Evaluation of tolerance towards ureteral double-J-stents in children: an unmet need.

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.