[Pigtail suture stent: decisive progress towards double-pigtail stent tolerance and unexpected properties of the...

Double-pigtail stent intolerance reduces the quality of life of patients. By decreasing the amount of material within the bladder, it should be possible to attenuate the symptoms linked to the stent. We evaluated the tolerance of a new stent with a dedicated questionnaire.

The major innovation of the pigtail suture stent (PSS and MiniPSS) was in the replacement of the lower part of the double-pigtail stent with a 0.3 F suture. One hundred and eight patients agreed to be fitted with a PSS. The double-pigtail stents of 24 patients complaining strongly of symptoms were replaced with PSS (group 1) and sixty-eight other patients were fitted directly with the PSS after an endoscopic intervention on the ureter (groups 2 and 3). Sixteen patients with non-obstructive kidney stone received MiniPSS (group 4).

Completed questionnaires were obtained from 94 patients. In group 1, the replacement of the double-pigtail stent with a PSS significantly decreased urinary symptom scores (34.4±9.0 vs 20.3±7.4, P<0.0000007), and pain scores (10.1±5.1 vs 4.8±3.2, P=0.0001). The scores of the two first groups fitted with a PSS were similar. Following PSS or MiniPSS implantation, a clear dilation of the ureteral meatus was probably induced by the sutures, facilitating the introduction of an ureteroscope or a flexible ureteroscope sheath (12 F). Following extracorporeal shockwave lithotripsy, the stone fragments gradually slid down the PSS sutures, without renal colic.

The PSS seems to improve the tolerance of ureteral stent. Unexpectedly, following PSS implantation, we observe a clear dilation of the ureter. We believe that use of a double-pigtail stent should no longer be considered the only way to drain the ureter. Instead, the form of the stent should depend on the patient's disease.

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