Assessing the Factors Affecting the Success of Ureteral Double-J (DJ) Stenting in Patients with Obstructing Ureteric Calculus: A Prospective Study

Dr. Somdutt Sharma, Dr. Umesh Sharma

Abstract: Objective: To study the demographic, clinical and radiological factors that affect the success of DJ (Double J) ureteral stenting in patients with obstructing ureteric calculus. Study Method: Single centre prospective observational study.51 patients aged > 18 years with single unilateral ureteric calculus with features of infected hydronephrosis and those with delay in definitive surgery (due to delayed pre - anesthetic clearance - untreated severe co - morbidities) were included in the study. Demographical and clinical factors like Age, Gender, BMI, Duration of symptoms were recorded from clinical history. Radiological factors like Stone laterality (Right/Left), site of ureteric stone, stone Size, degree of hydroureteronephrosis, ureteric wall thickness, were taken from NCCT KUB/CT Urography findings. After assessment, patients were taken for Cystoscopy Guided DJ stent insertion. Patients were divided into 2 groups - Successful DJ stent insertion, Failed DJ stent insertion. Results: Overall, the factors like age, gender, BMI, stone laterality, and stone location were non - significant in predicting the success of DJ stent insertion However, the study factors such as duration of symptoms, stone size, degree of hydroureteronephrosis and ureteric wall thickness ((p>0.005) were statistically significant to predict the success of DJ stent insertion. A cutoff value of Ureter wall thickness of 3.15 mm was highly predictive and in cases with a value higher than this calculation, the insertion of the DJ stent beyond the stone was not possible requiring additional procedures for renal drainage such as percutaneous nephrostomy insertion. Conclusion: Overall, the study factors like duration of symptoms, stone size, degree of hydroureteronephrosis and ureteric wall thickness were statistically significant to predict the success of DJ stent insertion. These factors can be easily assessed non - invasively, based on clinical history, examination and radiological investigations. By anticipating potential difficulty in DJ stent placement pre - operatively, patients can be directly taken up for percutaneous nephrostomy insertion, thereby preventing multiple procedure and additional complications.

Keywords: Obstructing ureteric calculus; DJ stent; Infected hydronephrosis; Ureteric wall thickness