title: Ureteral stents: morbidity and impact on quality of life.
abstract: BACKGROUND
  Stents offer a simple and effective drainage method for the upper urinary tract. However, ureteral stents are associated with frequent side effects, including irritative voiding symptoms and hematuria.
  
  
  OBJECTIVE
  To determine the side effects associated with ureteral stents and their impact on sexual function and quality of life.
  
  
  METHODS
  Symptom questionnaires were administered to 135 consecutive patients with unilateral ureteral stents. The questionnaire addressed irritative voiding symptoms, flank pain, hematuria, fever, loss of labor days, anxiety, sleep impairment, decreased libido, erectile dysfunction, dyspareunia, painful ejaculation, and a subjective overall impact on quality of life. The items were graded from 1 (minimal or no symptoms) to 5 (maximal symptoms). The patients were seen and questionnaires filled at 2 weekly intervals following stent insertion until stent extraction. Following removal of the stent, stent patency, impaction and migration rates were determined. Admissions to hospital and ancillary procedures to retreive stents were noted.
  
  
  RESULTS
  The findings presented refer to questionnaire items scoring 3 or more. Dysuria, urinary frequency and urgency were reported by 40%, 50% and 55% of the patients, respectively. Flank pain, gross hematuria or fever was reported by 32%, 42% and 15% respectively. Among working patients, 45% lost at least 2 labor days during the first 14 days, and 32% were still absent from work by day 30. A total of 435 labor days were lost in the first month. Anxiety and sleep disturbance were reported by 24% and 20% respectively, and 45% of patients reported impairment in their quality of life. Decreased libido was reported by 45%, and sexual dysfunction by 42% of men and 86% of women. Stent removal necessitated ureteroscpoy in 14 patients (10.5%), due to upward migration in 11 (8.2%) and incrustration and impaction in 3. Spontaneous stent expulsion occurred in one patient. Forty-six stents (34%) were obstructed at the time of removal. Obstructed stents were associated with a longer mean dwell time as compared to the whole population, 75 versus 62 days respectively (P = 0.04).
  
  
  CONCLUSIONS
  Ureteral stents are associated with frequent side effects and significant impact on patient quality of life. Our findings should be considered when deciding on ureteral stent insertion and dwell time.
authors.affiliation: Department of Urology, Assaf Harofeh Medical Center, Zerifin, Israel.
authors.forename: Dan
authors.initials: D
authors.lastname: Leibovici
authors.forename: Amir
authors.initials: A
authors.lastname: Cooper
authors.forename: Arie
authors.initials: A
authors.lastname: Lindner
authors.forename: Regina
authors.initials: R
authors.lastname: Ostrowsky
authors.forename: Judy
authors.initials: J
authors.lastname: Kleinmann
authors.forename: Sergey
authors.initials: S
authors.lastname: Velikanov
authors.forename: Helio
authors.initials: H
authors.lastname: Cipele
authors.forename: Eliahu
authors.initials: E
authors.lastname: Goren
authors.forename: Yoram I
authors.initials: YI
authors.lastname: Siegel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005548:Foreign-Body Migration; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life; D015607:Stents / Q000009:adverse effects*; D011795:Surveys and Questionnaires; D014513:Ureter; D014570:Urologic Diseases / Q000209:etiology* / Q000503:physiopathology