randomized Controlled Trial

Background

This monocentric, randomized controlled trial aims to compare the outcomes of kidney transplant recipients with magnetic double-J (DJ) stents versus conventional DJ stents. Specifically, we assessed stent-related symptoms, procedural difficulties, pain and duration of removal, and associated costs.

Methods

A total of 30 patients were randomly assigned to receive either a magnetic DJ (mDJ) stent or a conventional, standard DJ (sDJ) stent during kidney transplantation using the Lich-Gregoir technique. Quality of life was evaluated with the USSQ 7-10 d postoperation. sDJs stents were removed cystoscopically by a urologist while mDJ stents were removed bedside by a transplant surgeon. The duration of removal and procedure-associated pain were documented. Questionnaires for physicians and patients were used to assess peri-interventional experience and issues. Additionally, costs associated with the removal of both stents were analyzed.

Results

Quality of life showed no differences between the groups. Stent removal was successful in all cases, with no differences in duration of removal (P = 0.24) or major issues. Patients reported comparable pain levels during the removal of mDJs (P = 0.55) and higher satisfaction, although this was not statistically significant (P = 0.27). Cost analysis revealed a reduction of approximately €172 with the use of mDJ.

Conclusions

The use of mDJ stents in kidney transplantation is a safe alternative associated with comparable pain during removal. Additionally, it offers cost savings and reduces the logistical burden for both patients and hospitals.

Evaluation of Magnetic Ureteric Stents: A Systematic Review and Meta-Analysis

Magnetic ureteric stents offer a novel approach for simplifying stent removal, minimizing patient discomfort, and reducing procedural burdens. This systematic review and meta-analysis synthesized evidence from 12 studies involving 1,297 patients to evaluate the efficacy and safety of magnetic stent removal compared to conventional methods. Key outcomes included reductions in procedural pain scores, shorter removal times, and high patient satisfaction. Complication rates for magnetic stents were comparable to conventional stents, while cost analysis favored magnetic removal due to reduced resource utilization. These findings suggest magnetic stents are a safe, effective, and patient-friendly alternative. Further research with larger sample sizes is warranted to confirm these benefits.

Beyond the gut: spectrum of magnetic surgery devices

Since the 1970s, magnetic force has been used to augment modern surgical techniques with the aims of minimizing surgical trauma and optimizing minimally-invasive systems. The majority of current clinical applications for magnetic surgery are largely centered around gastrointestinal uses-such as gastrointestinal or bilioenteric anastomosis creation, stricturoplasty, sphincter augmentation, and the guidance of nasoenteric feeding tubes. However, as the field of magnetic surgery continues to advance, the development and clinical implementation of magnetic devices has expanded to treat a variety of non-gastrointestinal disorders including musculoskeletal (pectus excavatum, scoliosis), respiratory (obstructive sleep apnea), cardiovascular (coronary artery stenosis, end-stage renal disease), and genitourinary (stricture, nephrolithiasis) conditions. The purpose of this review is to discuss the current state of innovative magnetic surgical devices under clinical investigation or commercially available for the treatment of non-gastrointestinal disorders.

Comparison of the Removal Efficiency and Safety of Magnetic Versus Conventional Ureteral Stents: A Systematic Review and Meta-analysis

Context

The incidence of urolithiasis is increasing year by year. Ureteral stents are a popular treatment option for this condition. Efforts to improve the material and structure of stents to increase comfort and reduce complications have led to the introduction of magnetic stents.

Objective

To evaluate differences in removal efficiency and safety for magnetic and conventional stents.

Evidence acquisition

This study was conducted and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Data were extracted according to the PRISMA principles. We collected and combined data from randomized controlled trials on magnetic versus conventional stents to evaluate the efficiency of their removal and the associated effects. Data synthesis was performed using RevMan 5.4.1 and heterogeneity was evaluated using I² tests. A sensitivity analysis was also performed. Key metrics included the stent removal time, Visual Analog Scale (VAS) pain scores, and Ureteral Stent Symptom Questionnaire (USSQ) scores for various domains.

Evidence synthesis

Seven studies were included in the review. We found that magnetic stents had a shorter removal time (mean difference [MD] -8.28 min, 95% confidence interval [CI] -15.6 to -0.95; p = 0.03) and their removal was associated with less pain (MD -3.01 points, 95% CI -3.83 to -2.19; p < 0.01) in comparison to conventional stents. USSQ scores for urinary symptoms and sexual matters were higher for magnetic than for conventional stents. There were no other differences between the stent types.

Conclusions

Magnetic ureteral stents have the advantages of a shorter removal time, less pain during removal, and low cost in comparison to conventional stents.

Patient summary

For patients undergoing treatment of urinary stones, a thin tube called a stent is often temporarily inserted in the tube between the kidney and the bladder to allow stones to pass. Magnetic stents can be removed without any need for a second surgical procedure. Our review of studies comparing two types of stents suggests that magnetic stents are superior to conventional stents in terms of efficiency and comfort during removal.

The Function Improved of the Newly Designed Magnetic-End Ureteric Stenting Retrieval Device: A Clinical Prospective Randomized and Control Trial in a Multicenter Study

Objective

To demonstrate the advantage of our newly designed magnetic ureteric stenting retrieval device over traditional nonmagnetic ureteric stents and other retrieval devices without cystoscopy intervention on clinical application and cost-related outcomes. Patients and Methods. A total of 333 patients were recruited into two study groups: magnetic-end ureteral stent (Group A) and conventional ureteral stent (Group B). The effects were evaluated by Ureteral Stent Symptom Questionnaire (USSQ) scores, complications of the indwelling stent, visual analog scale (VAS) pain scores at stent removal, and cost-analysis outcomes between the magnetic ureteric stenting retrieval device and traditional double-J ureteral stent (DJUS) removed by cystoscopy.

Results

The VAS of the pain score of patients undergoing magnetic stent removal with the retrieval device was 2 ± 0.97, whereas that of patients undergoing conventional ureteral stent removal with cystoscopy was 5.76 ± 1.53 (p < 0.001). The removal of magnetic stents by a retrieval device proved to be less painful than cystoscopy-mediated stent removal (p < 0.001). Obviously, the total cost for the magnetic stent removal was much lower than the conventional ureteral stent removal, although the magnetic stent costs more than the conventional ureteral stent. The improved magnetic stent used in our study showed a remarkable cost saving of 705/111 USD Chinese Yuan (CNY) per patient when compared with the conventional ureteral stent.

Conclusion

We reported the integrated design features of the improved magnetic stent in the world, which was granted a patent in China. USSQ scores and rate of complications in the magnetic stent were as equally acceptable as a conventional stent. Furthermore, successful stent insertion rate reached 100% by both the antegrade and retrograde approaches, and no failure case of magnetic stent removal was reported in our study.

A systematic review of magnetic versus conventional ureteric stents for short term ureteric stenting

Ureteric stents play an essential role in urology. However, patients can suffer a range of stent-related symptoms with stent in situ and during removal. Conventional ureteric stents are removed using a flexible cystoscopy, whereas magnetic stents may be rapidly removed with a smaller catheter-like retrieval device. The primary aim of this systematic review was to compare the morbidity including pain associated with conventional versus magnetic ureteric stents. The secondary aim was cost comparison. Searches were performed across databases, including Medline, Scopus, Embase and Cochrane. This review was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The search from the 5 databases returned a total of 358 articles. After duplicates were removed as well as the inclusion and exclusion criteria applied, a total of 6 studies were included in the final review. Ureteric Stent Symptoms Questionnaire (USSQ) and Visual Analogue Score (VAS) were used in most of the studies. All the studies reported that magnetic ureteric stents resulted in a reduction in the pain on the removal of magnetic ureteric stents, and no statistically significant difference with indwelling ureteric stents. Furthermore, majority of the studies reported a reduction in the cost associated with magnetic ureteric stents. There is no significant difference in pain from indwelling ureteric stents. There is a reduction in pain with the removal of magnetic ureteric stents compared to conventional removal via cystoscopy and an associated reduction in cost.

Outpatient ureteric stent removal following kidney transplantation

During a kidney transplant, a plastic tube (stent) is placed in the ureter, connecting the new kidney to the bladder, in order to keep the new join open during the initial phase of transplantation. The stent is then removed after a few weeks via a camera procedure (cystoscopy), as it is no longer needed. The present study compared performing this in the operating theatre or in clinic for transplanted patients using a new single-use type of camera with an integrated grasper system. The results have shown that it is safe and cost-effective to do this in clinic, despite patients being susceptible to infection after transplantation.