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Evaluation of tolerance towards ureteral double-J-stents in children: an unmet need
Dafni Planta1, Raphael N Vuille-Dit-Bille1, Stefan Holland-Cunz1
1Division of Pediatric Surgery, University Children's Hospital Basel, University of Basel, Spitalstrasse 33, 4056, Basel, Switzerland.
Insights
Pediatric ureteric double-J stents (DJS) cause irritative symptoms in many children, with pain increasing with age. A new questionnaire helps assess DJS tolerance and quality of life in pediatric patients.
Area of Science:
- Pediatric Urology
- Medical Devices
- Patient Quality of Life
Background:
- Ureteric double-J stents (DJS) are frequently used in pediatric urology.
- Adults often experience severe irritative symptoms and decreased quality of life with DJS.
- Little is known about DJS tolerance in children, and standardized assessment methods are lacking.
Purpose of the Study:
- To assess pediatric tolerance of DJS in relation to age.
- To evaluate irritative symptom rates in children with DJS.
- To highlight the need for standardized DJS evaluation in pediatric care.
Main Methods:
- Prospective, observational, single-center study over 14 months.
- Developed and administered a questionnaire to children post-DJS removal, assessing 5 categories.
- Enrolled 20 pediatric patients (mean age 5.8 years) with indwelling DJS.
Main Results:
- 13 out of 20 patients reported irritative symptoms (pain, voiding problems) during the mean 6-week indwelling period.
- A positive association was found between patient age and reported pain scores (Spearman's ρ = 0.54, p = 0.04).
- Pediatric patients experienced less severe complications and a less impaired quality of life compared to adults, but symptom occurrence was high.
Conclusions:
- The study provides a foundation for standardized re-evaluation of ureteral stents in pediatric patients.
- A specialized questionnaire offers a quantitative tool for assessing pediatric quality of life with indwelling ureteral stents.
- Future validation of the questionnaire through a large-scale, multi-center study is recommended.
Abstract:
Ureteric double-J-stents (DJS) are commonly applied devices in urology that often cause irritative symptoms in adults, leading to decreased quality of life. Little is known about how they are tolerated by children. Furthermore, standardized patient-centered care for children has not yet been established. The objective of this observational study is to assess the tolerance of children towards DJS in relation to their age by evaluating their irritative symptom rate and to raise awareness of the need for a standardized evaluation method. A prospective observational single-center study was conducted over a period of 14 months on children with indwelling DJS. A questionnaire addressing 5 categories (voiding symptoms, general symptoms, social activities and/or sexual health, catheter removal, and medication) was developed for different age groups and employed after stent removal. Twenty patients with a mean age of 5.8 years (range 3 months to 15 years) were enrolled in the study. During the indwelling time (mean 6 weeks), 13 patients suffered from irritative symptoms (intermittent pain and/or voiding problems). There was a positive association between age and the reported pain score (Spearman's ρ = 0.54, p = 0.04). Overall, the quality of life (QoL) was less impaired than in adult patients and the complications were less severe, but the symptom occurrence rate was similarly high.
Conclusion:
The current study lays the groundwork for a standardized re-evaluation of ureteral stents in pediatric applications. Through the development of a specialized questionnaire, we provide a quantitative tool for assessing the QoL of children with indwelling ureteral stents. The next step in standardizing the use of DJS in the pediatric population involves the validation of our questionnaire through a large-scale multi-center study.
What Is Known:
• Ureteric double-J stents are commonly used devices in pediatric urology. • Double-J stents are often not well tolerated by adults due to severe irritating symptoms, which decreases their quality of life.
What Is New:
• In children, little is known about tolerance of double-J stents. • There is no standardized method to assess tolerance in children, especially with regard to age.
