Bladder histopathological changes secondary to double j stenting prospective selective study in patients of Upper Egypt
Mohammed Gamal, Mohammed Farag, Alla Refaat, Hazem Daaf, Gamal Morsy, Emad Salah
Objective: to evaluate the histopathological urinary bladder changes due to double J stenting and to correlate these changes with the period of the stenting in patients of Upper Egypt.
Material and Methods: This study includes 40 patients. The patients underwent Bladder cold cup biopsy in our Urology department, Alazhar University Hospital during removal of the double J stent from around the ureteric orifice and trigone of bladder. Stenting of the right ureter (57.5%) was slightly more common than of the left ureter (37.5%). The most common stent length and size used were 26 cm (95%) and 6 Fr (85%). The most common stent material was used in this study was Teflon (75%). These patients classified into 4 Groups according to duration of the stenting. Group 1 double J stenting for 2 weeks or less. Group 2 stenting for 2 to 6 weeks and Group 3 stenting for 6 to 12 weeks Group 4 stenting for more than 12 weeks. Then, the correlation between the histopathological changes and the period of the stenting determined.
Results: According to indication of stent placement the stents were fixed in 6 patients (15%) for two weeks or less, fixed in 17 patients (42.5%) for 4 to 6 weeks, fixed in 11 patients (27.5) for 6 to12 weeks, and fixed in 6 patients (15%) for period more than 12 weeks. the most common bladder histopathological changes due to double J stenting in patients of Upper Egypt for period 2 weeks or less are mild acute cystitis with mild edema and esinophilic infiltration and this found in (10%) of patients. While acute cystitis with sever edema and neutrophilic lymphocytic infiltration was found when fix double J stents for period from 2 to 6 weeks and this found in (37.5%) of patients. While brunn's nests was found when fix double J stents for period from 6 to 12 weeks and this found in (27.5%) of patients. While cystitis cystica was found when fix double J stents for period more than 12 weeks and this found in (10%) of patients.
Conclusion: We found that the urinary bladder inflammatory reactions increase as the stent duration increased, this reaction progresses from acute cystitis upto Brunn’s nests and cystitis cystica with longstanding stents inside the ureter. So we suggest that the use of double J stents should be limited to highly indicated cases only.